静脉营养液中加入小剂量肝素预防新生儿中心静脉置管相关感染

Administration of low-dose heparin in total nutrient admixture prevents central venous catheter-related infections in neonates

摘要:

目的：经外周导入中心静脉置管（PICC）是危重新生儿长期静脉营养的有效途径之一，但导管相关性感染（CRI）是其常见并发症。本研究对全合一静脉营养液中加入微量肝素持续输注对PICC相关感染的预防作用进行观察，探讨减少CRI的有效措施。方法：83例行PICC置管的患儿分为两组，肝素组（n=43）在营养液中加入肝素0.5 U/mL，对照组（n=40）不加肝素，观察两组CRI的发生情况。结果：肝素组发生导管堵塞2例（5%），对照组8例（20%）；肝素组导管内细菌定植1例（2%），对照组7例（18%）；肝素组无一例发生导管相关血流感染，对照组5例（13%），两组相比差异均有显著性（P＜0.05）。结论：静脉营养液中加入小剂量肝素可减少PICC堵管，预防CRI的发生。［中国当代儿科杂志，2009，11（12）：983-985］

Abstract:

OBJECTIVE: Peripherally inserted central catheter (PICC) is widely used to provide a long-term access for the administration of total parenteral nutrition and medications. Catheter-related infections (CRI) are common complications of PICC. The purpose of this retrospective study was to investigate the role of low-dose heparin added to the total nutrient admixture (CTNA) in the prevention of CRI. METHODS: Eighty-three neonates who underwent PICC received TNA with (heparin group, n=43) or without heparin (0.5 U/ mL) (control group, n=40). The incidence of CRI was compared between the two groups. RESULTS: The incidences of catheter obstruction (5% vs 20%) and the catheter-tip colonization (2% vs 18%) in the heparin group were significantly lower than those in the control group (P<0.05). None of the neonates in the heparin group had clinical evidence of catheter-related bloodstream infection, but 5 cases in the control group (P＜0.05). CONCLUSIONS: The administration of low-dose heparin in TNA may decrease the incidences of catheter obstruction and CRI.［Chin J Contemp Pediatr, 2009, 11 (12):983-985］