中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (05): 346-351.doi: 10.3969/j.issn.1671-4091.2018.05.014

• 护理研究 • 上一篇    下一篇

庆大霉素联合肝素封管治疗长期透析导管相关血流感染疗效观察

鄢成静1,3,熊楠楠2,于洋3,崔天蕾3,付平3   

  1. 1. 四川省凉山州第一人民医院肾内科
    2. 95171部队卫生队
    3. 四川大学华西医院肾内科
  • 收稿日期:2017-12-26 修回日期:2018-02-15 出版日期:2018-05-12 发布日期:2018-05-12
  • 通讯作者: 崔天蕾 tianleicui@163.com E-mail:tianleicui@163.com

Efficacy of the lock solution containing gentamicin and heparin for the treatment of long-term dialysis catheter related bloodstream infections

  • Received:2017-12-26 Revised:2018-02-15 Online:2018-05-12 Published:2018-05-12

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摘要： 【摘要】目的观察庆大霉素联合肝素封管治疗导管相关血流感染(catheter- related bloodstream infection,CRBSI)的有效性。方法回顾性分析2011 年1 月～2016 年9 月就诊于四川大学华西医院，诊断为CRBSI 的患者97 例。在静脉抗感染用药相同的前提下，以封管药物的不同分为两组：治疗组予庆大霉素(4mg/ml)+肝素(1000 IU/ml)混合液封管，对照组予哌拉西林他唑巴坦(125mg/ml)与与肝素(1000IU/ml)混合液封管。治疗72h 后以是否继续发热判断治疗方案的有效性，无效病例据药敏调整方案，1 周后仍发热的予行原位导管更换。结果本研究共纳入符合条件的病例97 例，平均年龄(59.10±17.54)岁，糖尿病患者占27.83%(27 例)，导管留置时间24 月(8 月,39.5 月)。对照组病程较治疗组长[19 天(10 天,30.25 天)比10 天(5 天,30 天)]，差异有统计学意义(P=0.037)。血培养阳性率46.39%，共分离出革兰氏阳性菌19 株(44.19%)，革兰氏阴性菌24 株(55.81%)，真菌2 株。革兰氏阳性菌中以金黄色葡萄球菌最多见：11 株(57.89%)，阴性菌以阴沟肠杆菌多见：6 株(25.00%)。治疗组中对庆大霉素耐药的菌株3 例；对照组耐药菌2 例。治疗组导管挽救成功率高于对照组(77.33%比54.54%)，差异有统计学意义(χ2=4.397，P=0.036)。原位导管更换26 例(26.80%)。所有病例随访3 月，仅3 例因CRBSI再入院。结论庆大霉素(4mg/ml)+肝素(1000 IU/ml)混合液封管联合全身使用抗生素治疗CRBSI 是有效的，对疗效不佳的病例采取原位导管更换是相对安全的。

关键词: 庆大霉素, 封管, 导管相关血流感染, 肾透析, 疗效

Abstract: 【Abstract】Objective To observe the efficacy of the lock solution containing gentamicin and heparin for the treatment of catheter-related bloodstream infections (CRBSI). Methods We retrospectively analyzed 95 patients diagnosed with CRBSI in West China Hospital, Sichuan University from January 2011 to September 2016. Two groups were divided according to the component of the lock solution: treatment group (gentamicin 4mg/ml plus heparin 1,000 IU/ml in the lock solution) and control group (piperacillin- tazobactam 125mg/ml plus heparin 1,000 IU/ml in the lock solution). The intravenous antibiotics were the same in the two groups. After 72 hours, fever was used as an indicator for the effectiveness of the treatment protocols. According to the results of drug sensitivity test, the treatment protocols were adjusted in failure cases. Patients remaining to have fever after one week were treated with wire-guided exchange of the catheters. Results A total of 97 eligible patients were enrolled in this study. They had an average age of 59.10±17.54 years and a catheter indwelling time of 24 months (8 months, 39.5 months). Twenty-seven of them (27.83%) had diabetes. The disease duration was longer in control group than in treatment group [19 days (10 days, 30.25 days) vs. 10 days (5 days, 30 days), P=0.037]. The positive rate of blood culture was 46.39%, including 19 strains of Gram-positive bacteria (44.19%), 24 strains of Gram-negative bacteria (55.81%) and 2 strains of fungi. The most common Gram-positive bacteria was Staphylococcus aureus (11 strains, 57.89%), and the most common Gram-negative bacteria was Enterobacter cloacae (6 strains, 25.00%). Three gentamicin resistant strains were isolated in treatment group, and 2 piperacillin-tazobactam resistant strains were isolated in control group. The success rate of catheter salvage was higher in treatment group than in control group (77.33% vs. 54.54%, χ2=4.397, P=0.036). Twenty-six cases (26.80%) were treated with wire-guided exchange of the catheters. All cases were followed up for 3 months, and only 3 cases re-hospitalized due to CRBSI. Conclusions Gentamicin (4mg/ml) + heparin (1,000 IU/ml) in lock solution combined with systemic antibiotics for the treatment of CRBSI was effective.Wire-guided exchange of the catheter was a safe measure for ineffective cases.

Key words: Gentamicin, Lock solution, Catheter related bloodstream infection, Renal dialysis, Efficacy