Skiest D J, Grant P, Keiser P
The University of Texas Southwestern Medical Center, Dallas 75235-9133, USA.
J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Mar 1;17(3):220-6. doi: 10.1097/00042560-199803010-00006.
Patients with AIDS frequently require long-term central venous access devices for intravenous (IV) therapy. We reviewed the medical records of all HIV-infected patients at a single large urban hospital who had a central venous catheter (CVC) placed during a 1-year period to assess the overall complication rate, infection rate, and the microbiology of infectious complications. One hundred fifty-six catheters were inserted in 87 patients for 11,041 catheter days. These catheters (142 of 156) were primarily nontunneled, nonimplantable CVCs (NT-CVCs), and analyses were limited to these. Of these catheters, 79% were primarily used to treat disease caused by cytomegalovirus (CMV). The complication rate for the NT-CVCs was 5.1/1000 catheter days with a mean time to any complication of 106 days. The total infection rate of the NT-CVCs was 2.8/1000 catheter days, and the serious infection rate (bacteremia) for the NT-CVCs was 1.4/1000 catheter days. The mean time to a serious infection was 407 days. None of the following parameters was associated with an increased infection rate: HIV risk factor, indication for catheter, medications received via catheter, number of catheter ports, anatomic site of catheter insertion, or the presence of neutropenia. NT-CVCs were associated with low complication and infection rates that were comparable with historical rates seen in AIDS patients with tunneled and totally implantable central venous access devices. NT-CVCs may be a safe, cost-effective alternative to other central venous access devices in patients with HIV/AIDS.
艾滋病患者经常需要长期的中心静脉通路装置来进行静脉治疗。我们回顾了一家大型城市医院中所有在1年期间置入中心静脉导管（CVC）的HIV感染患者的病历，以评估总体并发症发生率、感染率以及感染性并发症的微生物学情况。87例患者共置入156根导管，导管留置天数达11041天。这些导管（156根中的142根）主要为非隧道式、不可植入的CVC（NT-CVC），分析仅限于这些导管。在这些导管中，79%主要用于治疗由巨细胞病毒（CMV）引起的疾病。NT-CVC的并发症发生率为5.1/1000导管日，发生任何并发症的平均时间为106天。NT-CVC的总感染率为2.8/1000导管日，严重感染率（菌血症）为1.4/1000导管日。发生严重感染的平均时间为407天。以下参数均与感染率增加无关：HIV危险因素、置管指征、通过导管给予的药物、导管端口数量、导管插入的解剖部位或中性粒细胞减少的存在情况。NT-CVC的并发症和感染率较低，与艾滋病患者使用隧道式和完全植入式中心静脉通路装置的历史发生率相当。对于HIV/AIDS患者，NT-CVC可能是其他中心静脉通路装置的一种安全、经济有效的替代方案。
