两种不同敷料对连续性肾脏替代治疗导管相关性感染影响

    Observation of the effect of the use of two different dressings on the catheter infection during continuous renal replacement therapy

    • 摘要: 目的 观察纱布和敷贴两种不同敷料对连续性肾脏替代治疗(CRRT)置管导管相关性感染的影响。方法 选取在徐州市中心医院经临时深静脉置管进行CRRT治疗的80例患者为研究对象,并随机分为贴膜组和纱布组各40例,分别采用敷贴及纱布作为敷料。在置管及导管固定等所有操作均严格遵守无菌操作原则的情况下,通过对贴膜组和纱布组这2组患者年龄、血常规、白蛋白、尿素氮、肾功能、导管置留时间及部位等指标进行比较,同时参考北美血管通路协会制定的导管相关性感染诊断标准,结合临床实践相关症状,判定为置管感染从而终止置管的诊断标准的方法来进行研究。结果 经比较,在置管后2~5周及6~9周两个时间段内,纱布组导管感染发生率(10%,22.5%)均明显高于贴膜组(0,5%),差异均有统计学意义(χ2=4.037,5.518;P=0.044,0.035);纱布组患者的总体导管感染发生率(32.5%)同样明显高于贴膜组(5.0%),2组间差异具有统计学意义(χ2=6.136,P=0.013)。与传统的纱布相比,敷贴的密闭性更好,安全性更高,能有效地将外界的病原体隔离开来,降低导管感染的发生率;但在较长时间的导管置留治疗中,2组导管感染的发生率均有所上升,这与近期的研究结果即导管感染率与导管置留时间存在着密切联系相吻合。结论 与纱布相比,在进行临时深静脉置管的治疗中使用透明敷贴可明显减少置管感染的发生,同时可以降低患者费用,值得在临床中加以推广及应用。

       

      Abstract: Objective To investigate the influence of two different dressings on catheter infection in process of continuous renal replacement therapy(CRRT) for patients in ICU.Methods A prospective study was undertaken.All of 80 patients treated with CRRT who used temporary central venous catheter were randomly divided into transparent dressing group and double gauze group,40 patients were in each groups. in the case of the setting of the tube and the catheter and all of the operations were strictly adhered to the principles of the sterile operating principle, it was measured by the age, the blood, the albumin, the urea nitrogen, the renal function, the placement of the time and the space of the area, and the time and the location of the patient, and the criteria for the diagnostic criteria, and the clinical practice, to determine the diagnostic criteria for the infection and to terminate the diagnostic criteria of the tube, and to do the study.Results The rates of temporary central venous catheter infection in the double gauze group(10%,22.5%) were higher than those in transparent dressing group(0,5%) after 2-5 weeks and 6-9 weeks,there was significant difference between the two groups (χ2=4.037,5.518;P=0.044,0.035);The total rate of temporary central venous catheter infection in the double gauze group (32.5%) was also significantly higher than that in transparent dressing group (5.0%)(χ2=6.136,P=0.013).Compared with the traditional gauze, sticking in sealing better, safer, can effectively isolates external pathogens, reduce the incidence of catheter infections, but in a long time of catheter withhold treatment, two groups the incidence of catheter infections increased, this and recent research results of the catheter infection rate and the catheter withhold time there is a close contact.Conclusions The using of transparent dressing in process of CRRT could reduce the rate of temporary central venous catheter infection compared with the gauze for patients in ICU.At the same time, it can reduce the cost of patients to stay in ICU, and it is worth promoting and applying in clinic.

       

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