乳腺癌化疗患者PICC置管感染病原菌分布及危险因素分析
|
摘要
目的分析乳腺癌化疗患者外周中心静脉导管(peripherally inserted central catheter,PICC)置管感染病原菌分布特点及危险因素。方法选择2013年8月至2017年8月于本院行乳腺癌化疗并采用PICC置管的280例患者为研究对象,观察患者PICC置管感染的发生情况,并分析病原菌分布情况。收集患者临床资料,包括年龄、乳腺癌分期、穿刺部位、穿刺次数、置管时间、白细胞计数、化疗次数、是否合并基础疾病、更换敷料贴频率,并采用正念注意觉知量表(mindful attention awareness scale,MAAS)评价患者的正念水平,分析PICC置管感染相关的危险因素。结果 280例行PICC置管的乳腺癌化疗患者中,26例(9.29%)发生PICC置管感染,共培养出病原菌42株,其中革兰阴性菌22株(52.38%),革兰阳性菌15株(35.71%),真菌5株(11.90%)。多因素回归分析显示,置管时间> 7个月、化疗次数> 5次、白细胞计数≤(2～3)×10~9/L、合并基础疾病、正念水平较差均为乳腺癌化疗患者PICC置管感染的独立危险因素(P_均<0.05)。结论乳腺癌化疗患者PICC置管感染形势严峻,与感染相关的危险因素较多,临床上需制订有针对性的干预措施,最大限度地降低感染发生率,提高患者化疗疗效。
Objective To investigate the distribution characteristics of pathogenic bacteria in peripherally inserted central catheter (PICC) catheter infection in patients with breast cancer undergoing chemotherapy and analyzed the risk factors. Method 280 cases of breast cancer treated with chemotherapy and PICC catheterization in our hospital from August 2013 to August 2017 were selected as subjects. The incidence of PICC catheter infection was observed and the distribution of pathogens was observed. The clinical data included age, breast cancer stage, puncture site, puncture frequency, catheterization time, white blood cell count, number of chemotherapy, whether combined with basic disease, replacement dressing frequency of the patients were collected, evaluation by Mindfulness Attention Awareness Scale (MAAS). The mindfulness awareness scale (MAAS) was used to assess the mindfulness level of the patients. The patient's mindfulness level was analyzed for factors associated with PICC catheter infection. Analyzed the risk factors associated with PICC catheter infection. Result Among 280 cases of breast cancer patients undergoing chemotherapy and PICC catheterization, 26 cases (9.29%) had PICC catheter infection and 42 strains of pathogenic bacteria were cultured, including 22 strains (52.38%) of Gram-negative bacteria, 15 strains (35.71%) of Gram-positive bacteria and 5 strains (11.90%) of fungi. Multivariate Logistic regression analysis showed that, catheterization time > 7 months, number of chemotherapy > 5 times, white blood cell count < (2 ～ 3)×10~9/L, combined with basic disease, poor mindfulness were the independent risk factors for PICC catheter infection in breast cancer patients undergoing chemotherapy (P_(all)< 0.05). Conclusion The PICC catheter infection in patients with breast cancer chemotherapy undergoing chemotherapy is severe, and there are many risk factors associated with catheter infection. It is necessary to develop targeted interventions to minimize the incidence of catheter infection and improve the efficacy of chemotherapy treatment.
Objective To investigate the distribution characteristics of pathogenic bacteria in peripherally inserted central catheter (PICC) catheter infection in patients with breast cancer undergoing chemotherapy and analyzed the risk factors. Method 280 cases of breast cancer treated with chemotherapy and PICC catheterization in our hospital from August 2013 to August 2017 were selected as subjects. The incidence of PICC catheter infection was observed and the distribution of pathogens was observed. The clinical data included age, breast cancer stage, puncture site, puncture frequency, catheterization time, white blood cell count, number of chemotherapy, whether combined with basic disease, replacement dressing frequency of the patients were collected, evaluation by Mindfulness Attention Awareness Scale (MAAS). The mindfulness awareness scale (MAAS) was used to assess the mindfulness level of the patients. The patient's mindfulness level was analyzed for factors associated with PICC catheter infection. Analyzed the risk factors associated with PICC catheter infection. Result Among 280 cases of breast cancer patients undergoing chemotherapy and PICC catheterization, 26 cases (9.29%) had PICC catheter infection and 42 strains of pathogenic bacteria were cultured, including 22 strains (52.38%) of Gram-negative bacteria, 15 strains (35.71%) of Gram-positive bacteria and 5 strains (11.90%) of fungi. Multivariate Logistic regression analysis showed that, catheterization time > 7 months, number of chemotherapy > 5 times, white blood cell count < (2 ～ 3)×10~9/L, combined with basic disease, poor mindfulness were the independent risk factors for PICC catheter infection in breast cancer patients undergoing chemotherapy (P_(all)< 0.05). Conclusion The PICC catheter infection in patients with breast cancer chemotherapy undergoing chemotherapy is severe, and there are many risk factors associated with catheter infection. It is necessary to develop targeted interventions to minimize the incidence of catheter infection and improve the efficacy of chemotherapy treatment.
引文
[1]王乐,张玥,石菊芳,等.中国女性乳腺癌疾病负担分析[J].中华流行病学杂志,2016,37(7):970-976.
[2]廖先珍,颜仕鹏,石菊芳,等.城市女性乳腺癌高危评估及筛查结果分析[J].实用肿瘤学杂志,2016,30(3):245-248.
[3]师金,梁迪,李道娟,等.全球女性乳腺癌流行情况研究[J].中国肿瘤,2017,26(9):683-690.
[4]刘勇,杨海玉.2015版美国癌症协会乳腺癌筛查指南解读[J].中华肿瘤防治杂志,2016,23(4):275-278.
[5]Maizel J,Bastide MA,Richecoeur J,et al.Practice of ultrasound-guided central venous catheter technique by the French intensivists:a survey from the BoReal study group[J].Ann Intensive Care,2016,6(1):76.
[6]Wang L,Liu ZS,Wang CA.Malposition of Central Venous Catheter:Presentation and Management[J].Chin Med J(Engl),2016,129(2):227-234.
[7]林海玉,周欣华,郭君怡,等.白血病患者经外周静脉置入中心静脉导管感染的相关因素分析与对策[J].中华医院感染学杂志,2016,26(20):4760-4762.
[8]庞玉洪,赵建明,陈抗侵,等.临时中心静脉导管感染的病原菌变化及危险因素分析[J].中国血液净化,2016,15(5):315-318.
[9]陈民钧.美国临床实验室标准化委员会2004年版有关药敏试验标准化更新要点[J].中华检验医学杂志,2004,27(9):449-451.
[10]柳江,赵国光.中心静脉置管所致感染的诊断与防治[J].首都医科大学学报,1999,20(2):133-134.
[11]Brown KW,Ryan RM.The benefits of being present:mindfulness and its role in psychological well-being[J].J Pers Soc Psychol,2003,84(4):822-848.
[12]Kim JT,Oh TY,Chang WH,et al.Clinical review and analysis of complications of totally implantable venous access devices for chemotherapy[J].Med Oncol,2012,29(2):1361-1364.
[13]Chatzidaki P,Mellos C,Briese V,et al.Perioperative complications of breast cancer surgery in elderly women(≥80 years)[J].Ann Surg Oncol,2011,18(4):923-931.
[14]Teichgr?ber UK,Nagel SN,Kausche S,et al.Double-lumen central venous port catheters:simultaneous application for chemotherapy and parenteral nutrition in cancer patients[J].JVasc Access,2010,11(4):335-341.
[15]Madhukumar P,Loh GY,Maung ZA,et al.Incidence of nontunnelled central venous catheter-related infections in oncologic patients receiving chemotherapy in an outpatient setting[J].Singapore Med J,2012,53(8):513-516.
[16]龚海燕,王慧,黄林平.乳腺癌术后化疗患者癌因性疲乏的研究现状[J].中日友好医院学报,2016,30(4):247-249.
[17]许苗苗,魏芬芬,陈振东.乳腺癌患者化疗期间疲劳状况研究[J].山东医药,2010,50(8):49-51.
[18]熊学丽,杨凡.血液感染诊断中C反应蛋白、降钙素原及白细胞计数的应用价值[J].医学综述,2016,22(8):1628-1630.
[19]梁科,黄宗校,杨杰文.ICU中老年患者中心静脉导管相关感染的临床及病原学研究[J].中国医学前沿杂志(电子版),2014,6(6):158-160.
[20]许平.经外周静脉置入中心静脉导管在神经外科危重患者中的应用效果[J].中国医学前沿杂志(电子版),2014,6(2):48-50.
[2]廖先珍,颜仕鹏,石菊芳,等.城市女性乳腺癌高危评估及筛查结果分析[J].实用肿瘤学杂志,2016,30(3):245-248.
[3]师金,梁迪,李道娟,等.全球女性乳腺癌流行情况研究[J].中国肿瘤,2017,26(9):683-690.
[4]刘勇,杨海玉.2015版美国癌症协会乳腺癌筛查指南解读[J].中华肿瘤防治杂志,2016,23(4):275-278.
[5]Maizel J,Bastide MA,Richecoeur J,et al.Practice of ultrasound-guided central venous catheter technique by the French intensivists:a survey from the BoReal study group[J].Ann Intensive Care,2016,6(1):76.
[6]Wang L,Liu ZS,Wang CA.Malposition of Central Venous Catheter:Presentation and Management[J].Chin Med J(Engl),2016,129(2):227-234.
[7]林海玉,周欣华,郭君怡,等.白血病患者经外周静脉置入中心静脉导管感染的相关因素分析与对策[J].中华医院感染学杂志,2016,26(20):4760-4762.
[8]庞玉洪,赵建明,陈抗侵,等.临时中心静脉导管感染的病原菌变化及危险因素分析[J].中国血液净化,2016,15(5):315-318.
[9]陈民钧.美国临床实验室标准化委员会2004年版有关药敏试验标准化更新要点[J].中华检验医学杂志,2004,27(9):449-451.
[10]柳江,赵国光.中心静脉置管所致感染的诊断与防治[J].首都医科大学学报,1999,20(2):133-134.
[11]Brown KW,Ryan RM.The benefits of being present:mindfulness and its role in psychological well-being[J].J Pers Soc Psychol,2003,84(4):822-848.
[12]Kim JT,Oh TY,Chang WH,et al.Clinical review and analysis of complications of totally implantable venous access devices for chemotherapy[J].Med Oncol,2012,29(2):1361-1364.
[13]Chatzidaki P,Mellos C,Briese V,et al.Perioperative complications of breast cancer surgery in elderly women(≥80 years)[J].Ann Surg Oncol,2011,18(4):923-931.
[14]Teichgr?ber UK,Nagel SN,Kausche S,et al.Double-lumen central venous port catheters:simultaneous application for chemotherapy and parenteral nutrition in cancer patients[J].JVasc Access,2010,11(4):335-341.
[15]Madhukumar P,Loh GY,Maung ZA,et al.Incidence of nontunnelled central venous catheter-related infections in oncologic patients receiving chemotherapy in an outpatient setting[J].Singapore Med J,2012,53(8):513-516.
[16]龚海燕,王慧,黄林平.乳腺癌术后化疗患者癌因性疲乏的研究现状[J].中日友好医院学报,2016,30(4):247-249.
[17]许苗苗,魏芬芬,陈振东.乳腺癌患者化疗期间疲劳状况研究[J].山东医药,2010,50(8):49-51.
[18]熊学丽,杨凡.血液感染诊断中C反应蛋白、降钙素原及白细胞计数的应用价值[J].医学综述,2016,22(8):1628-1630.
[19]梁科,黄宗校,杨杰文.ICU中老年患者中心静脉导管相关感染的临床及病原学研究[J].中国医学前沿杂志(电子版),2014,6(6):158-160.
[20]许平.经外周静脉置入中心静脉导管在神经外科危重患者中的应用效果[J].中国医学前沿杂志(电子版),2014,6(2):48-50.