頁籤選單縮合
題 名 | 比較不同注射部位輸注全靜脈營養之相關感染=Comparison of Infection Rates Associated with Various Central Venous Catheter Sites for Total Parenteral Nutrition |
---|---|
作 者 | 陳瑛瑛; 蔡月妙; 余瑩娥; | 書刊名 | 院內感染控制雜誌 |
卷 期 | 10:6 2000.12[民89.12] |
頁 次 | 頁369-380 |
分類號 | 419.38 |
關鍵詞 | 全靜脈營養; 中心靜脈導管; 血流感染; Total parenteral nutrition; TPN; Central venous catheter; Blood stream infection; |
語 文 | 中文(Chinese) |
中文摘要 | 本研究目的為比較經由不同注射部位的中心靜脈導管輸注全靜脈營養發生感染與微生物之分佈,採觀察追蹤研究法,以某醫學中心 15 歲以上施行全靜脈營養輸注之所有病患為研究對象,並依院內感染之定義判斷相關感染。結果顯示:三年期間接受全靜脈營養輸注病患共放置中心靜脈導管1529次,血流感染率依序是股靜脈 12.5%(7/56)、內頸靜脈 10.4%(141/1360) 和鎖骨下靜脈 8.8%(10/113),注射部位的感染率分別為鎖骨下靜脈 2.7%(3/113)、內頸靜脈 2.5%(34/1360)和股靜脈 1.8%(1/56)。置於內頸靜脈感染的勝算是置鎖骨下靜脈的 1.19倍,置於股靜脈則是 2.14倍,但無統計上之顯著差異 (p>0.05)。不同注射部位發生感染與危險因子之單變項分析有關聯者 (p<0.05),包括置內頸靜脈者 65 歲 (含) 以上感染的危險性是 64 歲 (含) 以下的 1.57(95% 信賴區間 1.25-2.35)倍;全靜脈營養輸注 15 天 (含) 以上感染的危險性為 15 天以下的 4.52(95% 信賴區間 2.73-7.57) 倍;而置股靜脈者輸注白蛋白感染的危險性是未輸注者的 8.44(95%信賴區間 1.02-75.95)倍。經多變項分析在控制其他變項後,置鎖骨下靜脈者曾輸注新鮮冷凍血漿 (勝算比 1.31),以及置內頸靜脈者曾輸注白蛋白 (勝算比1.18) 和新鮮冷凍血漿 (勝算比 1.10) 為統計上之顯著危險因子 (p<0.05)。結論:中心靜脈導管置於股靜脈、內頸靜脈或鎖骨下靜脈輸注全靜營養的感染率並無統計上之顯著差異。(感控雜誌2000:10:369-80) |
英文摘要 | An observational study of infections associated with three different central venous catheter (CVP) sites for total parenteral nutrition (TPN) was carried out at a medical center in Taiwan. Over the three-year period between 1995 till 1997, there were a total of 1,529 CVPs placed for patients over 15 years of age, including 1,360 (88.9%) internal jugular, 113 (7.4%) subclavian, and 56 (3.7%) femoral. Median durations of the catheter placement were 22, 19, and 15.5 days respectively for the three groups. Blood stream infection rates were: 12.5% for the femoral, 10.4% for the jugular, and 8.8% for the subcla- vian site. Infection rates for different injection sites were: 1.8% femoral, 2.5% jugular, and 1.8% femoral. The ratio for the infection to occur at the jugular and femoral sites over the subclavian site was 1.18-I.32. There were no statistical significances between all these data. Employing Cox regression analysis, odds ratio of blood stream infection to occur for the jugular site over the subclavian site was 1.19 (95% confidence interval 0.68-2.09); and the ratio for the femoral site over the subclavian site was 2.14 (95% confidence interval 0.94-4.88). There were no significant differences either. Comparisons of the infection rates using the univariate analysis showed that the rate at the jugular site for those 65 years or higher was 1.57 times (95% confidence interval 1,25-2.35) that of patients below 65 years of age; those who received TPN 15 days or longer had an infection rate 4.52 timies (95% confidence interval 2.73-7.57) that of those less than 15 days; and at the femoral site, those who had albumin infusion had an infection rate 8.44 times (95% confidence interval 1.02 75.95) that of patients without the albumin infusion. Employing multivariate analysis, infusion of fresh frozen plasma at the subclavian site (odds ratio 1.31), and infusion of albumin (odds ratio 1.18) or the fresh frozen plasma (odds ratio 1.10) through the jugular site were the significant risk factors. The three most frequently isolated organisms were: coagulase-negative staphylococci (19.2%), Staphylococcus aureus (17%), and Candida albicans (14.3%). In contrast to reports by others, we did not find a difference in the infection rates among the three sites for CVP.(Nosocom Infect Control J 2000;10:369-80) |
本系統中英文摘要資訊取自各篇刊載內容。