[Influence of silver ion dressing on central venous catheter-related infection in severe burn patients].

Objective: To investigate the influence of silver ion dressing on related infections induced by inserted central venous catheter through wounds in patients with severe burn. Methods: From June 2017 to December 2018, 90 severe burn patients who were admitted to the First Hospital of Hebei Medical University and met the inclusion criteria were included in this prospectively randomized control study. According to the random number table, they were divided into silver ion dressing group (30 patients, 20 males and 10 females, aged (37.2±3.4) years), sterile dressing group (30 patients, 18 males and 12 females, aged (35.2±4.1) years), and Anerdian dressing group (30 patients, 17 males and 13 females, aged (36.3±2.6) years). After admission, the patients in three groups were treated with a 16 G single-lumen central venous catheter inserted into the subclavian vein of burn wounds, with the depth of 19 cm. The puncture points of the patients in silver ion dressing group, sterile dressing group, and Anerdian dressing group were covered with silver ion medical antibacterial dressing, sterile dressing, and sterile gauze dressing infiltrated with Anerdian skin and mucous membrane washing and disinfecting solution, respectively. The patients in three groups underwent catheter maintenance and dressing change every 12 hours. The thousand-day infection rates of catheter outlet infection and catheter-related bloodstream infection (CRBSI), catheter indwelling days, and pathogen detection of the patients in three groups were counted. Data were statistically analyzed with chi-square test, one-way analysis of variance, least significant difference test, Fisher's exact probability test, and Bonferroni correction. Results: (1) The thousand-day infection rates of catheter outlet infection of patients in sterile dressing group and Anerdian dressing group were 22.29‰ (7/314) and 20.83‰ (7/336), respectively, which were similar (P>0.05), and both were significantly higher than 1.54‰ (1/651) in silver ion dressing group (P<0.01). The thousand-day infection rates of CRBSI of patients in sterile dressing group and Anerdian dressing group were 25.48‰ (8/314) and 20.83‰ (7/336), respectively, which were similar (P>0.05), and both were significantly higher than 1.54‰ (1/651) in silver ion dressing group (P<0.01). The catheter indwelling days of patients in sterile dressing group and Anerdian dressing group were similar (P>0.05), and both were significantly shorter than the days in silver ion dressing group (P<0.01). (2) A total of 16 cases of CRBSI occurred in all the patients in 3 groups. A total of 16 pathogenic bacteria were isolated from catheter tip attachment microbial culture and blood microbial culture. The detections rates of pathogenic bacteria of patients in sterile dressing group and Anerdian dressing group were significantly higher than the rate in silver ion dressing group (P<0.05). Conclusions: For severe burn patients, the use of silver ion dressings in the maintenance of central venous catheters inserted through wounds can effectively reduce the rate of central venous catheter-related infections and extend the catheter indwelling days.目的： 探讨银离子敷料对重症烧伤患者经创面置入中心静脉导管引发相关感染的影响。 方法： 2017年6月—2018年12月，河北医科大学第一医院收治90例符合入选标准的重症烧伤患者，纳入本前瞻性随机对照研究。将患者按随机数字表法分为银离子敷料组30例[男20例、女10例，年龄(37.2±3.4)岁]、无菌敷贴组30例[男18例、女12例，年龄(35.2±4.1)岁]、安尔碘敷料组30例[男17例、女13例，年龄(36.3±2.6)岁]。银离子敷料组、无菌敷贴组、安尔碘敷料组患者入院后均实施经创面锁骨下静脉置入16 G单腔中心静脉导管，置入深度19 cm，分别采用银离子医用抗菌敷料、无菌敷贴、安尔碘皮肤黏膜冲洗消毒液浸润的无菌纱布覆盖穿刺点。3组患者每12小时进行导管维护更换敷料1次。统计3组患者导管出口感染千日感染率、导管相关性血流感染(CRBSI)千日感染率、导管留置天数、病原菌检出情况。对数据行χ(2)检验、单因素方差分析、LSD检验、Fisher确切概率法检验及Bonferroni校正。 结果： (1)无菌敷贴组和安尔碘敷料组患者导管出口感染千日感染率分别为22.29‰(7/314)和20.83‰(7/336)，二者相近(P>0.05)，且均明显高于银离子敷料组的1.54‰(1/651)，P<0.01。无菌敷贴组和安尔碘敷料组患者CRBSI千日感染率分别为25.48‰(8/314)和20.83‰(7/336)，二者相近(P>0.05)，且均明显高于银离子敷料组的1.54‰(1/651)，P<0.01。无菌敷贴组和安尔碘敷料组患者导管留置天数相近(P>0.05)，且均明显短于银离子敷料组(P<0.01)。(2)3组所有患者中共发生16例次CRBSI，导管尖端附着物微生物培养及血微生物培养共分离出16株病原菌。无菌敷贴组和安尔碘敷料组患者病原菌检出率均明显高于银离子敷料组(P<0.05)。 结论： 在重度烧伤患者中使用银离子敷料对经创面置入的中心静脉导管进行维护，能有效降低中心静脉导管相关感染率，延长导管留置天数。.