陈学勋 张成银 张云霞 等

[摘要]目的 探討75%乙醇封管治疗血液透析用隧道式中心静脉导管血流感染的临床效果。方法 选取潍坊医学院附属医院2016年8月～2018年3月收治的62例隧道式中心静脉导管血流感染的维持性透析患者作为研究对象，按照不同的封管方式分为对照组（18例）、头孢呋辛组（22例）、乙醇组（22例）。对照组采用单纯肝素50 mg/ml方法封管，头孢呋辛组采用肝素（50mg/ml）+头孢呋辛（20 mg/ml）混合封管，乙醇组采用75%乙醇封管。检测各组封管前后的体温、C反应蛋白（hs-CRP）、白细胞计数（WBC）、中性粒细胞计数（NEU）、中性粒细胞百分比（NEU%）等临床感染指标变化及导管功能不良情况，比较三组的临床有效率及导管功能不良发生率。结果 乙醇组的临床总有效率（95.5%）高于头孢呋辛组（81.8%），差异有统计学意义（P<0.05）。乙醇组的临床总有效率（95.5%）高于对照组（72.2%），差异有统计学意义（P<0.05）。头孢呋辛组的总有效率（81.8%）高于对照组（72.2%），差异有统计学意义（P<0.05）。乙醇组的导管功能不良总发生率（12.1%）低于头孢呋辛组（27.3%），差异有统计学意义（P<0.05）。乙醇组的导管功能不良总发生率（12.1%）与对照组（13.0%）比较，差异无统计学意义（P>0.05）。头孢呋辛组的导管功能不良总发生率（27.3%）高于对照组（13.0%），差异有统计学意义（P<0.05）。结论 75%乙醇封管和头孢呋辛封管在治疗导管血流感染方面均有良好效果，75%乙醇封管优于头孢呋辛封管，导管功能不良发生率低。

[关键词]隧道式中心静脉导管;导管相关性血流感染;维持性血液透析;75%乙醇;头孢呋辛

[中图分类号] R459.5          [文献标识码] A          [文章编号] 1674-4721（2019）2（a）-0035-04

[Abstract] Objective To investigate the clinical effect of 75% Ethanol catheter locks in the treatment of tunneled hemodialysis catheter-related blood stream infection. Methods A total of 62 cases of maintenance hemodialysis patients with central venous catheter-related blood stream infections from August 2016 to March 2018 in Affiliated Hospital of Weifang Medical University were selected as the research objects， according to different sealing methods， they were divided into the control group （18 cases）， the Cefuroxime group （22 cases） and the Ethanol group （22 cases）. The control group was sealed with 50 mg/ml Heparin alone. The Cefuroxime group was sealed with Heparin （50 mg/ml） and Cefuroxime （20 mg/ml）， while the Ethanol group was sealed with 75% Ethanol. The changes of body temperature， C-reactive protein （hs-CRP）， white blood cell count （WBC）， neutrophil count （NEU）， neutrophil percentage （NEU%） and catheter dysfunction before and after catheter closure were detected. The clinical efficiency and the incidence rate of catheter dysfunction were compared among the three groups. Results The total clinical effective rate of the Ethanol group （95.5%） was higher than that of the Cefuroxime group （81.8%）， the difference was statistically significant （P<0.05）. The total clinical effective rate of the Ethanol group （95.5%） was higher than that of the control group （72.2%）， the difference was statistically significant （P<0.05）. The total effective rate of the Cefuroxime group （81.8%） was higher than that of the control group （72.2%）， the difference was statistically significant （P<0.05）. The total incidence rate of catheter dysfunction in the Ethanol group （12.1%） was lower than that in the Cefuroxime group （27.3%）， the difference was statistically significant （P<0.05）. There was no significant difference in the total incidence rate of catheter dysfunction between the Ethanol group （12.1%） and the control group （13.0%） （P>0.05）. The total incidence rate of catheter dysfunction in the Cefuroxime group （27.3%） was higher than that in the control group （13.0%）， the difference was statistically significant （P<0.05）. Conclusion 75% Ethanol sealing and Cefuroxime sealing have good effect in the treatment of catheter blood stream infection， the effect of 75% Ethanol sealing is better than that of Cefuroxime sealing， and the incidence rate of catheter dysfunction is low.

[Key words] Tunneled central venous catheter; Catheter-related blood stream infection; Maintenance hemodialysis; 75% Ethanol; Cefuroxime

隧道式中心静脉导管是维持性血液透析（MHD）患者重要的血管通路之一，在血管条件差、血管耗竭及老年患者中发挥着重要而不可替代的角色[1-2]。目前，多数学者应用抗菌药物[3-5]、不同浓度的乙醇封管预防中心静脉导管感染的发生[6-8]。虽然多种预防方式使得隧道式中心静脉导管感染率下降，但由于带管时间长，反复操作，故仍不能避免导管相关性血流感染（CRBSI）情况的发生，且发生后处理棘手，最终导致导管拔除，甚至因重症菌血症而导致患者死亡，不仅给患者带来经济负担，甚至无法重新建立其他可替代的血管通路[1-2]。……