维持性血液透析患者中心静脉导管相关性感染临床剖析.docVIP

维持性血液透析患者中心静脉导管相关性感染临床剖析 　　[摘要] 目的 探讨中心静脉导管相关性感染的发生率、菌群分布及相关危险因素。方法 收集2008年1月―2014年9月该院血液透析中心中心静脉置管患者398例的临床资料，了解中心静脉导管相关性感染的发生率、菌群分布，分析年龄、原发病、置管部位及留管时间与中心静脉导管相关性感染发生的关系。结果 在所有患者中发生中心静脉导管相关性感染的有52例，感染率达到13.1%。革兰氏阳性菌34例，占65.38%，以表皮葡萄球菌、金黄色葡萄球菌为主；革兰氏阴性菌18例，占34.62%，以大肠埃希菌为主。患者年龄50岁感染率7.48%，≥50岁感染率16.33%（P0.05）；糖尿病肾病感染率19.72%，非糖尿病肾病为9.38%（P0.05）；股静脉置管感染率24.14%，明显高于颈内静脉10.25%及锁骨下静脉5.26%（P0.05）；置管时间≥2周较≤1周、1～2周组患者感染率明显增高，18.43%（P0.05）。结论 中心静脉导管相关性感染发生率高，以革兰氏阳性菌为主。高龄、糖尿病肾病、置管时间≥2周及股静脉置管都为中心静脉导管感染的危险诱因。 　　[关键词] 血液透析；中心静脉导管；导管相关性感染；危险因素 　　[中图分类号] R4 [文献标识码] A [文章编号] 1674-0742（2015）05（c）-0075-03 　　[Abstact] Objective To explore the incidence， bacterial distribution and risk factors for central venous catheter-related infection in maintenance hemodialysis patients. Methods The clinical data of 398 patients who underwent hemodialysis from January 2008 to September 2014 were collected， then the incidence of catheter-related infection and bacterial distribution were detemined， the relationship between the incidence of central venous catheter-related infection and the age， underlying diseases， intubation and indwelling time was analyzed. Results The central venous catheter-related infection occurred in 52 cases with the infection rate of 13.1%，including 34（65.38%） strains of gram-positive bacteria， Staphylococcus epidermidis and Staphylococcus aureus were the predominant species， and 18（34.62%） strains of gram-negative bacteria， Escherichia coli was the predominant species. The infection rate of the patients with more than 50 years of age was 16.33%，higher than 7.48% of the patients with less than 50 years of age （P0.05）；the infection rate of the patients with diabetes was 19.72%，higher than 9.38% of the patients without diabetes（P0.05）； the infection rate of the patients with femoral vein as the puncture site was 24.14% ，higher than jugular vein 10.25% and subclavian vein 5.26% （P0.05）； the infection rate of the patients with the catheter indwelling time more than 2 weeks wa