CAJ | 학술논문

目的研究去甲万古霉素封管在重症患者中心静脉导管相关性感染(CRI)中的临床应用价值.方法采用前瞻性随机对照研究方法,选择2012年1月至2014年1月入住重症医学科预计锁骨下静脉置管超过48 h、年龄≥18岁且≤80岁、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分10 ～ 29分的患者120例,利用随机数字表法将患者分为两组,最终完成研究患者116例,干预组(56例)采用去甲万古霉素与肝素盐水混合液封管,对照组(60例)采用肝素盐水封管.观察两组患者CRI发生率、CRI病原菌谱,以及不良事件发生率、病死率、住院时间、导管留置时间和住院费用.结果 ①干预组与对照组患者CRI发生率比较差异无统计学意义[7.14％(4/56)比8.33％(5/60),x2=0.058,P=1.000],但干预组无导管病原菌定植,对照组有2例导管定植.②两组共检出病原菌7例,干预组铜绿假单胞菌、鲍曼不动杆菌、真菌各1例,对照组金黄色葡萄球菌、表皮葡萄球菌、真菌、鲍曼不动杆菌各1例;两组比较差异均无统计学意义(均P＞0.05),但干预组革兰阳性球菌感染有减少的趋势.③干预组与对照组患者导管内血栓形成、导管局部渗血及导管意外脱落等不良事件发生率比较差异无统计学意义[21.43％(12/56)比23.33％(14/60),x2=0.060,P=0.806].④干预组与对照组患者的病死率[7.14％(4/56)比8.33％(5/60),x 2=0.058,P=1.000]、住院时间(d:35.9±15.2比34.1±16.3,t=16.330,P=0.620)、留置导管时间(d:25.0±4.5比24.5±5.1,t=26.427,P=2.560)及住院费用(万元:3.42±1.22比3.72±1.30,t=13.215,P=1.560)比较差异均无统计学意义.结论对中心静脉置管患者应用去甲万古霉素与肝素盐水混合液封管未能降低CRI发生率、不良事件发生率及病死率,未减少住院时间、导管留置时间及住院费用,但有可能减少导管内细菌定植及革兰阳性菌的感染.
목적 연구거갑만고매소봉관재중증환자중심정맥도관상관성감염(CRI)중적림상응용개치.방법 채용전첨성수궤대조연구방법,선택2012년1월지2014년1월입주중증의학과예계쇄골하정맥치관초과48 h、년령≥18세차≤80세、급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분10 ～ 29분적환자120례,이용수궤수자표법장환자분위량조,최종완성연구환자116례,간예조(56례)채용거갑만고매소여간소염수혼합액봉관,대조조(60례)채용간소염수봉관.관찰량조환자CRI발생솔、CRI병원균보,이급불량사건발생솔、병사솔、주원시간、도관류치시간화주원비용.결과 ①간예조여대조조환자CRI발생솔비교차이무통계학의의[7.14％(4/56)비8.33％(5/60),x2=0.058,P=1.000],단간예조무도관병원균정식,대조조유2례도관정식.②량조공검출병원균7례,간예조동록가단포균、포만불동간균、진균각1례,대조조금황색포도구균、표피포도구균、진균、포만불동간균각1례;량조비교차이균무통계학의의(균P＞0.05),단간예조혁란양성구균감염유감소적추세.③간예조여대조조환자도관내혈전형성、도관국부삼혈급도관의외탈락등불량사건발생솔비교차이무통계학의의[21.43％(12/56)비23.33％(14/60),x2=0.060,P=0.806].④간예조여대조조환자적병사솔[7.14％(4/56)비8.33％(5/60),x 2=0.058,P=1.000]、주원시간(d:35.9±15.2비34.1±16.3,t=16.330,P=0.620)、류치도관시간(d:25.0±4.5비24.5±5.1,t=26.427,P=2.560)급주원비용(만원:3.42±1.22비3.72±1.30,t=13.215,P=1.560)비교차이균무통계학의의.결론 대중심정맥치관환자응용거갑만고매소여간소염수혼합액봉관미능강저CRI발생솔、불량사건발생솔급병사솔,미감소주원시간、도관류치시간급주원비용,단유가능감소도관내세균정식급혁란양성균적감염.
Objective To evaluate the clinical value of tube-sealing with norvancomycin and heparin saline mixture for prevention of central venous catheter-related infection (CRI).Methods A prospective randomized controlled trial was performed.120 patients who were admitted to department of critical care medicine from January 2012 to January 2014 were included,with their subclavian vein catheterization installation time longer than 48 hours,age over 18 years and younger than 80 years,and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score reaching 10-29.The patients were divided into two groups using a random number table,and finally 116 patients were enrolled.Norvancomycin and heparin saline mixture were used for tube sealing in the intervention group (n=56),while only heparin saline was used in the control group (n=60).The incidence of CRI,catheter correlated spectrum of pathogens,adverse events,mortality,hospital day,catheter retention time,and hospital costs were compared between two groups.Results ① There was no significant difference in the incidence of CRI between intervention group and control group [7.14％ (4/56) vs.8.33％ (5/60),x2=0.058,P=1.000].There was no catheter pathogenic colonization in the intervention group,but there were 2 cases of catheter pathogenic colonization in control group.② A total of 7 pathogens were found in two groups.Three cases with pathogenic bacteria was found in the intervention group,with 1 case of Pseudomonas aeruginosa,1 case Acinetobacter baumannii,and 1 case fungi.Staphylococcus aureus,Staphylococcus epidermidis,fungi,and Acinetobacter baumannii was found in the control group,with 1 case of each.There was no significantly statistical difference between two groups (all P＞0.05),but there was a decreasing trend of Gram-positive cocci infection in the intervention group.③ There was no significant difference in the catheter thrombosis,local bleeding or hematoma,catheter dislocation and other adverse events between intervention group and control group [21.43％(12/56) vs.23.33％ (14/60),x2=0.060,P=0.806].④ There were no significant differences in mortality [7.14％(4/56) vs.8.33％ (5/60),x2=0.058,P=1.000],hospital day (days:35.9 ± 15.2 vs.34.1 ± 16.3,t=16.330,P=0.620),catheter retention time (days:25.0 ± 4.5 vs.24.5 ± 5.1,t=26.427,P=2.560) and cost of hospitalization (10 thousand Yuan:3.42 ± 1.22 vs.3.72 ± 1.30,t=13.215,P=1.560) between intervention group and control group.Conclusions For patients with central venous catheter,application norvancomycin with heparin saline mixture for tube sealing did not reduce the incidence of CRI,the incidence of adverse events and mortality,does not reduce hospitalization time,catheter retention time and hospital costs,but may reduce the catheter colonization and infection of Gram-positive bacteria.