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目的探讨多中心超声定位下深静脉置管在降低医院导管相关性感染的应用价值。方法选取在本院行多中心超声定位下深静脉置管的120例患者为研究组,选取同期传统体位标定下行深静脉置管的50例患者为对照组。比较深静脉置管相关指标(提前拔管率、一次置管成功率、机械损伤率);导管相关感染类型(导管细菌定植、出口部位感染、导管相关性血流感染);检测病原菌感染分布情况。结果研究组患者提前拔管和机械损伤比例(15.83%、4.17%)均明显低于对照组(28.00%、24.00%),一次置管成功率(90.00%)明显高于对照组(64.00%),差异均有统计学意义(均P<0.05)。研究组患者导管相关感染发生率明显低于对照组,其中导管细菌定植、出口部位感染、导管相关性血流感染发生率均明显低于对照组,差异有统计学意义(均P<0.05)。两组病原菌感染中革兰阳性菌比例明显高于革兰阴性菌,差异有统计学意义(P<0.05);革兰阳性菌中以金黄色葡萄球菌感染比例最高,革兰阴性菌中以鲍氏不动杆菌和大肠埃希菌为主。结论多中心超声定位下深静脉置管可有效降低置管时间,增加导管留置时间,降低导管相关性感染的发生率。
Objective To investigate the value of multi-center ultrasound-guided catheterization for deep-vein catheterization in hospital-associated infections. Methods A total of 120 patients undergoing deep venous catheterization in our hospital underwent multi-center ultrasound were selected as the study group. Fifty patients with traditional deep venous catheterization were selected as the control group. The indexes related to deep vein catheterization (early extubation rate, success rate of primary catheterization and mechanical injury rate); catheter-related infection types (catheter bacterial colonization, exit site infection and catheter-related bloodstream infection); detection of pathogen infection distribution . Results The rate of extubation and mechanical injury in the study group was significantly lower than that in the control group (28.00% vs 24.00%, 15.83% vs 4.17%, 90.00% vs 64.00%, respectively) , The differences were statistically significant (all P <0.05). The incidence of catheter-related infections in study group was significantly lower than that in control group. The incidence of ductal bacterial colonization, outlet site infection and catheter-related bloodstream infection in study group were significantly lower than those in control group (all P <0.05). Gram-positive bacteria in the two groups of pathogenic bacteria was significantly higher than Gram-negative bacteria, the difference was statistically significant (P <0.05); Gram-positive bacteria in the highest proportion of Staphylococcus aureus infection, gram-negative bacteria to abalone Acinetobacter and Escherichia coli mainly. Conclusion Multi-center ultrasound catheterization of deep venous catheter can effectively reduce the catheterization time, increase the catheter indwelling time and reduce the incidence of catheter-related infections.