本文選題：腸外營養(yǎng) + 糖脂供卡比　； 參考：《石河子大學》2015年碩士論文

【摘要】：目的:比較不同糖脂供卡比對ICU經(jīng)中心靜脈導管(CVC)進行營養(yǎng)支持患者導管相關性感染(CRI)發(fā)生率的影響,及CRI病原菌譜特征,為臨床預防CRI提供參考。方法:本課題采用隨機、前瞻、雙盲的臨床試驗設計方案,將符合納入標準的167例經(jīng)CVC行腸外營養(yǎng)的患者作為研究對象,按隨機數(shù)字表法分為三組,A組(糖脂供卡比4:6)、B組(糖脂供卡比5:5)、C組(糖脂供卡比6:4)行腸外營養(yǎng)。供給總熱量按125.6KJ/(kg·d)計算,觀察導管出口2cm范圍內(nèi)的皮膚情況。懷疑有導管感染時,分別留取外周靜脈血和經(jīng)中心靜脈導管采集血液進行血培養(yǎng),并拔除導管取導管尖端(5cm)進行細菌培養(yǎng)。患者治療結(jié)束或?qū)Ч苁褂媒Y(jié)束后拔除導管,無論有無感染征象均行導管尖端(5cm)培養(yǎng),記錄患者外周血、導管血及導管尖端細菌培養(yǎng)結(jié)果,計算感染率。于治療前、治療后第一天、第三天、治療結(jié)束后采血檢測前白蛋白、白蛋白、血紅蛋白。統(tǒng)計數(shù)據(jù)用SPSS17.0軟件分析,計數(shù)資料用頻數(shù)、百分比(%)表示,計量資料以(???s)表示,進行??檢驗及統(tǒng)計描述,重復測量資料比較采用重復測量的方差分析。結(jié)果:1.167例腸外營養(yǎng)治療患者中共出現(xiàn)CRI 18例,總體感染率為10.78%;2.三組CRI發(fā)生率比較,差異有統(tǒng)計學意義[A組5.36%(3/56),B組5.26%(3/57),C組21.82%(12/54),??=10.868,P=0.004];共培養(yǎng)出菌株31株,其中G+菌14株(45.16%)、G-菌12株(37.5%)、真菌5株(16.13%),真菌位居第三,5株(18.52%),主要致病菌為革蘭陽性菌。3.前白蛋白在治療后第一天、第三天及治療結(jié)束后均升高,與治療前比較組間差異無統(tǒng)計學意義;組內(nèi)比較差異有統(tǒng)計學意義。白蛋白在治療結(jié)束后升高與治療前比較,差異有統(tǒng)計學意義。隨著治療時間的延長,血紅蛋白較治療前升高,但差異無統(tǒng)計學意義。結(jié)論:1.腸外營養(yǎng)患者CRI發(fā)生與腸外營養(yǎng)液糖脂供卡比相關,過高的葡萄糖供卡會增加中心靜脈導管感染的風險。2.CRI主要病原菌依次為:表皮葡萄球菌、鮑曼不動桿菌、金黃色葡萄球菌。3.不同的糖脂供卡比的腸外營養(yǎng),均能改善患者的營養(yǎng)狀況;隨著治療的進行治療效果更加明顯。
[Abstract]:Objective: to compare the effect of different glucose and lipid donor Kabi on the incidence of catheter-associated infection (CRI) in patients with nutritional support through central venous catheterization (ICU), and to provide reference for clinical prevention of CRI. Methods: a randomized, prospective, double-blind clinical trial was designed to include 167 patients who underwent parenteral nutrition via CVC. According to the method of random number table, three groups were divided into three groups: group A (glucose and fat for Kabi 4: 6) and group B for Kabi 5: 5 and C (for Kabi 6: 4) for parenteral nutrition. The total calorie supply was calculated as 125.6KJ/(kg d, and the skin was observed in the 2cm area at the outlet of the catheter. For suspected catheterization, the peripheral venous blood and the blood collected through the central venous catheter were collected for blood culture, and the catheter tip was removed for bacterial culture. The catheter was removed at the end of the treatment or after the catheter was used. The infection rate was calculated by culturing the bacteria in the peripheral blood, blood and catheter tip of the patients with or without the signs of infection. Prealbumin and hemoglobin were collected before, on the first and third day after treatment. The statistical data is analyzed by SPSS17.0 software, the counting data is expressed by frequency and percentage), and the measurement data is expressed as "/ s". Test and statistical description, repeated measurement data comparison using repeated measurement analysis of variance. Results there were 18 cases of CRI in 1. 167 cases of parenteral nutrition. The total infection rate was 10. 78%. There were significant differences in the incidence of CRI among the three groups (group A 5.36% ~ 356%) [group A 5.26% ~ 5.26% ~ 5.26% ~ 5.26% ~ 5.26%], group C: 21.82P ~ (12)% ~ (12)% ~ (10.868) P ~ (0.004)]; among the 31 strains, 14 strains of G bacteria were found to be 45.16G- (12), 37.5B, 5 strains of fungi were 16.13%, and fungi were the third fifth strain (18.52%), and the main pathogenic bacteria were gram-positive bacteria (.30.32%), the main pathogenic bacteria were Gram-positive bacteria (.33.00%), and the main pathogenic bacteria were Gram-positive bacteria (.33.00%). Prealbumin increased on the first day, the third day and the end of the treatment, and there was no significant difference between the groups before and after treatment. The increase of albumin after treatment was significantly higher than that before treatment. With the prolongation of treatment time, hemoglobin was higher than that before treatment, but the difference was not statistically significant. Conclusion 1. The incidence of CRI in parenteral nutrition patients was related to the Kabi of parenteral nutrition solution. Too high glucose supply increased the risk of central venous catheter infection. 2. The main pathogens were Staphylococcus epidermidis, Acinetobacter baumannii, Staphylococcus aureus and Staphylococcus aureus. The parenteral nutrition of Kabi with different glucose and lipid could improve the nutritional status of the patients, and the effect was more obvious with the treatment.
【學位授予單位】：石河子大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R459.3

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