【摘要】 目的探讨接受肠外营养支持治疗患者中心静脉导管相关血行性感染(CLABSI)的发生情况及其危险因素。方法选择2011年8月—2012年3月入住我院ICU并经短期中心静脉导管(CVC)进行肠外营养支持治疗患者共190例为研究对象,患者均采用美国ARROW公司生产的单腔或双腔CVC。对CLABSI的相关危险因素进行分析。结果本组190例患者共出现CLABSI患者23例,累积感染率为16.96例/千导管日。共培养出菌株30株,其中G+菌15株、G-菌9株、真菌6株。单因素分析结果显示,导管留置时间、肠外营养时间、拔管时最高体温、多发创伤、导管管腔、肠外营养液中是否添加谷氨酰胺均是发生CLABSI的影响因素(P<0.05)。多因素Logistic回归分析显示,多发创伤〔OR=5.327,95%CI(1.772,16.013),P=0.003〕、肠外营养时间〔OR=3.185,95%CI(1.073,9.453),P=0.037〕是CLABSI的独立危险因素,而肠外营养液中添加谷氨酰胺〔OR=0.024,95%CI(0.082,0.716),P=0.01〕是保护性因素。结论肠外营养患者CLABSI发生率较高,且与多发创伤、肠外营养时间、肠外营养液中是否添加谷氨酰胺密切相关,应加强CVC无菌技术操作的规范化培训,选择谷氨酰胺强化的肠外营养,并在病情允许的情况下尽早恢复肠内营养。更多还原

【Abstract】 Objective To explore the prevalence of central line associated bloodstream infections(CLABSI) in patients receiving parenteral nutrition(PN)and their risk factors.Methods A total of 190 patients who were admitted to the intensive care unit of our center and received PN from August 2011 to March 2012 were enrolled in this study.All the patients were inserted with central venous catheters(CVC)for PN support.Clinical data were compared between patients with CLABSI or without CLABSI.Results Of these 190 patients,23 had CLABSI,with an incidence of CLABSI being 16.96 cases per 1 000 catheter days.Pathogens isolated included 15 strains of gram-positive bacteria,9 strains of gram-negative bacteria,and 6 strains of fungi.Univariate analysis results showed that,the time of catheter,time of PN,the highest temperature in the extubation,polytrauma,catheter lumen,and glutamine enriched parenteral nutrition were influencing factors of CLABSI.On multivariate Logistic analysis,polytrauma(OR=5.327,95%CI(1.772,16.013),P=0.003)and duration of PN(OR=3.185,95%CI(1.073,9.453),P=0.037) were the independent risk factors of CLABSI.Glutamine enriched parenteral nutrition(OR=0.024,95%CI(0.082,0.716),P=0.01)was a protective factor for CLABSI.Conclusion The incidence of CLABSI is high among patients receiving PN,and be resulted from factors including polytrauma and duration of PN.Glutamine enriched parenteral nutrition may help to reduce the incidence of CLABSI.Enteral nutrition should be employed as soon as possible.更多还原