论文部分内容阅读
目的探讨中心静脉置管对血液科住院患者医院感染的影响。方法研究对象为2013年1月至2014年12月第三军医大学新桥医院血液科住院时间超过48 h的全部住院患者。根据住院记录、护理记录和医院感染登记报告系统采集患者相关的临床、护理操作和医院感染相关资料。根据卫生部《医院感染诊断标准》将患者分为感染组和对照组,以非条件Logistic回归进行风险关联分析。结果纳入分析患者共7 381例,住院期间发生医院感染的患者771例,采用中心静脉置管患者484例。对全部7 381例患者和其中6 026例血液系统肿瘤患者的分析结果十分接近,单因素分析结果显示中心静脉置管使医院感染风险显著增加(OR全部=6.66,95%CI:5.45~8.16;OR肿瘤=5.67,95%CI:4.59~6.99),但经多因素校正后关联均不显著(OR全部=1.14,OR肿瘤=1.16)。但在住院时间较长(≥28 d)时,多因素分析结果显示中心静脉置管显著增加了医院感染风险(OR=1.60,95%CI:1.04~2.45),采用经外周静脉穿刺中心静脉置管方式(OR=1.71,95%CI:1.07~2.76)和以贵要静脉为穿刺部位时(OR=2.69,95%CI:1.44~5.02)均与医院感染有显著关联。住院时间长、粒细胞缺乏、使用糖皮质激素也与医院感染有显著关联。结论相对于其他危险因素,中心静脉置管使医院感染风险的增加在总体上不明显,但对长时间住院患者而言,中心静脉置管是相对独立的医院感染危险因素。
Objective To investigate the influence of central venous catheterization on nosocomial infection in hematology department. Methods The subjects were all inpatients who had been hospitalized for more than 48 hours in the Department of Hematology, Xinqiao Hospital, Third Military Medical University from January 2013 to December 2014. According to hospital records, nursing records and nosocomial infection registration reporting system to collect patient-related clinical, nursing operations and hospital-related information. Patients were divided into infection group and control group according to the “Diagnostic Criteria of Nosocomial Infections” issued by the Ministry of Public Health. Risk-related analysis was conducted by using unconditional Logistic regression. Results A total of 7 381 patients were analyzed, 771 were nosocomial infections during hospitalization, and 484 patients were treated with central venous catheterization. The analysis of all 7 381 patients and 6 026 patients with hematological malignancies was very close. Univariate analysis showed that central venous catheterization significantly increased the risk of nosocomial infection (OR = 6.66, 95% CI: 5.45-8.16; OR tumor = 5.67, 95% CI: 4.59-6.99). However, there was no significant association after multiple factors (OR = 1.14, OR tumor = 1.16). However, multivariate analysis showed that central venous catheterization significantly increased the risk of nosocomial infection (OR = 1.60, 95% CI: 1.04-2.45) when hospitalized for a long period of time (≥28 days). The central venous catheter Significant correlations were found between nosocomial infections in the control group (OR = 1.71, 95% CI: 1.07-2.76) and those in the VIP vein (OR = 2.69, 95% CI: 1.44-5.02). Long hospital stay, agranulocytosis, the use of glucocorticoids are also significantly associated with nosocomial infections. Conclusions Central venous catheterization generally does not increase the risk of nosocomial infection relative to other risk factors, but central venous catheterization is a relatively independent risk factor for nosocomial infection in long-term hospitalized patients.