胡健

【摘要】 目的：探討重症监护室中心静脉置管患者发生导管相关性感染的危险因素及护理对策。方法：回顾性分析2019年1-12月本院重症监护室的504例中心静脉置管患者的临床资料，包含性别、年龄、诊断结果、进入ICU后的APACHE-Ⅱ评分、ICU住院时间、总住院时间、合并症情况等基础资料，以及对可能引起导管相关性感染的危险因素进行分析，包括置管类型、置管部位、置管留置时间、主要理化生化指标等。采用单因素和多因素logistic回归分析中心静脉置管患者导管相关性感染的危险因素。结果：504例患者中有73例患者发生导管相关性感染，感染率为14.48%。感染组与未感染组在入ICU时APACHE-Ⅱ评分、糖尿病史、置管季节、置管类型、置管部位、置管时间、血红蛋白含量偏低、白蛋白含量偏低、操作人员工作年限方面比较，差异均有统计学意义（P<0.05）。logistic回归分析显示夏季置管、操作人员工作年限<5年、有糖尿病史、APACHE-Ⅱ评分>20分、置管时间>7 d是患者导管相关性感染的独立危险因素（P<0.05）。结论：APACHE-Ⅱ评分>20分、有糖尿病史、夏季置管、操作人员工作年限较短、置管时间>7 d是引起重症监护室中心静脉置管患者发生导管相关性感染的独立危险因素，护理过程中应注意提高护理人员操作和护理技术，选择合适置管方式、缩短置管时间是降低导管相关性感染风险的重要措施。

【关键词】 中心静脉置管 导管相关性感染 危险因素 护理对策

Risk Factors Analysis of Catheter-related Infection in Patients with Central Venous Catheterization in Intensive Care Unit/HU Jian. //Medical Innovation of China， 2021， 18（12）： -114

[Abstract] Objective： To explore the risk factors and nursing strategies of catheter-related infection in intensive care unit （ICU） patients with central venous catheterization. Method： The clinical data of 504 patients with central venous catheterization in ICU of our hospital from January to December 2019 were retrospectively analyzed， including gender， age， diagnosis results， APACHE-Ⅱ score after entering ICU， ICU length of stay， total length of stay， complications and other basic data， as well as the risk factors of catheter-related infection， including catheter type， catheter location， indwelling time， main physical and chemical indexes， etc. Univariate and multivariate logistic regression were used to analyze the risk factors of catheter-related infection in patients with central venous catheterization. Result： Catheter-related infections occurred in 73 patients of 504 patients， the infection rate was 14.48%. Comparison of APACHE-Ⅱ score， diabetes history， catheterization season， catheterization type， catheterization position， catheterization time， low hemoglobin content， low albumin content， and working years of operators between the infected group and the uninfected group at the time of admission to ICU， the differences were statistically significant （P<0.05）. Logistic regression analysis showed that summer catheterization， operator working years <5 years， diabetes history， APACHE-Ⅱ score >20 points， and catheterization time >7 d were independent risk factors for catheterization associated infection （P<0.05）. Conclusion： APACHE-Ⅱ score >20 points， diabetes history， summer tube placement， short working years of operators， and catheterization time >7 d are independent risk factors for catheter-related infection in patients with central venous catheter placement in ICU. In the nursing process， attention should be paid to improve the operation and nursing technology of nursing staff， and the choice of appropriate placement mode and shortening the time of catheter placement are the important measures to reduce the risk of catheter-related infection.

[Key words] Central venous catheterization Catheter-related infection Risk factors Nursing strategy

First-authors address： Macheng Peoples Hospital， Macheng 438300， China

doi：10.3969/j.issn.1674-4985.2021.12.026

中心静脉置管是一种经皮穿刺锁骨下静脉、颈静脉、股静脉并沿血管走向将导管插至到达中心静脉的方法，由于中心静脉血管直径粗、血流量大，穿刺成功率高，注射进入体内……