葡萄糖酸氯己定抗菌敷料在血液透析长期导管中的应用

刘文杰; 张留平; 王越; 李梦婷

doi:10.3969/j.issn.1671-4091.2019.12.007

中国血液净化 >

2019 , Vol. 18 >Issue 12: 834 - 836

DOI: https://doi.org/10.3969/j.issn.1671-4091.2019.12.007

血管通路

葡萄糖酸氯己定抗菌敷料在血液透析长期导管中的应用

刘文杰 ,
张留平 ,
王越 ,
李梦婷

展开

1东南大学附属中大医院肾科血液净化中心

收稿日期: 2019-06-24

修回日期: 2019-09-01

网络出版日期: 2019-12-03

收起

Application of antibacterial dressing containing chlorhexidine gluconate for long- term hemodialysis catheters#br#

LIU Wen-Jie ,
ZHANG Liu-Ping ,
WANG Yue ,
LI Meng-Ting

Expand

1Blood Purification Center, Zhongda Hospital, Southeast University, Nanjing 210009, China

Received date: 2019-06-24

Revised date: 2019-09-01

Online published: 2019-12-03

Fold

摘要

【摘要】目的探讨葡萄糖酸氯己定抗菌透明敷料在维持性血液透析长期导管维护中的作用。方法本研究为单中心前瞻性队列研究，纳入符合标准的长期导管患者56 例按随机数字表法分为观察组和对照组各28 例，观察组在长期导管出口处采用葡萄糖酸氯己定抗菌透明敷料，每周更换1 次；对照组则使用传统的无菌纱布敷料，每周更换3 次。2 组每次导管护理和上下机操作均一致，并测量记录长期导管外露的长度。观察2 组患者的导管相关性感染率和导管滑脱率，观察期为12 个月。结果Kaplan-Meier 生存曲线提示，抗菌敷料组的导管相关性感染率与对照组无统计学差异(Log-rank 检验：P=0.078)，抗菌敷料组的导管滑脱率要低于对照组(Log-rank 检验：P=0.040)。结论葡萄糖酸氯己定抗菌透明敷料能有效降低血液透析患者导管滑脱率，但2组患者的导管相关性感染率无显著差异。

关键词： 葡萄糖酸氯己定; 长期导管; 导管维护; 感染; 滑脱

本文引用格式

刘文杰 , 张留平 , 王越 , 李梦婷 . 葡萄糖酸氯己定抗菌敷料在血液透析长期导管中的应用[J]. 中国血液净化, 2019 , 18(12) : 834 -836 . DOI: 10.3969/j.issn.1671-4091.2019.12.007

Abstract

【Abstract】Objective To investigate the effect of antimicrobial transparent dressing containing chlorhexidine gluconate on the maintenance of long-term hemodialysis catheters. Methods This was a single- center prospective cohort study enrolling 56 patients with long-term catheters. The patients in the observation group were treated with antimicrobial transparent dressing containing chlorhexidine gluconate at the outlet of longterm catheters, and the dressing was replaced once a week. The patients in the control group were given traditional sterile gauze dressing, which was changed three times a week. The length of long-term catheter outside of the outlet was measured and recorded. The rates of catheter-related infection and catheter slippage in the two groups were observed for 12 months. Results Kaplan-Meier survival curve showed that there was no significant difference in catheter-related infection rate between the two groups (log-rank test, P=0.078). The catheter slippage rate was lower in the observation group than in the control group (log-rank test, P=0.040). Conclusion Antimicrobial transparent dressing containing chlorhexidine gluconate can effectively reduce the catheter slippage rate in hemodialysis patients. However, there is no significant difference in catheter-related infection rate between the two groups.

Key words： Chlorhexidine gluconate; Long-term catheter; Maintenance of catheter; Infection; Catheter slippage

参考文献

[1]Moist LM,Trpeski L,Na Y,et a1.Increased hemodialysis catheter use in Canada and associated mortality risk:data from the Canadian Organ Replacement Registry 2001-2004[J].Clin J Am Soc Nephrol,2008,3:l726- 1732.
[2] 王玉柱,叶朝阳,金其庄. 中国血液透析用血管通路专家共识(第1版)[J]. 中国血液净化,2014,08:549-558.
[3]Mayer MA,Soundararajan V,Soundararajan R.Safety　
and efficacy of placing internal jugular dialysis
catheter tip in the inferior vena cava[J].J Vasc
Access,2017,18(1):79-81.
[4]Goel N, Kwon C,Zachariah TP,et al.Vascular access
place ment in patients with chronic kidney disease
stages 4 and 5 attending an inner city nephrology
clinic:a cohort study and survey of providers[J]
.BMC Nephrol,2017,18(1):28.
[5] 向晶，马志芳. 血液透析专科护理操作指南［M］.北京: 人民卫生出版社，2014: 23－42．
［6］叶朝阳. 血液透析血管通路技术与临床应用［M］.上海: 复旦大学出版社，2010: 52－56．
[7] Vascular Access Work Group.Clinical practice guidelines for vascular access[J].American Journal of Kidney Diseases, 2006, 48 (Suppl):248-274
[8] Lok CE, Mokrzycki MH.Prevention and management of catheter-related infectionin hemodialysis patients[J].Kidney international,2011,79:587-598
[9] Donlan RM.Biofilm formation: a clinically relevant microbiological process[J].Clin Infect Dis,2001, 33:1387-1392
[10]3M.Instructions For Use:3MTMTegadermTM CHG Chlorhexidine Gluconate I.V. Securement Dressing [obtained via sponsor’s submission].2012.
[11]National Institute for Health and Care Excellence.Medical Technologies Consultation Document: The 3M Tegaderm CHG IV securement dressing for central venous and arterial catheter insertion sites.2015.

Options

文章导航

模态框（Modal）标题

摘要

本文引用格式

Abstract

参考文献