长效物理抗菌材料应用于中心静脉导管相关性感染的有效性及安全性分析
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摘要
目的探讨长效物理抗菌材料"洁悠神"应用于中心静脉导管相关性感染的有效性及安全性,为中心静脉导管相关性感染预防提供依据。方法选择2015年1月-2017年2月于医院接受脊柱外科手术治疗且术后留置中心静脉导管的120例患者为研究对象,分为对照组与试验组各60例,所有患者术前血培养均为阴性,对照组采用洗必泰预防术后中心静脉导管相关性感染,试验组采用洁悠神局部喷洒预防感染,两组均留取血标本,进行血培养,置管7、14d分别拔除10例导管进行插入点导管细菌培养,统计两组患者置管期间感染的发生率,利用激光扫描共聚焦显微镜观察两组中心静脉导管的插入点导管表面细菌生物膜形成情况,记录不良反应,并采用视觉模拟评分表(VAS)评估两组患者疼痛程度。结果试验组患者血培养感染率为3.33%,低于对照组的18.33%(P<0.05);两组病原菌分布均以表皮葡萄球菌、金黄色葡萄球菌为主;试验组患者导管维护后24h贴膜卷边率及渗液率均低于对照组(P<0.05);试验组患者不同留置时间穿刺部位疼痛评分均低于对照组(P<0.05)。结论在中心静脉导管相关性感染预防中采用长效抗菌材料洁悠神可降低CVC相关性感染的风险,且安全性较好。
OBJECTIVE To investigate the effectiveness and safety of application of JUC long-acting antimicrobial material in central venous catheter(CVC)related infections,so as to provide the basis for prevention of CVC related infections.METHODS A total of 120 patients who underwent spinal surgery and indwelling CVC in our hospital from Jan.2015 to Feb.2017 were enrolled in the study,and were divided into control group and experimental group,with 60 cases in each group.The blood culture results of all patients were negative.Patients in control group were treated with chlorhexidine for prevention of CVC related infections after surgery,while in experimental group were treated with JUC local spraying for prevention of infection.Blood samples of the two groups were collected for blood culture,and catheter bacterial culture of 10 removed cases at insertion point was performed on the7 th and 14 th day after catheterizing.The incidence of infection during catheterization was statistically analyzed,and the formation of bacterial biofilm on the catheter surface at insertion sites in the two groups were observed by laser scanning confocal microscope.Adverse reactions were recorded,and the visual analogue scale(VAS)was used to assess the pain degree.RESULTS Blood culture results showed that the infection rate of blood culture in experimental group was 3.33%,which was significantly lower than 18.33% in control group(P <0.05),and most of pathogenic bacteria in the two groups were Staphylococcus epidermidis and Staphylococcus aureus.The rates of film curling and oozing in experimental group at 24 hafter catheter maintenance were lower than those in control group(P < 0.05).Pain scores of puncture sites in experimental group after different significantly indwelling time were significantly lower than those in control group(P<0.05).CONCLUSIONThe application of JUC long-acting antimicrobial material in the prevention of central venous catheter related infections can reduce the risk of CVC related infections,with high safety.
OBJECTIVE To investigate the effectiveness and safety of application of JUC long-acting antimicrobial material in central venous catheter(CVC)related infections,so as to provide the basis for prevention of CVC related infections.METHODS A total of 120 patients who underwent spinal surgery and indwelling CVC in our hospital from Jan.2015 to Feb.2017 were enrolled in the study,and were divided into control group and experimental group,with 60 cases in each group.The blood culture results of all patients were negative.Patients in control group were treated with chlorhexidine for prevention of CVC related infections after surgery,while in experimental group were treated with JUC local spraying for prevention of infection.Blood samples of the two groups were collected for blood culture,and catheter bacterial culture of 10 removed cases at insertion point was performed on the7 th and 14 th day after catheterizing.The incidence of infection during catheterization was statistically analyzed,and the formation of bacterial biofilm on the catheter surface at insertion sites in the two groups were observed by laser scanning confocal microscope.Adverse reactions were recorded,and the visual analogue scale(VAS)was used to assess the pain degree.RESULTS Blood culture results showed that the infection rate of blood culture in experimental group was 3.33%,which was significantly lower than 18.33% in control group(P <0.05),and most of pathogenic bacteria in the two groups were Staphylococcus epidermidis and Staphylococcus aureus.The rates of film curling and oozing in experimental group at 24 hafter catheter maintenance were lower than those in control group(P < 0.05).Pain scores of puncture sites in experimental group after different significantly indwelling time were significantly lower than those in control group(P<0.05).CONCLUSIONThe application of JUC long-acting antimicrobial material in the prevention of central venous catheter related infections can reduce the risk of CVC related infections,with high safety.
引文
[1]斯一夫,姜建平,闫广玲,等.ICU患者中心静脉导管相关性感染病原菌与耐药性分析[J].中华医院感染学杂志,2015,25(6):1331-1333.
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[4]王晶,崔朝勃,王金荣,等.去甲万古霉素封管预防重症患者中心静脉导管相关性感染的前瞻性随机对照研究[J].中华危重病急救医学,2014,26(7):468-472.
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[9]Schoot RA,van Ommen CH,Stijnen T,et al.Prevention of central venous catheter-associated bloodstream infections in paediatric oncology patients using 70%ethanol locks:a randomised controlled multi-centre trial[J].Eur J Cancer,2015,51(14):2031-2038.
[10]廖宁,闫萍,谢正福,等.抗菌导管在预防导管相关感染中的研究应用[J].广西医科大学学报,2015,32(1):154-156.
[11]刘峻.血液透析患者中心静脉导管相关性血流感染的多因素分析[J].医学临床研究,2013,15(11):2166-2168.
[12]Ishizuka M,Nagata H,Takagi K,et al.Needleless closed system does not reduce central venous catheter-related bloodstream infection:a retrospective study[J].Int Surg,2013,98(1):88-93.
[13]McNiven C,Switzer N,Wood M,et al.Central venous catheter repair is not associated with an increased risk of central line infection or colonization in intestinal failure pediatric patients[J].J Pediatr Surg,2016,51(3):395-397.
[14]Miller DL,O′Grady NP,Society of Interventional Radiology.Guidelines for the prevention of intravascular catheter-related infections:recommendations relevant to interventional radiology for venous catheter placement and maintenance[J].J Vasc Interv Radiol,2012,23(8):997-1007.
[15]Yacobovich J,Ben-Ami T,Abdalla T,et al.Patient and central venous catheter related risk factors for blood stream infections in children receiving chemotherapy[J].Pediatr Blood Cancer,2015,62(3):471-476.
[16]Youn SH,Lee JC,Kim Y,et al.Central venous catheter-related infection in severe trauma patients[J].World J Surg,2015,39(10):2400-2406.
[2]方烈奎,袁谦,黄向江,等.物理抗菌材料防治输尿管支架管留置相关感染的临床研究[J].中华实验外科杂志,2015,32(3):641-643.
[3]Rabensteiner J,Theiler G,Duettmann W,et al.Detection of central venous catheter-related bloodstream infections in haematooncological patients[J].Eur J Clin Invest,2015,45(8):824-832.
[4]王晶,崔朝勃,王金荣,等.去甲万古霉素封管预防重症患者中心静脉导管相关性感染的前瞻性随机对照研究[J].中华危重病急救医学,2014,26(7):468-472.
[5]Ishizuka M,Nagata H,Takagi K,et al.Systemic inflammatory response predicts perioperative central venous catheterrelated bloodstream infection in patients undergoing colorectal cancer surgery with administration of parenteral nutrition[J].Anticancer Res,2012,32(9):4045-4050.
[6]胡波,徐秋玲,李健强,等.以视觉模拟量表评价电针镇痛的累积效应[J].国际中医中药杂志,2013,35(4):343-344.
[7]Hammarskjold F,Berg S,Hanberger H,et al.Sustained low incidence of central venous catheter-related infections over six years in a Swedish hospital with an active central venous catheter team[J].Am J Infect Control,2014,42(2):122-128.
[8]陈亚萍,周萍萍,王聪,等.血液透析患者中心静脉导管相关性感染的危险因素分析[J].中华医院感染学杂志,2014,24(6):1432-1434.
[9]Schoot RA,van Ommen CH,Stijnen T,et al.Prevention of central venous catheter-associated bloodstream infections in paediatric oncology patients using 70%ethanol locks:a randomised controlled multi-centre trial[J].Eur J Cancer,2015,51(14):2031-2038.
[10]廖宁,闫萍,谢正福,等.抗菌导管在预防导管相关感染中的研究应用[J].广西医科大学学报,2015,32(1):154-156.
[11]刘峻.血液透析患者中心静脉导管相关性血流感染的多因素分析[J].医学临床研究,2013,15(11):2166-2168.
[12]Ishizuka M,Nagata H,Takagi K,et al.Needleless closed system does not reduce central venous catheter-related bloodstream infection:a retrospective study[J].Int Surg,2013,98(1):88-93.
[13]McNiven C,Switzer N,Wood M,et al.Central venous catheter repair is not associated with an increased risk of central line infection or colonization in intestinal failure pediatric patients[J].J Pediatr Surg,2016,51(3):395-397.
[14]Miller DL,O′Grady NP,Society of Interventional Radiology.Guidelines for the prevention of intravascular catheter-related infections:recommendations relevant to interventional radiology for venous catheter placement and maintenance[J].J Vasc Interv Radiol,2012,23(8):997-1007.
[15]Yacobovich J,Ben-Ami T,Abdalla T,et al.Patient and central venous catheter related risk factors for blood stream infections in children receiving chemotherapy[J].Pediatr Blood Cancer,2015,62(3):471-476.
[16]Youn SH,Lee JC,Kim Y,et al.Central venous catheter-related infection in severe trauma patients[J].World J Surg,2015,39(10):2400-2406.