心脏术后中心静脉导管相关性感染与置管时间的探讨

摘要

目的 探讨心脏术后中心静脉导管相关性感染(CRI)的发生率与中心静脉导管留置时间的关系及CRI感染的途径.方法 选取242例心脏直视术后留置深静脉导管的病例,依据拔管时间将患者分为1～5 d组、6～8 d组及9～11 d组,对拔除导管的尖端进行细菌培养,并统计三组病原菌菌株数及相关构成比.结果 共38例患出现CRI,培养出病原菌48株,留置时间1～5 d、6～8 d、9～11 d时患者CRI发生率分别为8.26%、18.18%和36.36%,三组间CRI感染率有统计学差异(P＜0.01).48株病原菌中革兰阳性菌占54.16%,革兰阴性菌占37.5%,真菌占8.33%.结论 随中心静脉导管留置时间延长CRI呈显著增加趋势,以革兰阳性菌感染为主,CRI以局部细菌侵入途径为主.%Objective To investigate the relationship between the incidence of central venous catheter related infections ( CRI ) and catheter retention time after heart surgery, and the pathway of CRI. Methods The patients ( n = 242 ) with deep vein catheter retention after open-heart surgery were selected and divided into 1 ~ 5 day group, 6 ~ 8 day group and 9 ~ 11 day group according to the time of extubation. The bacteria on the tip of catheter were cultured, and strains and relevant constituent ratio of pathogenic bacteria were counted in three groups. Results There were totally 38 patients suffering from CRI and 48 stains of pathogenic bacteria cultured. The incidence of CRI was, respective1y,8.26% ,18. 18% and 36. 36% in three groups ( P <0. 01 ). Among 48 stains of pathogenic bacteria,Gram-positive bacteria accounted for 54. 16% ,Gram-negative bacteria,37. 5% ,and fungus,8. 33% . Conclusion The incidence of CRI has a significant increasing tendency as the prolong of catheter retention time. The infections are mainly Gram-positive bacteria infection and the pathway of CRI is focal invasion.