目的 探讨在新生儿重症监护病房（neonatal intensive care unit,NICU）的低出生体重儿中给予经外周穿刺中心静脉导管（peripherally inserted central catheters,PICC）置管的相关性血流感染的影响因素,为NICU开展PICC置管提供依据。方法 选取2021年1月―2022年6月在长沙市某三甲医院NICU住院并行PICC置管的低出生体重儿为研究对象。回顾性分析其临床资料,采用病例对照的方法,以发生导管相关性感染为病例组,未发生者为对照组,采用单因素分析和多因素Logistic回归分析探讨发生导管相关性血流感染的危险因素。结果 共有19例低出生体重儿发生导管相关性血流感染,总置管时长为3,466天,感染的发生率为每千导管日5.48例次。Logistic回归分析结果显示,出生体重<1 000 g（OR=0.266,95%CI：0.084~0.842）及置管日龄≤7 d（OR=0.193,95%CI：0.057~0.653）是导管相关性血流感染的危险因素。出生体重、置管日龄两者联合,曲线下面积最大为0.741,约登指数为0.369,较单独更能有效地对低出生体重儿PICC导管相关性血流感染进行预测。结论 对于低出生体重儿,尤其是出生体重<1 000 g的超低级出生体重儿以及置管日龄≤7天的早产儿,应该提高警惕,预防导管相关性血流感染的发生。
Abstract
Objective To explore the influencing factors of peripherally inserted central catheter (PICC) -related infections in low birth weight infants in the Neonatal Intensive Care Unit (NICU) and provide a basis for PICC placement in NICUs. Methods We included low birth weight infants who were hospitalized in a tertiary hospital in Changsha City from January 2021 to June 2022 and underwent PICC placement. We retrospectively analyzed their clinical data, used a case-control method, with those who experienced catheter-related infections as the case group and those who did not as the control group. We conducted univariate and multivariate logistic regression analyses to investigate the risk factors for catheter-related bloodstream infections. Results A total of 19 low birth weight infants developed catheter-related bloodstream infections during a total catheterization duration of 3,466 days, with an infection rate of 0.5% per catheter day. The results of logistic regression analysis showed that birth weight<1 000 g (OR=0.266, 95% CI 0.084-0.842) and catheterization age≤7 days (OR=0.193, 95% CI 0.057-0.653) were risk factors. Birth weight and the age at catheter placement, when combined, have a maximum area under the curve of 0.741 and an approximate odds ratio of 0.369. This combination is more effective in predicting Catheter-related bloodstream infection in low birth weight infants compared to individual factors alone. Conclusion For low birth weight infants, especially those with a birth weight of less than 1 000 g and premature infants with catheter placement at ≤7 days of age, increased vigilance and preventive measures should be taken to reduce the occurrence of Catheter-related bloodstream infection.
关键词
NICU /
低出生体重儿 /
外周静脉穿刺中心静脉导管 /
导管相关性血流感染
Key words
NICU /
low birth weight infants /
peripherally inserted centralcatheters /
catheter-related bloodstream infection
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基金
湖南省自然科学基金“早产儿母乳喂养O2O健康教育模式的构建与效果评价”（2021JJ70127）
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