外周插入中心导管的血液病患者导管相关血流感染和血栓形成风险

摘要

目的 探究外周插入中心导管(PICC)的血液病患者导管相关血流感染和血栓形成风险.方法 收集2017年1月至2018年5月在本院住院的PICC置管的血液病患者,以PICC留置过程中首次发生导管感染的血液病患者作为感染组,随机选取性别、置管时间以及年龄相近的没有血流感染的患者以1∶3的比例进行配对,将其作为对照组.收集两组相关临床资料,对血液病患者PICC导管相关血流感染和血栓的危险因素进行回顾性分析.采取1∶3配对的条件logistics回归模型进行多因素分析.结果 感染组与对照组肺部感染发生例数分别为3例和5例,差异有统计学意义(P＜0.05).感染组与对照组肛周感染发生例数分别为3例和0例,差异有统计学意义(P＜0.05).感染组与对照组泌尿道感染发生例数分别为1例和0例,差异无统计学意义(P＞0.05).感染组与对照组发生心功能不全的例数分别为11例和2例,差异有统计学意义(P＜0.05).感染组与对照组发生呼吸衰竭的例数分别为3例和3例,差异无统计学意义(P＞0.05).感染组与对照组发生肝功能不全的例数分别为4例和4例,差异有统计学意义(P＜0.05).多因素分析表明,急性白血病P=0.021,OR值为2.021,OR值95％的可信区间为(1.245,3.639);置管次数P＜0.01,OR值为1.886,OR值95％的可信区间为(1.557,2.276);粒缺持续时间P=0.001,OR值为1.025,OR值95％的可信区间为(1.011,1.038);最低白蛋白值P＜0.01,OR值为0.937,OR值95％的可信区间为(0.917,0.959).血液病患者菌种分析PICC导管相关性局部感染主要为G+菌.PICC导管相关性血流感染主要为G-菌.结论 粒缺持续时间、置管次数、治疗过程中白蛋白最低值是出现PICC导管血流感染和血栓形成的危险因素.血液病患者发生PICC导管相关血流感染和血栓形成时必须采用覆盖G-菌和真菌的抗生素进行治疗.%Objective To study the risk of catheter-related bloodstream infection and thrombosis in patients with peripherally inserted central catheter (PICC).Methods The patients taking PICC catheterization at our hospital from January,2017 to May,2018 were selected.The patients with PICC catheterization infection for the first time during the process of PICC catheterization were randomly selected as an infection group,The patients without bloodstream infection were matched at a ratio of 1:3 in terms of sex,catheterization time,and age,and were set as a control group.The clinical data of the two groups were collected and the risk factors of PICC catheter-related bloodstream infection and thrombosis in the patients with hematological diseases were retrospectively analyzed.The conditional logistic regression model of 1:3 pairing was used for multivariate analysis.Results There were 3 cases of pulmonary infection and 5 cases of pulmonary infection in the infection group and the control group,respectively,with a statistical significance (P ＜ 0.05).There were 3 cases of perianal infection in the infection group and 0 case in the control group,with a statistical significance (P ＜ 0.05).1 got urinary tract infection in the infection group and 0 in the control group,with no statistical significance (P ＞ 0.05).There were 11 cases of heart insufficiency in the infection group and 2 cases in the control group (P ＜ 0.05).There were 3 cases of respiratory failure in the infection group and 3 cases in the control group (P ＞ 0.05).There were 4 cases of hepatic insufficiency in the infection group and 4 cases in the control group (P ＞ 0.05).Multivariate analysis showed that acute leukemia [P=0.021,OR value 2.021,OR value 95％ CI (1.245,3.639)],the times of catheterization [P ＜ 0.01,OR value 1.886,OR value 95％ CI(1.557,2.276)],the duration of granular deficiency [P=0.001,OR value 1.025,the OR value 95％ CI (1.011,1.038)],and the lowest albumin value [P ＜ 0.01,OR value 0.937,OR value 95％ CI (0.917,0.959)].The analysis of bacterial strains in the patients with hematological diseases showed that G+ bacteria was the main local infection associated with PICC catheter.G bacteria was the main pathogens of PICC catheter-related bloodstream infections.Conclusion The duration of granular deficiency,the times of catheterization,and the lowest albumin level during treatment are risk factors for PICC catheter bloodstream infection and thrombosis.Antibiotics covered with G bacteria and fungi have to be used to treat PICC catheter-related bloodstream infections and thrombosis in patients with hematological diseases.