摘要目的: 探究透析导管相关血流感染(Catheter Related Blood Stream Infection,CRBSI)危险因素及预防措施。方法: 选择2013年2月至2017年3月在肾内科行中心静脉置管的CRBSI患者63例为CRBSI组,并选择同期行中心静脉置管的非感染患者63例为对照组,分析CRBSI的相关危险因素以及病原学特征。结果: CRBSI发生与外院置管、颈内静脉置管、ICU住院时间、身体质量指数(Body Mass Index,BMI)、平均动脉压(Mean artery pressure,MAP)、急性生理与慢性健康评估(Acute physiology and chronic health evaluation,APACHE)Ⅱ评分、导管留置时间、CD4+细胞有关,组间比较差异有统计学意义(P<0.05);股静脉置管、使用免疫抑制剂、血浆置管或双重血浆滤过、空腹血糖升高、白蛋白、免疫球蛋白G(Immunoglobulin G,IgG)水平与CRBSI发生无关,组间比较差异无统计学意义(P>0.05);多因素分析显示:外院置管、颈内静脉置管、MAP、APACHEⅡ评分、导管留置时间、CD4+细胞是CRBSI发生的重要危险因素(P<0.05);ICU住院时间、BMI与CRBSI发生无明确相关性(P>0.05);CRBSI中检出微生物以革兰阳性菌为主,占50.78%,其次为革兰阴性菌,占36.51%;表皮葡萄球菌、金黄色葡萄球菌和阴沟肠杆菌是常见的病原菌。结论: MAP、APACHEⅡ评分、导管留置时间、CD4+细胞是CRBSI发生的重要危险因素,革兰阳性球菌是CRBSI主要致病菌,临床应根据病原菌进行药敏试验,根据药敏结果选择抗菌药物;严格执行无菌操作,缩短置管时间,加强对于危重症及免疫功能低下患者的预防,以降低CRBSI发生率。
Abstract：Objective: To explore the risk factors and preventive measures of dialysis catheter related blood stream infection (CRBSI). Methods: 63 CRBSI patients who had received central venous indwelling catheter for treatment in the Nephrology of our hospital from February 2013 to March 2017 were selected as the CRBSI group, and another 63 cases without infection given central venous indwelling catheter as control group. The related risk factors and pathogenic characteristics of CRBSI were analyzed. Results: The occurrence of CRBSI was related with catheterization outside of the hospital, internal jugular vein catheterization, length of hospital stay in ICU, body mass index (BMI), mean artery pressure (MAP), acute physiology and chronic health evaluation (APACHE) Ⅱscores, catheter dwelling time, and CD4+, with statistically significant difference between the two groups (P<0.05). Femoral vein catheterization, the use of immunosuppressor, plasma catheterization or double plasma filtration, the increase of fasting plasma glucose, albumin and immunoglobulin G (IgG) levels were not related with the occurrence of CRBSI, with statistically significant difference (P>0.05); the multiple-factor analysis showed that: Catheterization outside of the hospital, internal jugular vein catheterization, MAP, APACHE) Ⅱscore, catheter dwelling time, and CD4+ were important risk factors of the occurrence of CRBSI (P<0.05). The length of hospital stay in ICU and BMI showed no definite correlation (P>0.05); the gram positive bacteria was the major microorganism detected, which accounted for 50.78%, followed by gram negative bacteria, which accounted for 36.51%; the common pathogenic bacteria were staphylococcus epidermidis, staphylococcus aureus and enterobacter cloacae. Conclusion: MAP, APACHE) Ⅱscore, catheter dwelling time, and CD4+ were important risk factors of the occurrence of CRBSI, gram positive cocci is the main pathogen for CRBSI; therefore, in clinical practice, susceptibility testing should be performed according to the pathogen, and antibacterial agents should be selected according to antimicrobial susceptibility results; aseptic operation should be strictly implemented, and catheterization time shortened to strengthen the prevention for critical illness and immune hypofunction and reduce the incidence rate of CRBSI.
2018, Vol. 24 
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