ICU颅脑损伤患者静脉置管相关血流感染的临床特征及危险因素调查(1)
【摘 要】目的：了解我院ICU病房颅脑损伤患者静脉置管相关血流感染的病原菌分布特征并探索其相关危险因素，为临床控制与治疗这类感染提供相关理论依据。方法：回顾性的分析我院2012年—2016年诊治的52例ICU病房的中心静脉置管相关血流感染(CRBSI)的颅脑损伤患者，首先对其临床资料、菌株分布及药敏情况进行分析，并进行其危险因素调查。结果：ICU颅脑损伤患者CRBSI发生率为13.6%，以革兰阴性菌(主要是铜绿假单胞菌)感染为主，占56.9%，其次为革兰阳性菌(主要是金黄色葡萄球菌)感染，占32.6%，而真菌感染最少占(10.5%)；根据菌株药敏结果，可分别使用碳青酶烯类抗生素和万古霉素进行革兰阴性菌和阳性菌的抗感染治疗；从危险因素调查结果来看，高龄、肠外营养、长时间导管置留是CRBSI的独立危险因素。结论：我院ICU颅脑损伤患者CRBSI发生率为13.6%，以革兰阴性菌感染为主，预防控制高龄、肠外营养、长时间导管置留等独立危险因素，从而减少中心静脉置管相关血流感染的产生和传播。
【关键词】颅脑损伤；中心静脉置管；血流感染
[Abstract] Objective：To expore the distribution of pathogens and the risk factors of the central venous catheter-related bloodstream in ICU brain injury patients for the clinical treatment and prevention.Methods：52brain injury patients infected with CRBSI were retrospectively collected in our study from2012to2016and used for analyzing the clinical data， strains distribution， and drug susceptibilities.In addition， case patients with CRBSI and controls without CRBSI were compared for evaluating the risk factors， thus329patients were enrolled in control groups.Results： A total of52inpatients had CRBSI， and the incidence of infection was13.6%.Gram-negative bacteria (56.9%) was the most frequent strains in CRBSI patients， followed by Gram-positive (32.6%) and fungus (10.5%)， which could be treated by carbapenem and vancomycin.Moreover， we found that elderly， parenteral nutrition， long-time catheterization were identified as significant risk factors for CRBSI in ICU brain injury patients.Conclusion： The incidence of CRBSI in our study was13.6%， and the pathogens showed that gram-positive bacteria were the predominant.The prevention and control of the independent risk factors (such as elderly， parenteral nutrition， long-time catheterization) can effectively reduce the occurrence and transmission of CRBSI infection for patients with severe brain injury in ICU.
[Key words] Brain injury； Central venous catheter； Bloodstream
【中圖分类号】R446.5 【文献标识码】A 【文章编号】2095-6851(2018)08--01
目前颅脑损伤已成重症监护室(ICU)最常见及危害最大的疾病之一，其常常伴有病情危重、发展迅速、烦躁多动以及治疗难度大等特点，而对此类患者采用中心静脉置管来进行及时的抢救和治疗是必要手段之一，但其常常会引起导管相关性血流感染(CRBSI)，需要引起高度重视，加之颅脑损伤患者本身病情重、抵抗力低、免疫功能低下，则更容易导致CRBSI的发生，进而加重患者病情、延长住院时间、增加患者病死率[1，2]。本研究通过探讨我院2012年～2016年ICU病房中颅脑损伤患者导管相关性血流感染的病原菌特征及危险因素，为临床降低CRBSI发生率并及时有效的进行治疗提供理论依据。
1 材料与方法
1.1 临床资料
收集我院2012年1月～2016年12月ICU病房中颅脑损伤患者393例，其中进行中心静脉置管操作患者381例，包括男性217例，女性164例，平均年龄为(47.40±8.30)岁。疾病种类分布：脑挫裂伤198例，脑干出血19例，小脑出血51例，基底节区脑出血78例。所有中心静脉置管患者均取静脉血或导管标本，送检血培养或导管细菌培养试验。 (田时志 董剑 王杉)
【关键词】颅脑损伤；中心静脉置管；血流感染
[Abstract] Objective：To expore the distribution of pathogens and the risk factors of the central venous catheter-related bloodstream in ICU brain injury patients for the clinical treatment and prevention.Methods：52brain injury patients infected with CRBSI were retrospectively collected in our study from2012to2016and used for analyzing the clinical data， strains distribution， and drug susceptibilities.In addition， case patients with CRBSI and controls without CRBSI were compared for evaluating the risk factors， thus329patients were enrolled in control groups.Results： A total of52inpatients had CRBSI， and the incidence of infection was13.6%.Gram-negative bacteria (56.9%) was the most frequent strains in CRBSI patients， followed by Gram-positive (32.6%) and fungus (10.5%)， which could be treated by carbapenem and vancomycin.Moreover， we found that elderly， parenteral nutrition， long-time catheterization were identified as significant risk factors for CRBSI in ICU brain injury patients.Conclusion： The incidence of CRBSI in our study was13.6%， and the pathogens showed that gram-positive bacteria were the predominant.The prevention and control of the independent risk factors (such as elderly， parenteral nutrition， long-time catheterization) can effectively reduce the occurrence and transmission of CRBSI infection for patients with severe brain injury in ICU.
[Key words] Brain injury； Central venous catheter； Bloodstream
【中圖分类号】R446.5 【文献标识码】A 【文章编号】2095-6851(2018)08--01
目前颅脑损伤已成重症监护室(ICU)最常见及危害最大的疾病之一，其常常伴有病情危重、发展迅速、烦躁多动以及治疗难度大等特点，而对此类患者采用中心静脉置管来进行及时的抢救和治疗是必要手段之一，但其常常会引起导管相关性血流感染(CRBSI)，需要引起高度重视，加之颅脑损伤患者本身病情重、抵抗力低、免疫功能低下，则更容易导致CRBSI的发生，进而加重患者病情、延长住院时间、增加患者病死率[1，2]。本研究通过探讨我院2012年～2016年ICU病房中颅脑损伤患者导管相关性血流感染的病原菌特征及危险因素，为临床降低CRBSI发生率并及时有效的进行治疗提供理论依据。
1 材料与方法
1.1 临床资料
收集我院2012年1月～2016年12月ICU病房中颅脑损伤患者393例，其中进行中心静脉置管操作患者381例，包括男性217例，女性164例，平均年龄为(47.40±8.30)岁。疾病种类分布：脑挫裂伤198例，脑干出血19例，小脑出血51例，基底节区脑出血78例。所有中心静脉置管患者均取静脉血或导管标本，送检血培养或导管细菌培养试验。 (田时志 董剑 王杉)