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ID:33046051
大小:1.27 MB
页数:34页
时间:2019-02-19
《外科icu中心静脉导管相关血流感染的回顾性病例对照研究》由会员上传分享,免费在线阅读,更多相关内容在学术论文-天天文库。
1、青岛大学硕士学位论文外科ICU中心静脉导管相关血流感染的回顾性病例对照研究姓名:王惠芬申请学位级别:硕士专业:护理学指导教师:孙运波20120601中文摘要摘要外科IOU中心静脉导管相关血流感染的回顾性病例对照研究摘要目的了解外科ICU(Intensivecareunit,重症监护室)中心静脉导管相关’血流感染(Centralvenouscatheterrelated-bloodstreaminfection,CRBSI)的发病率、病原菌分布及相关危险因素,为临床经验性治疗提供依据。方法回顾性调查我院外科ICU2010年1月"--2011年8月的中心静脉导管置管病例,根据血培养和导管培养结果
2、分为CRBSI组和非CRBSI组,统计CRBSI的发病率、致病菌;比较CRBSI组与非CRBSI组的临床资料,应用单因素分析及多因素Logistic回归分析筛查相关危险因素。结果共收集249例中心静脉置管病例,其中21例(8.43%)发生了CRBSI,发病率为8.41例次/千导管日。病原菌分布为G+菌4例,6一菌9例,真菌8例,均存在不同程度的耐药性。单因素分析显示导管留置时间、静脉营养时间、插管时血尿素氮水平、拔管时体温、入ICU后第一个24小时的APACHEII评分、完全胃肠外营养有统计学意义(P3、~10.168,P=O.038)、APACHEII评分(OR1.137,95%CI1.067~1.213,P=O.ooo)、完全胃肠外营养(0R1.117,95%CI1.023---i.219,P=O.014)是CRBSI的独立危险因素。结论CRBSI主要致病菌是革兰氏阴性杆菌,且真菌感染率有明显上升趋势。导管留置时间、APACHEII评分、完全胃肠外营养是CRBS]的独立危险因素。硕=J..研究生:王惠芬(护理学)指导教师:孙运波教授关键词:中心静脉导管;血流感染;重症监护病房;外科AbstractCentralvenouscatheterrelated—bloodstreaminfect4、ioninsurgicalintensivecareunit:aretrospective,case.controlledstudyObjectiveToanalyzetheincidence,pathogensdistributionandriskfactorsofcentralVenOUScatheterrelated-bloodstreaminfectioninsurgicalintensivecareunit.andprovidetheevidenceoftreatmentwithelinicexperience.MethodsPatientsadmittedinsurgicalin5、tensivecareunitofourhospitalfromJanuary2010.August201witllCVCwereenrolled,anddividedintoCRBSIgroupandnon·CRBSIgrouponthebasisoftheoutcomesofgermicultureofbloodsamplesandhubtips.Then,theincidenceandpathogensofCRBSlwereanalyzedretrospectively.TheclinicaldataofCRBSIgroupandnon·Cl迅SIgroupwerecomparedin6、univariateanalysis,andthen,amultivariateanalysishasbeenperformedwi也logisticregressiontoinvestigatetheriskfactors.ResultsOfthe249caseswithCVCinthestudy,21cases(8.43%)hadCRBSI,andtheincidenceWas8.41casesper1000catheterdays.21pathogenswereisolated,including4gram-positivebacteria,9gram-negativebacteria7、and8fungi,andsomewereantibiotic-resistancestrains.Onunivariateanalysis,significantriskfactorsweredurationofcatheterization,durationofPN,ThelevelofbloodureanitrogenwheninsertCVC,ThetemperaturewhenremoveCVC,c
3、~10.168,P=O.038)、APACHEII评分(OR1.137,95%CI1.067~1.213,P=O.ooo)、完全胃肠外营养(0R1.117,95%CI1.023---i.219,P=O.014)是CRBSI的独立危险因素。结论CRBSI主要致病菌是革兰氏阴性杆菌,且真菌感染率有明显上升趋势。导管留置时间、APACHEII评分、完全胃肠外营养是CRBS]的独立危险因素。硕=J..研究生:王惠芬(护理学)指导教师:孙运波教授关键词:中心静脉导管;血流感染;重症监护病房;外科AbstractCentralvenouscatheterrelated—bloodstreaminfect
4、ioninsurgicalintensivecareunit:aretrospective,case.controlledstudyObjectiveToanalyzetheincidence,pathogensdistributionandriskfactorsofcentralVenOUScatheterrelated-bloodstreaminfectioninsurgicalintensivecareunit.andprovidetheevidenceoftreatmentwithelinicexperience.MethodsPatientsadmittedinsurgicalin
5、tensivecareunitofourhospitalfromJanuary2010.August201witllCVCwereenrolled,anddividedintoCRBSIgroupandnon·CRBSIgrouponthebasisoftheoutcomesofgermicultureofbloodsamplesandhubtips.Then,theincidenceandpathogensofCRBSlwereanalyzedretrospectively.TheclinicaldataofCRBSIgroupandnon·Cl迅SIgroupwerecomparedin
6、univariateanalysis,andthen,amultivariateanalysishasbeenperformedwi也logisticregressiontoinvestigatetheriskfactors.ResultsOfthe249caseswithCVCinthestudy,21cases(8.43%)hadCRBSI,andtheincidenceWas8.41casesper1000catheterdays.21pathogenswereisolated,including4gram-positivebacteria,9gram-negativebacteria
7、and8fungi,andsomewereantibiotic-resistancestrains.Onunivariateanalysis,significantriskfactorsweredurationofcatheterization,durationofPN,ThelevelofbloodureanitrogenwheninsertCVC,ThetemperaturewhenremoveCVC,c
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