烧伤科中心静脉置管患者导管相关性感染的发生情况及病原学特点

摘要 目的 明确烧伤科中心静脉置管患者导管相关性感染的病原学特点及危险因素。方法 选取在某院烧伤科住院治疗留置中心静脉导管的烧伤患者297例为研究对象,对中心静脉置管患者导管相关性感染的病原学特点和危险因素进行分析。结果 烧伤科297例中心静脉导管穿刺的患者中,共有47例发生导管相关性感染,中心静脉导管感染发生率为15.82%。47例感染的患者共培养出61株病原菌,其中以革兰阴性菌和革兰阳性菌为主,分别占总数的44.26%和40.98%|多因素Logistic回归分析结果显示,年龄≥65岁、股静脉置管、烧伤面积≥50%、血清白蛋白<30 g/L、导管留置时间≥10 d以及合并吸入性损伤是导致烧伤科中心静脉导管发生相关性感染的危险因素(OR>1,P<0.05)。结论 烧伤科中心静脉置管患者导管相关性感染的发生率较高,其与患者的年龄、置管部位、烧伤面积、血清白蛋白数值、导管留置时间和是否合并吸入性损伤等有关,我们应予以重视。     

心脏外科术后中心静脉导管相关感染致病菌及危险因素分析

目的 研究心脏外科术后中心静脉导管相关感染(CRI)、导管相关性菌血症(CRB)的发生率和菌群分布状况,以及CRI的危险因素,为临床科学管理中心静脉导管,降低CRI、CRB的发病率提供有益的参考.方法 自2005年1月至2005年12月共随机选取在心脏外科手术治疗的300例患者留置的中心静脉导管进行尖端细菌培养,同时进行血培养.结果 300例中35例(11.7%)发生CBI,CBB 5例(1.7%).病原菌菌群分布:革兰阳性球菌占54.3%,革兰阴性杆菌占34.3%.真菌占11.4%.前5位致病菌分别为:表皮葡萄球茵、金黄色葡萄球菌、肺炎克雷白杆菌、铜绿假单胞杆茵、白色念珠菌.CRl、CRB的危险因素包括:原发疾病种类、穿刺置管部位、中心静脉导管留置时间等.中心静脉导管留置时间>6d,感染率明显增加.结论 CBI、CBB是留置中心静脉导管最严重的并发症,旱期诊断、及时合理应用抗生素对降低病死率具有重要的意义.     

ICU中心静脉置管时间与导管相关性感染的研究

目的探讨ICU中心静脉置管时间与导管相关感染发生率的因果关系。方法分析ICU中心静脉置管151例患者的导管相关感染（CRI）情况。结果共发生感染23例,感染率15．2％;导管相关血行感染（CRBSI）发生3例,感染率1．98％;感染发生率2．1／千导管置管日。感染病原菌以金黄色葡萄球菌和表皮葡萄球菌为主。回归分析显示：导管留置时间与感染率之间存在一定联系（r^2=0．81）,但差异无显著意义（P=0．29）。结论未发现ICU中心静脉置管时间与导管感染有明确相关性。     

中心静脉导管性感染及其护理

目的探讨导管相关性感染(Catheter-refectionInfection,CRI)的临床特点及护理措施。方法回顾分析2001年1月～2003年6月1372例次中心静脉置管病例中24例CRI病例,探讨其临床特点及危险因素与护理的关系。结果确诊CRI24例次中留置单腔导管者9例,留置双腔导管者15例,共分离菌株25株。CRI置管后8～14天发生率最高(56%)。结论预防的重点在于避免导管腔内和腔外的污染。加强无菌操作,重视穿刺点皮肤的消毒,选用单腔导管,减少不必要的间置装置,及时拔除感染的导管,操作者水平的提高以及抗生素的合理使用法均能有效地减少CRI的发生。     

EICU中心静脉导管相关性感染危险因素分析及护理观察

目的:分析急诊重症监护病房(EICU)中心静脉导管相关性感染危险因素,并探究其护理措施。方法:选取2019年9月—2020年9月在本院EICU采用中心静脉导管治疗的600例病人作为研究对象,根据其是否出现中心静脉导管相关性感染,将其分为感染组及非感染组,比较两组病人基础资料、置管情况及置管操作人员工作时间,分析其危险因素,并探究护理对策。结果:EICU中心静脉导管相关性感染发生率为14.83%,且病人年龄≥60岁、急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)≥20分、夏季置管、颈内静脉置管、置管持续时间≥7 d、非抗感染管置管、多腔导管及操作人员工作时间<5年均为导致中心静脉导管相关性感染的危险因素(P<0.05)。结论:EICU中心静脉导管相关性感染危险因素包括病人年龄、病情严重情况、置管季节、置管部位、导管留置时间、导管类型及操作人员因素等,应在置管前对病人病情及体征进行详细判定,选择更加适合的置管部位及导管种类,控制导管留置时间及强化操作人员业务能力等方法降低感染的发生率。     

急诊手术深静脉置管患者导管相关性感染的危险因素及致病菌特点

摘要 目的 分析急诊手术深静脉置管患者发生导管相关性感染的病原菌及危险因素,为实施针对性干预措施提供依据。方法 选取在该院行急诊手术且深静脉置管的患者为研究对象,对可能导致急诊手术深静脉置管患者发生导管相关性感染的危险因素进行单因素及多因素Logistic回归分析。结果 249例急诊手术深静脉置管患者中,共有54例患者发生了导管相关性感染,感染率为21.69%。感染患者送检标本培养出致病菌62株,其中革兰阳性菌占46.77%、革兰阴性菌占35.48%、真菌占17.74%。Logistic回归分析结果显示,年龄≥60岁、置管位置在股静脉、穿刺针数≥3针、深静脉导管留置时间≥14 d及双腔导管等是急诊手术深静脉置管患者发生导管相关性感染的危险因素(OR>1,P<0.05),而穿刺前外科洗手及超声引导下穿刺则是其保护因素(OR<1,P<0.05)。结论 急诊手术深静脉置管患者导管相关性感染发生率较高,革兰阳性菌为主要致病菌,其与患者年龄、置管位置、导管留置时间、穿刺熟练程度及导管类型等有关。     

重症监护室中心静脉导管相关性感染的预防及护理

[目的]分析我院重症监护室深静脉置管病人中心静脉导管相关性感染的发生情况、病原菌种类及影响因素。[方法]对我院重症监护室299例深静脉置管病人抽血进行血培养及拔管进行导管尖端培养,调查中心静脉导管相关性感染发生情况及病原菌监测情况。[结果]299例病人中,中心静脉导管相关性感染发生率为21.4%(64/299)。检出病原菌64株,排在前3位的是金黄色葡萄球菌29株(45.32%)、铜绿假单胞菌7株(10.94%)、鲍曼不动杆菌6株(9.38%)。[结论]重症监护室中心静脉导管相关性感染的发生率较高,耐药菌感染多,与导管部位、留置时间有关,故应加强无菌操作及置管的规范管理,降低中心静脉导管相关性感染发生率。     

新生儿中心静脉置管导管相关感染的临床研究

摘要 目的 研究新生儿中心静脉置管导管相关感染的发生情况及危险因素。方法 采用回顾性调查方法,对2008年12月-2011年12月某医院新生儿重症监护室（NICU）脐静脉置管（UVC）和经外周中心静脉置管（PICC）患儿的临床资料进行分析,分析导管相关性血流感染（CRBSI）的发生率和病原菌构成,探讨其危险因素。结果 582例静脉置管患者发生CRBSI 37例,其中PICC组32例,感染率8.1%,为2.79‰导管日;UVC组5例,感染率2.7%,为3.9‰导管日。PICC组的主要致病菌为真菌、凝固酶阴性葡萄球菌和革兰阴性杆菌,UVC组的主要致病菌为真菌和革兰阳性球菌。中心静脉置管并发CRBSI的危险因素为胎龄、出生体重、置管时间和多种侵入性操作。结论 胎龄小、出生体质量轻,中心静脉置管时间长及进行多种侵入性操作可造成CRBSI感染率升高。     

PICC导管相关感染的研究进展

经外周静脉置入的中心静脉导管(peripherally inserted central catheter,PICC)从20世纪80年代开始被首次应用于临床静脉治疗,因为能减轻患者痛苦.提高医务人员工作效率和具有较长的留置时间等优点,目前,PICC的使用仅次于紧急救护的中心静脉导管[1].但是患者因为置管发生感染的危险性也在增加[2].导管相关感染(catheter-related infection,CRI)是长期置管的常见并发症,有研究提出PICC置管感染率约占其所有并发症的40%,位居首位[3].明确诊断标准及诱发因素,采取恰当的防护措施,将有助于减少CRI的发生.为此,笔者对导致PICC置管期间CRI的相关因素及防护进展综述如下.     

老年患者中心静脉置管相关感染的危险因素分析

目的探讨老年患者中心静脉置管(central venous catheters,CVC)发生导管相关感染的危险因素,为制定护理措施提供依据。方法选择2010年1月—2011年12月255例中心静脉置管的老年患者作为研究对象,对可能影响导管相关感染发生的因素做单因素分析与Logistic多元回归分析。结果 29例患者发生了导管相关感染,单因素分析筛选出导管的类型、导管放置的场所、导管留置时间、穿刺血管4个因素,以有细菌定植为应变量,其他因素为自变量赋值后进行非条件多因素分析,显示导管留置时间≥7 d是导管相关感染的危险因素。结论严格控制置管天数,可以有效预防导管相关感染的发生。     

Encrustations of the urinary catheter and prevention strategies: a literature review

Patients with an indwelling urinary catheter are at risk of developing urinary tract infection: for each day of the catheter remaining in situ, there is an increasing risk from 3% to 7% for infection to appear. One of the main complications of catheterization is the onset of encrustations, frequently resulting in obstruction of the catheter. Aim of this study is to describe the problem of indwelling urinary catheter encrustation and prevention strategies. A narrative review of the literature was conducted. Indwelling urinary catheter encrustations originate more easily when urine contains high concentrations of poorly soluble constituents and when the state of the urinary tract enables their precipitation as an alkaline urinary pH, often associated with the presence of bacteria urease‐producers, for instance Proteus mirabilis. Urease can generate crystals and this process keeps going until the accumulation of crystalline deposits block the urine flow within the catheter lumen. The literature suggests that there are manifold pharmacological and non‐pharmacological strategies to prevent encrustations. The literature analysis suggests that the permanence of the catheter could potentially be one of the most relevant causes of encrustation. The catheterization duration is the most important risk factor for bacteriuria, essential for the process of encrustation to start off. There are many prevention strategies, among which promotion of nucleation pH (pHn) supplementation in the daily diet with liquids containing citrate; this is the most simple and suitable for all patients being inexpensive and effective.     

Encrustations of the urinary catheter and prevention strategies: an observational study

Patients with an indwelling urinary catheter are at risk of developing urinary tract infection: for each day of the catheter remaining in situ, there is an increasing risk from 3% to 7% for infection to appear. One of the main complications of catheterization is the onset of encrustations, frequently resulting in obstruction of the catheter. To investigate the prevalence of encrusted indwelling urinary catheters in outpatients referred to the Department of Urology. An observational study was carried out on outpatients referred to the Department of Urology in need of removal or replacement of indwelling urinary catheters. A table was completed to collect the data of each patient in order to investigate the presence of any possible encrustation. The collected data concerned 85 patients, 81 male (95·3%) and 4 female (4·7%). Patients had different pathologies and different types of catheter, with different sizes and different materials. The number of indwelling urinary catheters that during removal/replacement were visibly encrusted in the eyehole area totaled eight (9·4%). The analysis of the collected data suggests that the permanence of the catheter could potentially be one of the most relevant causes of encrustation; five out of eight patients with encrusted urethral catheter had it in place for 1 month, three of them for 2 weeks. There are many prevention strategies, among which promotion of nucleation pH (pHn) supplementation in the daily diet with liquids containing citrate is the most simple and suitable for all patients being inexpensive and effective.     

两种不同留置导尿管方法对男性导尿困难患者的效果分析

目的观察两种不同留置导尿管方法对男性导尿困难患者的效果。方法将80例男性导尿困难患者分为观察组和对照组,各40例。观察组采用自制不锈钢导尿管支架插入导尿管腔内进行导尿。对照组采用普通尿道探子先扩张尿道再进行导尿。观察两组一次性插管成功率。结果两组一次性插管成功率比较有显著性差异（P〈0．01）。结论采用自制不锈钢导尿管支架插入导尿管腔内进行导尿,能提高一次性插管成功率,减轻患者痛苦,可应用于临床。     

带状疱疹后遗神经痛远期疗效临床研究

目的：带状疱疹后遗神经痛属于较剧烈的顽固性疼痛症之一,主要发生于中老年病人。本文报告一组32例病人接受定位神经节段注药为主的治疗,并取得较满意疗效的远期病人随访结果。方法：在达到有效缓解疼痛的治疗效果后,分别在一年至两年期间（10～26个月）通过门诊和电话家访两种方式进行随访,项目包括疼痛疗效,情绪,生活质量以及工作能力,患区后遗症状等。结果：32人在治疗后的1～2年内均能保持稳定疗效,精神面貌好,生活质量显著改善,睡眠及饮食起居均恢复正常或基本正常,但患区后遗症状,如痒感,蚁行感和牵拉或紧束感仍然存在。结论：带状疱疹后遗神经痛经过以精确的定位神经节段或区域注药为主要治疗手段取得确切的疗效后均能保持疗效。说明了该疗法是治疗带状疱疹后遗神经痛较为满意的方法。     

Perspectives on caregiving: A qualitative evaluation of certified nursing assistants

This study sought Certified Nursing Assistants' (CNAs) perspectives on the activities that compose quality care. CNAs provide the majority of hands on care in nursing homes positioning them to have a unique perspective on factors that constitute good quality care. Using semi-structured interviews, 23 CNAs from New York State nursing homes were asked to identify factors they felt were components of good care. Interviews were recorded, transcribed verbatim, and coded using open coding. Three themes emerged: (1) technical aspects of care; (2) care of the environment; and (3) a little bit more. Our results emphasize the complexities of providing care that go beyond items that can be regulated. Assessments of quality care should incorporate the voices of CNAs.     

Catheter-related infection in critically ill patients

Objective To describe the incidence of the catheter-related local infection (CRLI) and catheter-related bloodstream infection (CRBSI) of central venous catheters (CVCs) and arterial catheters (ACs).Design Prospective, observational study.Setting A 24-bed medical-surgical intensive care unit of a 650-bed university hospital.Patients We included 988 consecutive patients admitted to the ICU during 18 months.Measurements The incidence density of CRLI and CRBSI, per 1000 catheter-days, of CVC and AC.Results Central venous catheters had a significantly higher incidence density of CRLI (4.74 vs 0.97/1,000 catheter-days; p<0.001) than ACs. Femoral venous access had a higher incidence density of CRLI than subclavian (13.15 vs 1.81/1,000 catheter-days, p=0.003) and than peripheral access (13.15 vs 2.30/1,000 catheter-days, p<0.001). Jugular venous access had a higher incidence density of CRLI (6.29 vs 1.81/1,000 catheter-days, p<0.001) than subclavian access. We found no significant differences in the incidence density of CRLI and CRBSI between the different AC accesses.Conclusions In the CDC guidelines, catheter insertion at the subclavian site is recommended in preference to femoral and jugular accesses, and there is no recommendation about AC site insertion. Our data support these recommendations about CVCs. Because the AC infection rate was very low, our study suggests that the access site is probably not of major importance for this type of catheter.     

肿瘤患者外周中心静脉置管导管相关性感染的危险因素研究

目的探讨肿瘤患者外周中心静脉置管(PICC)导管相关性感染的危险因素。方法 348例行PICC的肿瘤患者根据是否发生导管相关性感染分为感染组61例和对照组287例,回顾性分析2组患者临床资料,筛选导管相关性感染的危险因素。结果单因素分析表明,年龄、文化程度、病程、是否应用高营养化疗药物、是否应用激素、白细胞计数(WBC)、是否掌握PICC自我护理知识、置管部位、导管类型、留置时间及操作者的经验等因素均与导管相关性感染相关(P0.01),Logistic回归分析显示,静脉高营养、应用激素、PICC自我护理知识掌握不良、导管留置时间长、留置部位为股静脉、操作者经验少、WBC降低为PICC导管相关性感染的危险因素(P0.05或P0.01)。结论 PICC导管相关性感染受多重因素影响,临床应针对上述因素进行干预,预防导管相关性感染的发生。