中华临床感染病杂志
中華臨床感染病雜誌
중화림상감염병잡지
CHINESE JOURNAL OF CLINICAL INFECTIOUS DISEASES
2011年
3期
139-143
,共5页
杨钧%程芮%公静%奚晶晶
楊鈞%程芮%公靜%奚晶晶
양균%정예%공정%해정정
导管插入术,中心静脉%感染%细菌定植%随机对照研究
導管插入術,中心靜脈%感染%細菌定植%隨機對照研究
도관삽입술,중심정맥%감염%세균정식%수궤대조연구
Catheterization,central venous%Infection%Bacteria colonization%Randomized controlled trials
目的 比较用磺胺嘧啶银和洗必泰抗感染的中心静脉导管(CVC)与普通导管在减少细菌定植和导管相关性感染方面的差异.方法 采用前瞻性、随机对照分析方法,对2007年6月-2009年6月武警总医院ICU收治的70例需要深静脉置管患者进行随机分组,留置双腔抗感染CVC(抗感染组,n=28)和双腔普通CVC(对照组,n=42),两组采用相同的穿刺部位和消毒护理措施,观察记录患者的一般情况、APACHE Ⅱ评分、导管留置天数、拔除导管原因等,通过对导管尖端及皮下部分的细菌半定量培养、血培养以及局部皮肤有无红肿、脓性分泌物来确定有无导管定植(CBC)、导管相关性血流感染(CRBSI)和局部导管相关感染(CRI).采用SPSS 11.5软件包进行统计分析,CVC留置时间与细菌定植和感染发生率采用Kaplan-Meier曲线分析,组间差异比较用Log-rank检验.结果 抗感染组由于感染原因被迫提前拔管1例,占3.6%,对照组9例,占21.4%,比较差异有统计学意义(x2=5.143,P<0.05);抗感染组有2例(7.1%)发现导管细菌定植,明显低于对照组(15/42,35.7%),比较差异有统计学意义(x2=7.458,P<0.01).抗感染组第19天出现感染和定植,2周内定植和感染率为0.0%,14～28 d定植率和感染率分别为31.4%和14.3%;对照组第6天出现感染,2周内定植率和感染率分别为60.0%和32.0%,14～28 d定植率和感染率超过90%和70%(u=27.5和14.31,P值均<0.01).结论 抗感染CVC能够显著降低局部导管相关感染和导管细菌定植,但两种导管一旦发生细菌定植,导管相关性感染的发生率均在50%以上,导管留置时间超过2周,抗感染CVC的定植和感染率也明显增高,尽量缩短导管留置时间是减少导管相关性感染的有效手段.
目的 比較用磺胺嘧啶銀和洗必泰抗感染的中心靜脈導管(CVC)與普通導管在減少細菌定植和導管相關性感染方麵的差異.方法 採用前瞻性、隨機對照分析方法,對2007年6月-2009年6月武警總醫院ICU收治的70例需要深靜脈置管患者進行隨機分組,留置雙腔抗感染CVC(抗感染組,n=28)和雙腔普通CVC(對照組,n=42),兩組採用相同的穿刺部位和消毒護理措施,觀察記錄患者的一般情況、APACHE Ⅱ評分、導管留置天數、拔除導管原因等,通過對導管尖耑及皮下部分的細菌半定量培養、血培養以及跼部皮膚有無紅腫、膿性分泌物來確定有無導管定植(CBC)、導管相關性血流感染(CRBSI)和跼部導管相關感染(CRI).採用SPSS 11.5軟件包進行統計分析,CVC留置時間與細菌定植和感染髮生率採用Kaplan-Meier麯線分析,組間差異比較用Log-rank檢驗.結果 抗感染組由于感染原因被迫提前拔管1例,佔3.6%,對照組9例,佔21.4%,比較差異有統計學意義(x2=5.143,P<0.05);抗感染組有2例(7.1%)髮現導管細菌定植,明顯低于對照組(15/42,35.7%),比較差異有統計學意義(x2=7.458,P<0.01).抗感染組第19天齣現感染和定植,2週內定植和感染率為0.0%,14～28 d定植率和感染率分彆為31.4%和14.3%;對照組第6天齣現感染,2週內定植率和感染率分彆為60.0%和32.0%,14～28 d定植率和感染率超過90%和70%(u=27.5和14.31,P值均<0.01).結論 抗感染CVC能夠顯著降低跼部導管相關感染和導管細菌定植,但兩種導管一旦髮生細菌定植,導管相關性感染的髮生率均在50%以上,導管留置時間超過2週,抗感染CVC的定植和感染率也明顯增高,儘量縮短導管留置時間是減少導管相關性感染的有效手段.
목적 비교용광알밀정은화세필태항감염적중심정맥도관(CVC)여보통도관재감소세균정식화도관상관성감염방면적차이.방법 채용전첨성、수궤대조분석방법,대2007년6월-2009년6월무경총의원ICU수치적70례수요심정맥치관환자진행수궤분조,류치쌍강항감염CVC(항감염조,n=28)화쌍강보통CVC(대조조,n=42),량조채용상동적천자부위화소독호리조시,관찰기록환자적일반정황、APACHE Ⅱ평분、도관류치천수、발제도관원인등,통과대도관첨단급피하부분적세균반정량배양、혈배양이급국부피부유무홍종、농성분비물래학정유무도관정식(CBC)、도관상관성혈류감염(CRBSI)화국부도관상관감염(CRI).채용SPSS 11.5연건포진행통계분석,CVC류치시간여세균정식화감염발생솔채용Kaplan-Meier곡선분석,조간차이비교용Log-rank검험.결과 항감염조유우감염원인피박제전발관1례,점3.6%,대조조9례,점21.4%,비교차이유통계학의의(x2=5.143,P<0.05);항감염조유2례(7.1%)발현도관세균정식,명현저우대조조(15/42,35.7%),비교차이유통계학의의(x2=7.458,P<0.01).항감염조제19천출현감염화정식,2주내정식화감염솔위0.0%,14～28 d정식솔화감염솔분별위31.4%화14.3%;대조조제6천출현감염,2주내정식솔화감염솔분별위60.0%화32.0%,14～28 d정식솔화감염솔초과90%화70%(u=27.5화14.31,P치균<0.01).결론 항감염CVC능구현저강저국부도관상관감염화도관세균정식,단량충도관일단발생세균정식,도관상관성감염적발생솔균재50%이상,도관류치시간초과2주,항감염CVC적정식화감염솔야명현증고,진량축단도관류치시간시감소도관상관성감염적유효수단.
Objective To investigate whether antiseptic central venous catheters (CVC) modified with chlorhexidine acetate and silver sulfadiazine can be beneficial in reducing bacterial colonization and catheter-related infection. Methods Prospective controlled non-blinded randomized clinical trial was conducted. Seventy adult inpatients with CVC from intensive care unit of General Hospital of Chinese People's Armed Police Force during June 2007-June 2009 were enrolled. Their baseline characteristics, APACHE Ⅱ score and therapeutic interventions were comparable. Patients were randomly received either an antiseptic CVC ( antiseptic group, n = 28) or a standard two-lumen CVC ( control group, n = 42 ). Microbiological evaluation was done after CVC removal. A catheter bacterial colonization ( CBC) was considered if bacterial growth of > 15 CFU was found by semi-quantitative roll-plate technique from a proximal or distal catheter segment. A catheter-related infection ( CRI) was defined as a colonized catheter with local signs of inflammation. A catheter-related bloodstream infection ( CR-BSI) was defined as a colonized catheter with isolation of the same organism from the patient' s blood with accompanying clinical signs of infection. SPSS 11.5 software was used for statistical analysis. Kaplan Meier curve was used to evaluate the association between CVC retention time and bacterial colonization or infection, and Log-rank test was performed to compare between the groups. Results CVC was removed from 3.6% (1/28) patients of antiseptic group and 21.4% (9/42) patients of control group because of infection (x2 = 5. 143, P <0. 05). Colonization of CVC was observed in 7. 1% (2/28) patients from antiseptic group and 35. 7% ( 15/42) from control group (x2 =7.458, P<0.01). CBC or CRI was not observed in antiseptic group until day 19, while CRI occurred at day 6 in the control group. CVC colonization and infection were developed in 31.4% and 14. 3% patients of antiseptic group during day 14-day 28 respectively, while the rates in the control group were 90% and 70% ( u = 27.5 and 14.31, P < 0.01). Conclusions Antiseptic CVC modified with chlorhexidine acetate and silver sulfadiazine can significantly lower the risks of CBC and CRI. But more than 50% patients would develop infection when colonization occured, no matter patients receive standard or antiseptic CVC. After CVCs have been inserted for > 2 weeks, the colonization and infection will increase significantly in both standard or antiseptic CVC, so to shorten the insertion time is an effective measure to decrease the CVC-related infection.
