熊琴 唐亞 朱雅竹
[摘要]目的:分析大面積燒傷患者發(fā)生早期深靜脈置管導管相關性血流感染(Catheter related blood stream infection,CRBSI)的危險因素。方法:收集筆者醫(yī)院2013年1月-2018年10月收治的110例行深靜脈置管輸液大面積燒傷患者的臨床資料,根據(jù)是否發(fā)生CRBSI將其分為感染組(n=40)和非感染組(n=70),比較兩組臨床資料并分析感染危險因素。結果:兩組導管類型、留置部位、留置時間、靜脈營養(yǎng)、置管次數(shù)、營養(yǎng)不良及是否合并糖尿病比較差異具有統(tǒng)計學意義(P<0.05);兩組性別、年齡、是否手術及輸血比較差異無統(tǒng)計學意義(P>0.05);Logistic多因素回歸分析結果顯示,導管類型(OR=1.41,95%CI:1.09~1.84)、留置部位(OR=1.42,95%CI:1.13~1.78)、留置時間(OR=1.42,95%CI:1.04~1.94)、靜脈營養(yǎng)(OR=1.39,95%CI:1.03~1.87)、置管次數(shù)(OR=1.44,95%CI:1.14~1.81)、營養(yǎng)不良(OR=1.42,95%CI:1.15~1.76)及糖尿?。∣R=1.42,95%CI:1.15~1.74)為CRBSI發(fā)生的獨立危險因素(P<0.05)。結論:導管類型、留置部位、留置時間、靜脈營養(yǎng)、置管次數(shù)、營養(yǎng)不良及是否合并糖尿病為大面積燒傷患者發(fā)生早期深靜脈置管CRBSI發(fā)生的危險因素。
[關鍵詞]大面積燒傷;早期;深靜脈置管;導管相關性血流感染;危險性因素;Logistic多因素回歸分析
[中圖分類號]R622 ? ?[文獻標志碼]A ? ?[文章編號]1008-6455(2019)11-0026-03
Abstract: Objective ?To analyze the risk factors of early deep venous catheter-related blood stream infection (CRBSI) in patients with extensive burns. Methods ?The clinical data of 110 patients with extensive burns undergoing deep vein catheterization infusion in our hospital from January 2013 to October 2018 were collected. According to whether CRBSI occurred, they were divided into infected group (n=40) and non-infected group (n=70), the clinical data of the two groups were compared and the risk factors were analyzed. Results ?There were significant differences between the two groups in catheter type, indwelling position, indwelling time, intravenous nutrition, tube placement, malnutrition and diabetes (P<0.05). There was no significant difference in gender, age, surgery and blood transfusion between the two groups (P>0.05). Logistic multi-factor regression analysis showed catheter type (OR=1.41, 95%CI:1.09~1.84), indwelling site (OR=1.42, 95%CI:1.13~1.78), indwelling time (OR=1.42, 95%CI:1.04~1.94), intravenous nutrition (OR=1.39, 95%CI=1.03~1.87), number of catheterizations (OR=1.44, 95%CI=1.14~1.81), malnutrition (OR=1.42, 95%CI:1.15~1.76) and diabetes (OR=1.42, 95%CI:1.15~1.74) were independent risk factors for CRBSI(P<0.05). Conclusion ?Catheter type, indwelling site, indwelling time, venous nutrition, number of catheterizations, malnutrition and diabetes are risk factors for CRBSI.
Key words: large area burn; early stage; deep vein catheterization; catheter-related blood stream infection; risk factors; Logistic multi-factor regression analysis
大面積燒傷患者輸液量大、輸液時間長,且患者正常殘留皮膚較少,表淺靜脈常常損傷,因而臨床常采用建立靜脈通道來保證體液的輸入[1]。而深靜脈置管可將各種血管導管置入深靜脈管腔內,不僅為各種治療提供直接便利通道,也可測定各種生理參數(shù)。但長時間放置深靜脈置管會引起導管相關性感染(Catheter-related infection,CRI),其中導管相關性血流感染(Catheter-related blood stream infection,CRBSI)是最嚴重的并發(fā)癥,其發(fā)病率及致死率較高,在感染疾病中是最為嚴重和棘手的問題之一[2]。近年來隨著深靜脈置管的廣泛應用,使燒傷患者CRBSI發(fā)生率逐漸上升,不僅延長住院時間,加重患者負擔,且嚴重影響患者生活質量及預后[3]。因此預防CRBSI發(fā)生的相關危險因素對深靜脈置管應用于大面積燒傷患者的救治及預后尤為重要[4]。收集筆者醫(yī)院2013年1月-2018年10月收治的110例行深靜脈置管輸液大面積燒傷患者的臨床資料,進行對比回顧性分析,以期通過尋找病因為臨床預防提供可靠的依據(jù),現(xiàn)將結果報道如下。
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[收稿日期]2019-04-10
本文引用格式:熊琴,唐亞,朱雅竹.大面積燒傷患者發(fā)生早期深靜脈置管導管相關性血流感染的危險因素分析[J].中國美容醫(yī)學,2019,28(11):26-28.