急性白血病患者PICC置管相关性感染因素及对策分析

目的：分析急性白血病患者经外周静脉置入中心静脉导管(peripherally inserted central catheter， PICC)相关性感染因素，为有效防治提供理论依据。方法：选取保定市第一医院2009年8月至2015年6月100例急性白血病患者及100例实体肿瘤患者行PICC置管，分析急性白血病PICC置管相关性感染发生率及原因。结果：100例急性白血病发生PICC置管相关性感染患者21例，置管相关性感染发生率为21.00%，其中局部感染12例，占12.00%，全身性感染9例，占9.00%；明显高于实体肿瘤患者10.00%(10/100)，P<0.05，与患者年龄、性别、急性白血病类型、选择静脉、置管长度无显著相关。而中性粒细胞计数<0.5×109/L、粒细胞缺乏时间≥7 d，CD4/CD8<1.00、置管留置时间≥60 d患者置管相关性感染发生率明显升高。结论：白血病患者PICC置管相关性感染明显高于实体肿瘤患者，其中与中性粒细胞计数、粒细胞缺乏时间，CD4/CD8比值、置管留置时间密切相关，因此对急性白血病患者要严格执行PICC操作流程及无菌操作以减少患者置管相关性感染发生率。

Analysis and measurement the factors of PICC related infection in acute leukemia

Objective:To analyze infection factors of peripherally inserted central catheter (PICC) in patients with acute leukemia and provide theoretical basis for effective prevention and treatment of the infection.Methods: 100 acute leukemia patients and 100 solid tumor patients with PICC catheter were selected in the No. 1 Hospital of Baoding from June 2015 to August 2009. The incidence and infection factors of PICC catheter were analyzed. Results: hTe PICC catheter-related infections account to 21 cases in 100 acute leukemia patients, including 12 cases of local infection (12.00%), 9 cases of systemic infection (9.00%) which was signiifcantly higher than that solid tumors with 10.00% (10/100),P<0.05. hTe risk of infection has no correlation with age, gender, types of acute leukemia, intravenous selection and catheter length; the infection rate increased in patients with the neutrophil count <0.5×109/L, agranulocytosis time ≥7 days, and CD4/CD8 <1.00, intubation time ≥60 days. Conclusion: The PICC related infection in leukemia patients was significantly higher than that in solid tumor patients. hTe infection has a correlation with neutrophil count, agranulocytosis time, CD4/CD8 ratio, intubation time. So the strict implementation with PICC operation process and aseptic operation was important to reduce the catheter related infection incidence in acute leukemia patients.