血液净化股静脉无涤纶套导管感染的危险因素分析

    Risk factors for catheter-related infection of non-cuffed femoral vein catheter in blood purification therapy patients

    • 摘要: 目的 探讨血液净化治疗行股静脉无涤纶套导管置管术患者发生导管相关感染(catheter related infection,CRI)的危险因素。方法 研究分析海南省人民医院2015年4月至2017年2月经皮股静脉留置双腔导管行血液净化治疗的252例患者的基本信息资料,依据导管感染程度分为无感染组、局部感染组(出现导管细菌定植或导管出口感染)、导管相关血流感染组,对CRI发生的相关因素进行单因素分析和多因素Logistic回归分析。结果 在252例患者中发生导管相关血流感染18例(7.1%)、导管出口感染10例(4%)、导管细菌定植21例(8.3%)。在单因素分析中,三组患者在慢性肾脏病5期及急性肾损伤比例方面,差异存在统计学意义(P<0.05);三组患者的白蛋白水平差异存在统计学意义(P<0.05);三组在性别方面差异有统计学意义(P<0.05),男性的CRI发生率高于女性;三组患者在病程中是否使用抗生素方面的差异有统计学意义(P<0.05),因其他部位感染,在置管前或带管期间使用抗生素的患者其CRI发生率较低。多因素Logistic回归分析结果提示男性(OR=2.71,95%CI 1.218~6.033,P<0.05)和病程中没有使用抗生素(OR=2.22,95%CI 1.086~4.540,P<0.05)是CRI的发生的危险因素。结论 改善患者营养状态,合理使用抗生素,重视导管集束化管理,可减少股静脉无涤纶套导管相关感染的发生。

       

      Abstract: Objective To explore risk factors for catheter-related infection (CRI) of non-cuffed femoral vein catheter in blood purification therapy patients undergoing non-cuffed femoral vein catheterization.Methods The basic information of 252 blood purification therapy patients,treated with double lumen catheter in Hainan Province People's Hospital from April 2015 to February 2017,was analyzed.According to the severity of catheter infection,they were divided into three groups,non-infection group,local infection group (developing bacterial colonization in catheters or catheter opening infection) and catheter-related bloodstream infection group.Univariate analysis and multivariate Logistic regression analysis was performed for the related factors of CRI.Results Among 252 patients,18 cases (7.1%) had catheter-related bloodstream infection (CRBI),10 cases (4%) were catheter-related local infection (CRLI),and 21 cases (8.3%) were catheter bacterial colonization.In univariate analysis,the difference was significant among the three groups in chronic kidney disease stage 5 (CKD 5) and acute renal injury (AKI) proportions (P<0.05);the differences in albumin levels among the three groups were significant (P<0.05);the CRI rate was different in gender,and the CRI rate was higher in males (P<0.05);because of other site infections,the CRI rate of patients who used antibiotics before or during catheterization was lower,and there was significant difference among the three groups in different antibiotic use (P<0.05).Multivariate analysis suggested that male and no antibiotic use during progression were risk factors of CRI (OR=2.22,95%CI 1.086~4.540,P<0.05).Conclusions We can reduce the occurrence of non-cuffed catheter-related infections in the femoral vein,by improving the nutritional status of patients,properly using antibiotics and stressing on catheter cluster management.

       

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