Askew A A, Tuggle D W, Judd T, Smith E I, Tunell W P
Children's Hospital of Oklahoma, Oklahoma City.
J Pediatr Surg. 1990 Jan;25(1):117-9. doi: 10.1016/s0022-3468(05)80175-7.
Routine frequent central venous catheter (CVC) changes in burned patients (either change in insertion site or change over guidewires) has been advocated to decrease catheter-related sepsis. The need for this management has not been verified for children with burns. We reviewed our pediatric burn population with regard to CVC sepsis rate and individual CVC longevity to confirm this traditional policy. From 1978 to 1988, 70 children admitted to the Children's Hospital of Oklahoma Burn Unit required central venous access. Patients in whom CVCs were changed frequently (FC), (n = 10; no. of CVC, 46) were compared with those in whom CVCs were changed only for mechanical complications or sepsis (NFC), (n = 60; no. of CVC, 74). There were 10 septic CVCs in each group. The difference in mean length of individual CVC use between FC and NFC was significant (4.6 v 17.7 days; P less than .01). The difference in the number of septic CVCs per total number of catheter days in each group was highly significant (FC: 10 CVC/212 d. = 0.05; NFC: 10 CVC/1,112 d = 0.009; P less than .001). This study demonstrates a significant decrease in catheter-related sepsis when CVCs are not changed on a routine frequent basis.
为降低导管相关脓毒症的发生率，有人主张对烧伤患者常规频繁更换中心静脉导管（CVC）（即更换穿刺部位或通过导丝更换）。但对于烧伤儿童是否需要这种处理方式尚未得到证实。我们回顾了本院儿科烧伤患者的CVC脓毒症发生率及单个CVC的使用寿命，以确认这一传统策略。1978年至1988年，俄克拉荷马儿童医院烧伤科收治的70例儿童需要中心静脉置管。将频繁更换CVC的患者（FC组，n = 10；CVC数量46根）与仅因机械性并发症或脓毒症而更换CVC的患者（NFC组，n = 60；CVC数量74根）进行比较。两组各有10根CVC发生脓毒症。FC组和NFC组单个CVC的平均使用时长差异有统计学意义（4.6天对17.7天；P＜0.01）。两组中每导管日脓毒症CVC数量的差异有高度统计学意义（FC组：10根CVC/212天 = 0.05；NFC组：10根CVC/1112天 = 0.009；P＜0.001）。本研究表明，不常规频繁更换CVC时，导管相关脓毒症发生率显著降低。
