Clarke D E, Raffin T A
Department of Medicine, Kaiser Hospital, Santa Clara, CA.
Chest. 1990 Apr;97(4):966-72. doi: 10.1378/chest.97.4.966.
The long-term CVC allows patients with a variety of diseases to lead a more normal and pain-free life. The use of these catheters has become commonplace in most hospitals, and the physician caring for patients in the ICU will be caring for increasing numbers of patients with an indwelling long-term CVC. Infections of these catheters can be manifested in many different ways: tunnel infections, exit site infections, catheter-related bacteremia, and septic thrombophlebitis. The overwhelming majority of these infections are caused by coagulase-negative staphylococci, but physicians should be aware of the wide variety of organisms that can infect the long-term CVC. The diagnosis of long-term CVC sepsis can be difficult, but the use of quantitative blood cultures for catheters left in place and the Maki method for culturing those catheters that are removed will aid physicians in their quest for diagnostic certainty. The great majority of catheter infections will resolve with antibiotic therapy alone without the need for catheter removal, but there are important exceptions to this general rule. Tunnel infections and fungal long-term CVC infections often require catheter removal for their resolution; septic thrombophlebitis and CR-SCVT require the addition of anticoagulation or fibrinolytic therapy to antibiotic regimens for resolution of the infection, and surgical debridement may be warranted if these modalities fail to resolve the infection.
长期中心静脉导管（CVC）使患有各种疾病的患者能够过上更正常且无痛的生活。在大多数医院，使用这些导管已变得很普遍，在重症监护病房（ICU）护理患者的医生将会护理越来越多留置长期CVC的患者。这些导管感染可表现为多种不同形式：隧道感染、出口部位感染、导管相关菌血症和脓毒性血栓性静脉炎。这些感染绝大多数是由凝固酶阴性葡萄球菌引起的，但医生应意识到有多种微生物可感染长期CVC。长期CVC败血症的诊断可能很困难，但对留置导管进行定量血培养以及对拔除的导管采用Maki培养方法，将有助于医生确定诊断。绝大多数导管感染仅通过抗生素治疗即可治愈，无需拔除导管，但这一普遍规则也有重要的例外情况。隧道感染和真菌性长期CVC感染通常需要拔除导管才能治愈；脓毒性血栓性静脉炎和CR - SCVT需要在抗生素治疗方案中加用抗凝或纤溶治疗以治愈感染，如果这些方法未能治愈感染，可能需要进行手术清创。
