重症监护室老年患者中心静脉导管相关性感染的危险因素

发布时间：2018-06-07 22:02

本文选题：重症监护室 + 中心静脉导管相关性感染　；参考：《中国老年学杂志》2017年08期

【摘要】：目的探讨重症监护室老年患者中心静脉导管相关性感染(CRI)的危险因素。方法选取行中心静脉置管(CVCs)的老年患者450例,发生CRI 47例,收集患者流行病学及住院临床观察指标包括性别、年龄、白蛋白水平、插管前抗生素应用情况、穿刺次数、穿刺部位、导管留置时间、基础疾病及原发疾病类型等方面资料。怀疑患者出现CRI时,做病原菌定量培养。结果行CVCs的老年患者450例,发生CRI者47例(10.44%),其中导管出口感染11例,隧道感染15例,导管相关性血源性感染21例。平均置管后发生感染的时间为6~35〔平均(16±9)〕d,将47例CRI患者样本送本行病原学检查,共检出病原菌52株,革兰阴性菌14株,革兰阳性菌35株,真菌3株。选取性别、年龄、插管前是否用抗生素、插管次数、置管时间、基础疾病、白蛋白水平、穿刺部位作为CRI可能的危险因素,结果提示不同年龄、插管次数、置管时间、是否有基础疾病、血浆白蛋白是否低于35 g/L方面感染比例差异有统计学意义(P0.05)。将年龄、插管次数、置管时间、是否有基础疾病、血浆白蛋白是否低于35 g/L作为参数,行进一步多因素Logistic回归分析,结果表明:老年患者白蛋白水平低、插管次数多、置管时间长、合并基础疾病是CRI发生的独立危险因素。结论重症监护室老年住院患者是CRI发生率较高群体,经病原菌检测可见主要致病菌为革兰阳性菌、革兰阴性菌及真菌,而CRI的发生与白蛋白水平低,插管次数多,置管时间长,合并基础疾病相关。
[Abstract]:Objective to investigate the risk factors of central venous catheter associated infection (CRI) in elderly patients in intensive care unit (ICU). Methods 450 elderly patients with CVCsunderwent central venous catheterization and 47 patients with CRI were selected. Data of epidemiology and hospitalization were collected, including sex, age, albumin level, antibiotic use before intubation and puncture times. Puncture site, catheter indwelling time, basic disease and primary disease types and other information. When CRI was suspected, the pathogen was cultured quantitatively. Results among 450 elderly patients with CVCs, there were 47 cases with CRI (10.44%), including 11 cases of catheter outlet infection, 15 cases of tunnel infection and 21 cases of catheter-related hematogenous infection. The mean time of infection after catheterization was 60.35 (mean 16 卤9g / d). A total of 52 pathogens, 14 Gram-negative bacteria, 35 Gram-positive bacteria and 3 fungi were collected from 47 patients with CRI. Sex, age, antibiotics before intubation, times of intubation, time of catheterization, basic diseases, albumin level and puncture site were selected as possible risk factors for CRI. The results indicated that age, times of intubation, and time of catheterization were the main risk factors for CRI. Whether there is a underlying disease, whether plasma albumin is lower than 35 g / L, the difference is statistically significant (P 0.05). Age, intubation times, catheterization time, whether there were underlying diseases, whether plasma albumin was lower than 35 g / L as parameters, and further multivariate logistic regression analysis were performed. The results showed that the albumin level in elderly patients was low and the number of catheterization was high. The long time of catheterization and the combination of underlying diseases are independent risk factors for CRI. Conclusion the incidence of CRI in elderly inpatients in intensive care unit was high. The main pathogenic bacteria were Gram-positive bacteria, Gram-negative bacteria and fungi. However, the incidence of CRI and albumin level was low, the number of intubation was more, and the time of catheterization was long. Associated with underlying diseases.
【作者单位】：衢州市第三医院内科;
【分类号】：R472.2

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