课题背景：目前中心静脉血管内留置管道在体外循环心脏手术后的应用逐渐增多，中心静脉留置管道感染成为一个重要课题。

应用要点：目前常用的是经中心静脉途径留置导管，虽然经中心静脉途径比经外周静脉途径感染率高，但对于心脏术后患者，中心静脉途径的用途和优点很多。文章结果表明，经中心静脉留置的中心静脉管道中经颈静脉、经锁骨下静脉及经股静脉途径的感染率也有显著差异。因置管技术难度相对较小，作者早期多选用股静脉途径，但调查比较后发现，经股静脉途径中心静脉导管的感染率显著高于其他两种途径，目前已基本不再使用股静脉途径。

偏倚或不足：心脏术后中心静脉感染问题不仅与留置途径有关，还与中心静脉导管留置时间、患者本身状况等众多因素有关联，在此，因受篇幅所限未能详细论述，这也是今后工作中需要关注的问题。

摘要

目的：中心静脉留置管道感染是体外循环心脏手术后面临的重要课题。比较分析体外循环心脏手术后经不同途径留置中心静脉管道而发生感染的差异。
方法：西京医院心血管外科重症监护病区2002-12/2004-11收治体外循环术后患者2 218例，共行经皮穿刺留置中心静脉管道治疗2 743例次，其中经股静脉放置573例次，经颈静脉放置1 997例次，经锁骨下静脉放置136例次，经外周静脉放置37例次。对出现明确的或可疑的感染患者，留取外周血和中心静脉导管标本进行培养，比较不同途径留置的中心静脉管道的感染情况。
结果：共观察留置导管2 743例次，无漏检现象。①经股静脉途径留置的中心静脉管道感染率为12.6%，经锁骨下静脉途径的感染率为8.1%，经颈静脉途径的感染率为4.1%，经外周静脉途径留置的感染率为2.7%。不同留置途径的中心静脉管道感染率差异具有显著性意义（P < 0.01）。②中心静脉留置管道感染的致病菌以革兰氏阳性菌为主。
结论：体外循环术后中心静脉留置管道的感染率与留置途径有一定相关性，中心静脉留置管道感染的致病菌以革兰氏阳性菌为主。
关键词: 体外循环；导管插入术，中心静脉；感染；生物材料

郭利明，胡雪慧，崔勤，薛卫斌，郑霄，苏洁，赵荣.体外循环术后经不同途径留置中心静脉管道发生感染的比较[J].中国组织工程研究与临床康复，2008，12(18):3489-3492 [www.zglckf.com/zglckf/ejournal/upfiles/08-18/18k-3489(ps).pdf]

Comparison of infection from central venous catheters through various approaches in cardiopulmonary bypass patients

Abstract

AIM: Infection from central vein catheter is an important topic following cardiopulmonary bypass surgery. This study was designed to analyze infection difference after surgery from central venous catheter through various approaches on cardiopulmonary bypass patients.
METHODS: A total of 2 218 patients undergoing cardiopulmonary bypass surgery in the Intensive Care Unit, Department of Cardiovascular Surgery, Xijing Hospital between December 2002 and November 2004, were enrolled in this study. They were treated with percutaneous puncture for central venous catheter indwelling for totally 2 743 times, including 573 times through jugular vein, 1 997 times through jugular vein, 136 times through subclavian vein, and 37 times through peripheral vein. Peripheral blood samples and central venous catheter samples were obtained from the explicit definite or suspected infection patients, for the culture. And the infection of central venous catheter through various approaches was compared.
RESULTS: Totally 2 743 catheter indwelling were observed, without loss detection. The infection rate of central vein catheter was 12.6% for those through femoral vein, 8.1% for those through subclavian vein, 4.1% for those through jugular vein, and 2.7% for those through peripheral vein. The diversity of infection rate of central vein catheter in various ways was significant (P < 0.01). Gram-positive bacteria were the main pathogenic bacterium in the infection of catheter in central vein.
CONCLUSION: After the cardiopulmonary bypass surgery, there is a distinct relationship between the infection rate of central vein with the catheter and the way the catheter is indwelled. And Gram-positive bacteria are the main pathogenic bacterium in the infection of catheter in central vein.

Guo LM, Hu XH, Cui Q, Xue WB, Zheng X, Su J, Zhao R.Comparison of infection from central venous catheters through various approaches in cardiopulmonary bypass patients.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(18):3489-3492(China) [www.zglckf.com/zglckf/ejournal/upfiles/08-18/18k-3489(ps).pdf]