脑出血患者经外周静脉置入中心静脉导管后导管相关性感染的危险因素研究

摘要

Objective To investigate the risk factors of catheter - related infection in patients with cerebral hemorrhage undergoing central venous catheterization through peripheral vein. Methods A total of 246 patients with cerebral hemorrhage undergoing central venous catheterization through peripheral vein were selected in the 309th Hospital of Chinese People′ s Liberation Army from January 2011 to January 2014,and they were divided into A group(did not complicated with catheter -related infection,n = 232)and B group(complicated with catheter - related infection,n = 14)according to the incidence of catheter - related infection. Age, gender, smoking history, drinking history, GCS score, hematoma volume, hematoma involved ventricle or not,received hematoma drilling drainage under CT localization or not,duration of coma,infection history and incidence of diabetes were compared between the two groups,and risk factors of catheter - related infection were analyzed. Results No statistically significant differences of gender,smoking history or drinking history was found between the two groups (P > 0. 05),while there were statistically significant differences of age,the proportion of patients with GCS score equal 3, hematoma volume,the proportion of patients with hematoma involved ventricle,the proportion of patients treated by hematoma drilling drainage under CT localization,duration of coma,infection history and incidence of diabetes between the two groups(P< 0. 05). Multivariate logistic regression analysis showed that,equal or over 60 years old〔 OR = 9. 508,95% CI(5. 039, 15. 528)〕,received hematoma drilling drainage under CT localization〔OR = 3. 025,95% CI(1. 812,7. 354)〕,duration of coma equal or over 1 week〔 OR = 5. 711,95% CI(1. 123,19. 780)〕 and diabetes〔 OR = 15. 547,95% CI(1. 382, 74. 898)〕 were risk factors of catheter - related infection in patients with cerebral hemorrhage undergoing central venous catheterization through peripheral vein( P < 0. 05). Conclusion Equal or over 60 years old,received hematoma drilling drainage under CT localization,duration of coma equal or over 1 week and diabetes are risk factors of catheter - related infection in patients with cerebral hemorrhage undergoing central venous catheterization through peripheral vein.%目的：探讨脑出血患者经外周静脉置入中心静脉导管（PICC）后导管相关性感染的危险因素。方法选取2011年1月—2014年1月于中国人民解放军第三〇九医院行 PICC 的脑出血患者246例，按是否发生 PICC 后导管相关性感染分为无 PICC 后导管相关性感染组（A 组）232例，PICC 后导管相关性感染组（B 组）14例。比较两组患者年龄、性别、吸烟史、酗酒史、格拉斯哥昏迷量表（GCS）评分、血肿体积、血肿累及脑室情况、行 CT 定位下血肿钻孔引流术情况、昏迷时间、感染史、糖尿病发生情况，并分析 PICC 后导管相关性感染的危险因素。结果两组患者性别、吸烟史、酗酒史比较，差异无统计学意义（P >0.05）；两组患者年龄、GCS 评分为3分者所占比例、血肿体积、血肿累及脑室者所占比例、行 CT 定位下血肿钻孔引流术者所占比例、昏迷时间、感染史、糖尿病发生率比较，差异有统计学意义（ P <0.05）。多因素 logistic 回归分析结果显示，年龄≥60岁〔 OR =9.508，95% CI（5.039，15.528）〕、行 CT 定位下血肿钻孔引流术〔 OR =3.025，95% CI（1.812，7.354）〕、昏迷时间≥1周〔 OR =5.711，95% CI（1.123，19.780）〕、糖尿病〔OR =15.547，95% CI（1.382，74.898）〕为脑出血患者 PICC 术后导管相关性感染的危险因素（P <0.05）。结论年龄≥60岁、行 CT 定位下血肿钻孔引流术、昏迷时间≥1周、糖尿病为脑出血患者 PICC 术后导管相关性感染的危险因素。