【摘要】目的 观察万古霉素、浓肝素钠溶液交替封管对中心静脉导管金黄色葡萄球菌感染的疗效。 方法 选取空军总医院血液净化中心金黄色葡萄球菌导致的中心静脉导管相关血流感染(catheter-related bloodstream infection，CRBSI)20例，万古霉素、浓肝素钠溶液每6h交替封管，同时全身应用万古霉素。 结果 20例CRBSI患者中，糖尿病肾病的比例明显高于非CRBSI组，2组比较有统计学差异(45%比19.6%，c2=4.73，P＜0.05)；经过万古霉素、浓肝素钠溶液交替封管，20例CRBSI患者中14例有效，有效率为70%，5例拔管，拔管率25%，1例死亡；有效病例的血红蛋白[(96.5±19.2)g/L比(92.2±22.1)g/L，t=2.4，P＜0.05]、血白蛋白[(35.6±3.8)g/L比(32.7±4.2)g/L，t=2.3，P＜0.05]水平高于无效病例，差异有统计学意义。 结论 万古霉素、浓肝素钠溶液交替封管可以明显降低金黄色葡萄球菌导致的CRBSI的拔管率。
【Abstract】 Objective To investigate the effect of vancomycin to lock catheter on central venous catheter-related bloodstream infection (CRBSI) due to staphylococcus aureus. Methods A total of 20 patients with CRBSI due to staphylococcus aureus in our center were included in this study. All patients were used long-term central venous catheter for hemodialysis. Antibiotic lock therapy alternately with vancomycin and heparin every 6 hours was used for catheter salvage. In addition to antibiotic lock therapy, systemic vancomycin therapy was administered to all patients. Results The percentage of diabetic nephropathy was higher in CRBSI group than in control group (45% vs. 19.6%, χ2=4.73, P＜0.05). Of the 20 patients with CRBSI, 14 patients recovered by using the antibiotic lock therapy (70%), and the catheters were successfully salvaged; the remaining 6 patients did not respond to the therapy, of whom 5 underwent catheter removal and one died of infective endocarditis. Serum hemoglobin (96.5±19.2 g/L vs. 92.2±22.1 g/L, t=2.4, P＜0.05) and albumin (35.6±3.8 g/L vs. 32.7±4.2 g/L, t =2.3, P＜0.05) levels were higher in responsive group than in no-responsive group. Conclusion Antibiotic lock therapy alternately with vancomycin and heparin can effectively reduce catheter removal rate caused by CRBSI due to staphylococcus aureus.
