Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine.
Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, University Medical Centre, Homburg/Saar, Germany.
Br J Anaesth. 2016 Apr;116(4):546-53. doi: 10.1093/bja/aew026.
Catheter-related infections are a serious complication of continuous thoracic epidural analgesia. Tunnelling catheters subcutaneously may reduce infection risk. We thus tested the hypothesis that tunnelling of thoracic epidural catheters is associated with a lower risk of catheter-related infections.
Twenty-two thousand, four hundred and eleven surgical patients with continuous thoracic epidural analgesia included in the German Network for Regional Anaesthesia registry between 2007 and 2014 were grouped by whether their catheters were tunnelled (n=12 870) or not (n=9541). Catheter-related infections in each group were compared with Student's unpaired t and χ(2) tests. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with logistic regression, adjusting for potential confounding factors, including age, ASA physical status score, use of catheter for ≥4 days, multiple skin puncture, hospital, and surgical department.
There were fewer catheter-related infections in patients with tunnelled catheters (4.5 vs 5.5%, P<0.001). Mild infections were also less common (4.0 vs 4.6%, P=0.009), as were moderate infections (0.4 vs 0.8%, P<0.001). After adjustment for potential confounding factors, tunnelling remained an independent prevention for any grade of infection (adjusted OR 0.51, 95% CI 0.42-0.61, P<0.001) and for mild infections (adjusted OR 0.54, 95% CI 0.43-0.66, P<0.001) and moderate and severe infections (adjusted OR 0.44, 95% CI 0.28-0.70, P=0.001).
Tunnelling was associated with a lower risk of thoracic epidural catheter-related infections.
导管相关性感染是连续胸部硬膜外镇痛的严重并发症。经皮隧道式置管可降低感染风险。因此，我们假设经皮隧道式置管与降低导管相关性感染风险相关。
纳入 2007 年至 2014 年德国区域麻醉网络注册的 22411 例连续胸部硬膜外镇痛的手术患者，根据导管是否经皮隧道式置管（n=12870）或未经皮隧道式置管（n=9541）分组。对每组的导管相关性感染进行学生独立样本 t 检验和卡方检验。采用逻辑回归计算比值比（OR）和 95%置信区间（CI），并校正年龄、ASA 体格状况评分、导管使用≥4 天、多次皮肤穿刺、医院和手术科室等潜在混杂因素。
经皮隧道式置管患者的导管相关性感染发生率较低（4.5%比 5.5%，P<0.001）。轻度感染也较少见（4.0%比 4.6%，P=0.009），中度感染也较少见（0.4%比 0.8%，P<0.001）。校正潜在混杂因素后，经皮隧道式置管仍然是预防任何严重程度感染（校正 OR 0.51，95% CI 0.42-0.61，P<0.001）和预防轻度感染（校正 OR 0.54，95% CI 0.43-0.66，P<0.001）、中度和重度感染（校正 OR 0.44，95% CI 0.28-0.70，P=0.001）的独立保护因素。
经皮隧道式置管与降低胸部硬膜外导管相关性感染风险相关。
