肠外营养不同糖脂供卡比对中心静脉导管感染的影响

发布时间：2018-05-28 01:21

本文选题：肠外营养 + 糖脂供卡比　；参考：《石河子大学》2015年硕士论文

【摘要】：目的:比较不同糖脂供卡比对ICU经中心静脉导管(CVC)进行营养支持患者导管相关性感染(CRI)发生率的影响,及CRI病原菌谱特征,为临床预防CRI提供参考。方法:本课题采用随机、前瞻、双盲的临床试验设计方案,将符合纳入标准的167例经CVC行肠外营养的患者作为研究对象,按随机数字表法分为三组,A组(糖脂供卡比4:6)、B组(糖脂供卡比5:5)、C组(糖脂供卡比6:4)行肠外营养。供给总热量按125.6KJ/(kg·d)计算,观察导管出口2cm范围内的皮肤情况。怀疑有导管感染时,分别留取外周静脉血和经中心静脉导管采集血液进行血培养,并拔除导管取导管尖端(5cm)进行细菌培养。患者治疗结束或导管使用结束后拔除导管,无论有无感染征象均行导管尖端(5cm)培养,记录患者外周血、导管血及导管尖端细菌培养结果,计算感染率。于治疗前、治疗后第一天、第三天、治疗结束后采血检测前白蛋白、白蛋白、血红蛋白。统计数据用SPSS17.0软件分析,计数资料用频数、百分比(%)表示,计量资料以(???s)表示,进行??检验及统计描述,重复测量资料比较采用重复测量的方差分析。结果:1.167例肠外营养治疗患者中共出现CRI 18例,总体感染率为10.78%;2.三组CRI发生率比较,差异有统计学意义[A组5.36%(3/56),B组5.26%(3/57),C组21.82%(12/54),??=10.868,P=0.004];共培养出菌株31株,其中G+菌14株(45.16%)、G-菌12株(37.5%)、真菌5株(16.13%),真菌位居第三,5株(18.52%),主要致病菌为革兰阳性菌。3.前白蛋白在治疗后第一天、第三天及治疗结束后均升高,与治疗前比较组间差异无统计学意义;组内比较差异有统计学意义。白蛋白在治疗结束后升高与治疗前比较,差异有统计学意义。随着治疗时间的延长,血红蛋白较治疗前升高,但差异无统计学意义。结论:1.肠外营养患者CRI发生与肠外营养液糖脂供卡比相关,过高的葡萄糖供卡会增加中心静脉导管感染的风险。2.CRI主要病原菌依次为:表皮葡萄球菌、鲍曼不动杆菌、金黄色葡萄球菌。3.不同的糖脂供卡比的肠外营养,均能改善患者的营养状况;随着治疗的进行治疗效果更加明显。
[Abstract]:Objective: to compare the effect of different glucose and lipid donor Kabi on the incidence of catheter-associated infection (CRI) in patients with nutritional support through central venous catheterization (ICU), and to provide reference for clinical prevention of CRI. Methods: a randomized, prospective, double-blind clinical trial was designed to include 167 patients who underwent parenteral nutrition via CVC. According to the method of random number table, three groups were divided into three groups: group A (glucose and fat for Kabi 4: 6) and group B for Kabi 5: 5 and C (for Kabi 6: 4) for parenteral nutrition. The total calorie supply was calculated as 125.6KJ/(kg d, and the skin was observed in the 2cm area at the outlet of the catheter. For suspected catheterization, the peripheral venous blood and the blood collected through the central venous catheter were collected for blood culture, and the catheter tip was removed for bacterial culture. The catheter was removed at the end of the treatment or after the catheter was used. The infection rate was calculated by culturing the bacteria in the peripheral blood, blood and catheter tip of the patients with or without the signs of infection. Prealbumin and hemoglobin were collected before, on the first and third day after treatment. The statistical data is analyzed by SPSS17.0 software, the counting data is expressed by frequency and percentage), and the measurement data is expressed as "/ s". Test and statistical description, repeated measurement data comparison using repeated measurement analysis of variance. Results there were 18 cases of CRI in 1. 167 cases of parenteral nutrition. The total infection rate was 10. 78%. There were significant differences in the incidence of CRI among the three groups (group A 5.36% ~ 356%) [group A 5.26% ~ 5.26% ~ 5.26% ~ 5.26% ~ 5.26%], group C: 21.82P ~ (12)% ~ (12)% ~ (10.868) P ~ (0.004)]; among the 31 strains, 14 strains of G bacteria were found to be 45.16G- (12), 37.5B, 5 strains of fungi were 16.13%, and fungi were the third fifth strain (18.52%), and the main pathogenic bacteria were gram-positive bacteria (.30.32%), the main pathogenic bacteria were Gram-positive bacteria (.33.00%), and the main pathogenic bacteria were Gram-positive bacteria (.33.00%). Prealbumin increased on the first day, the third day and the end of the treatment, and there was no significant difference between the groups before and after treatment. The increase of albumin after treatment was significantly higher than that before treatment. With the prolongation of treatment time, hemoglobin was higher than that before treatment, but the difference was not statistically significant. Conclusion 1. The incidence of CRI in parenteral nutrition patients was related to the Kabi of parenteral nutrition solution. Too high glucose supply increased the risk of central venous catheter infection. 2. The main pathogens were Staphylococcus epidermidis, Acinetobacter baumannii, Staphylococcus aureus and Staphylococcus aureus. The parenteral nutrition of Kabi with different glucose and lipid could improve the nutritional status of the patients, and the effect was more obvious with the treatment.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.3

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