CAJ | 학술논문

目的回顾性分析带涤纶套隧道血液透析导管相关感染资料,探讨感染发生时间及细菌种类,导管感染发生率,抗生素治疗效果等,为有效防治导管相关感染提供理论依据。方法选择符合导管相关感染诊断标准的患者74例(85例次),进行抗生素肝素盐水封管及静脉滴注抗生素,有出口感染及隧道感染的还进行局部换药。结果颈内静脉导管相关感染83例次,其中81例次为导管相关血流感染,2例次为皮肤出口及隧道感染；股静脉导管相关感染2例,均为导管相关血流感染。总的导管相关感染发生天数的中位数为368导管日,四分位间距为975导管日。金黄色葡萄球菌占检出细菌总数的32.94%。导管相关感染发生率在1年内为6.5例次/1000导管日,总的导管相关感染发生率为1.29例次/1000导管日。2例患者因基础疾病死亡,其余均临床治愈。结论带涤纶套隧道血液透析导管相关感染的患者,可使用敏感抗生素导管封管及静脉滴注抗生素治疗2~3周,无效者可拔管。检出细菌种类以金黄色葡萄球菌最常见。铜绿假单胞菌较其他菌种抗生素使用时间较长,导管相关感染发生率在1年内最高,带涤纶套隧道血液透析导管相关感染重在预防。
목적회고성분석대조륜투수도혈액투석도관상관감염자료,탐토감염발생시간급세균충류,도관감염발생솔,항생소치료효과등,위유효방치도관상관감염제공이론의거。방법선택부합도관상관감염진단표준적환자74례(85례차),진행항생소간소염수봉관급정맥적주항생소,유출구감염급수도감염적환진행국부환약。결과경내정맥도관상관감염83례차,기중81례차위도관상관혈류감염,2례차위피부출구급수도감염；고정맥도관상관감염2례,균위도관상관혈류감염。총적도관상관감염발생천수적중위수위368도관일,사분위간거위975도관일。금황색포도구균점검출세균총수적32.94%。도관상관감염발생솔재1년내위6.5례차/1000도관일,총적도관상관감염발생솔위1.29례차/1000도관일。2례환자인기출질병사망,기여균림상치유。결론대조륜투수도혈액투석도관상관감염적환자,가사용민감항생소도관봉관급정맥적주항생소치료2~3주,무효자가발관。검출세균충류이금황색포도구균최상견。동록가단포균교기타균충항생소사용시간교장,도관상관감염발생솔재1년내최고,대조륜투수도혈액투석도관상관감염중재예방。
Objective Toinvestigatetheoccurrenceoftunneledcatheter-relatedinfection,bac-terial species,and effect of antibiotic therapy in hemodialysis patients in order to provide a theoretical basis for effective prevention of tunneled catheter-related infection in hemodialysis patients. Methods Aretrospectivestudywasperformedon74cases(85case-times)selectedaccordingtodiag-nostic criteria of tunneled catheter-related infection and given antibiotics and heparinate from tube and antibiotics by intravenous drip.Tho patients with and tunnel infection were also given fresh dressing changefortheirinfectionsitesofcatheterexitandaround.Results In83case-timeswithvenajugu-laris intema tunneled catheter,there were 8 1 case-times of catheter-related blood stream infection,and 2 case-times of and tunnel infection.Both two case-times of femoral vein catheter-related infection were of blood stream infection.The median value of catheter-related infection days was 368,and the quartile range was 975 catheter day.32.94% infections were caused by staphylococcus aureus.Occur-rence rate of tunneled catheter-related infection was 6.5 episodes per 1 000 catheter days within 1 year and the total occurrence rate of tunneled catheter-related infection was 1 .29 episodes per 1 000 catheter days.Allpatientsbut2diedfromunderlyingdiseaseswereclinicallycured.Conclusions Patients with tunneled catheter-related infection were given sensitive antibiotics from tube and intravenous drip for 2 to 3 weeks,and the catheters were pulled out if infection was not controlled.Staphylococcus au-reus was the most common in detected bacterial species.In group of patients with pseudomonas aerug-inosa infection,the duration of antibiotic use was longer and the occurrence rate of tunneled catheter-related infection within 1 year was higher than in other groups.It was important for hemodialysis pa-tients to prevent tunneled catheter-related infection.