血液腫瘤病人中心靜脈導管血流感染相關因素之探討

Factors toward Bloodstream Infection in Hospitalized Patients with Hematological Malignancy

王曉婷(Hsiao-Ting Wang) ； 徐明儀(Ming-Yi Hsu) ； 廖浚凱(Chun-Kai Liao)

《腫瘤護理雜誌》 20卷1期 (2020/06) Pp. 5-18

https://doi.org/10.6880/TJON.202006_20(1).01

摘要

背景：中心靜脈導管是血液腫瘤住院病人接受化學藥物給藥的一項重要途徑，但易因血流感染而影響預後。目的：探討裝置中心靜脈導管血液腫瘤住院病人血流感染及其相關因素。方法：採回溯性個案對照研究設計。依據2010年1月1日到2015年3月30日研究單位入院病人進行資料收集，感染組為中心靜脈導管施打化學治療發生血流感染的血液腫瘤病人，對照組為同期間採相同條件但無感染者。變項包括病人屬性（年齡、性別、中心靜脈導管、診斷、絕對嗜中性白血球（absolute neutrophil count, ANC）低下數值、絕對嗜中性白血球低下天數、查爾森共病症指數、體能狀況）；醫療處置（接受化學藥物的劑量、接受預防性抗生素）；護理處置（敷料更換的方式、使用輸液管路的數目、接觸性皮膚炎）。以Mann-Whitney U test、卡方檢定及單變項邏輯式迴歸進行資料分析。結果：符合收案條件共405位病人，有血流感染者122人、無血流感染者283人。結果顯示絕對嗜中性白血球低下數值、絕對嗜中性白血球持續低下天數、敷料更換的方式、使用輸液管路數目是中心靜脈導管血流感染的相關因素（p ＜ .05）。結論：絕對嗜中性白血球低下數值小於500/mm3期間內，須嚴格執行預防感染措施，衛教病人穿著透氣衣物、洗澡時以塑膠袋覆蓋人工血管部位，減少非必要的輸液管路，都可降低中心靜脈導管血流感染的發生。

關鍵字

血液腫瘤病人 ； 血流感染 ； 中心靜脈導管

並列摘要

Background: Central Venous Catheter (CVC) is commonly used for chemotherapy-induced hematological malignancies and the CVC related bloodstream infections are usually associated with poor prognosis. Purpose: The purpose of this paper is to explore central venous catheter-related bloodstream infections and its relative factors in hospitalized patients with hematological malignancies. Methods: We conducted a retrospective case-control study in a hospital. Data were collected from hospitalized patients of the research unit between January 1, 2010 and March 30, 2015. The infected group was patients with hematological malignancies undergoing chemotherapy suffering from central venous catheter-related bloodstream infections while the comparison group was uninfected patients with hematological malignancies undergoing chemotherapy. Variables included attribute of patient (age, gender, central venous catheter, diagnosis, values of neutropenia, days of neutropenia, Charlson Comorbidity Index, and physical status); Medical Treatments (dosage of chemotherapy, preoperative antibiotics); and nursing intervention (change of dressing, number of previous infusion lines, contact dermatitis). The data were analyzed by using Mann-Whitney U test, Chi-Square Test, and univariatelogistic regression analysis. Results: A total of 405 patients were recruited (bloodstream infection - 122, no bloodstream infection - 283). Results showed the values of neutropenia, days of neutropenia, change of dressing, and number of previous infusion lines were the related factors of central venous catheter-related bloodstream infections (p ＜ .05). Conclusions: When the ANC falls below 500 per mm3, measures of infection prevention should be firmly enforced, patients are to be educated to wear clothing of breathable material, vascular grafts should be covered with plastic bag when taking a bath, and the unnecessary infusion tubes should be reduced to lower the incidence of central venous catheter-related bloodstream infections.

並列關鍵字

patients with hematological malignancies ； bloodstream infections ； central venous access device

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