慢性疼痛患者硬膜外镇痛导管细菌定植路径与预测因子分析

汤壮; 周黎明; 胡平; 赵林; 洪威鹏; 沈兴利; 李星宇; 杨灵杰; 贺奇志

doi:10.7619/jcmp.20245808

慢性疼痛患者硬膜外镇痛导管细菌定植路径与预测因子分析

Analysis of bacterial colonization pathways and predictive factors of epidural analgesia catheters in patients with chronic pain

摘要

摘要:
目的分析慢性疼痛患者硬膜外镇痛导管细菌定植发生率、定植路径及预测因子。
方法选取接受硬膜外置管连续阻滞术的150例慢性疼痛患者(导管留置时间为7~10 d)作为研究对象，分别选取3个部位样本进行细菌培养。收集患者的临床资料，分析细菌培养阳性率、菌种分布特征和细菌定植路径，通过受试者工作特征(ROC)曲线评估预测因子的效能。
结果穿刺点周围皮肤擦拭液、导管皮下段和导管尖端样本的细菌培养阳性率分别为22.0%、7.3%和8.7%, 表皮葡萄球菌为主要定植菌种。Spearman相关系数法分析结果显示，穿刺点周围皮肤细菌培养结果与导管尖端定植显著相关(r=0.47, P < 0.01)。ROC曲线分析结果显示，穿刺点周围皮肤细菌培养结果预测导管尖端细菌定植的曲线下面积为0.843, 灵敏度为84.9%, 特异度为84.6%。
结论细菌沿导管迁移是导管尖端细菌定植的主要路径，穿刺点周围皮肤细菌培养结果是细菌定植风险的有效预测因子。

Abstract:
Objective To analyze the incidence, colonization pathways, and predictive factors of bacterial colonization of epidural analgesia catheters in patients with chronic pain.
Methods A total of 150 patients with chronic pain who underwent continuous epidural catheterization (catheter indwelling time of 7 to 10 days) were selected as study subjects. Samples from three sites were collected for bacterial culture. Clinical data of the patients were collected, and the positive rate of bacterial culture, characteristics of bacterial species distribution, and bacterial colonization pathways were analyzed. The efficacy of predictive factors was assessed using the receiver operating characteristic (ROC) curve.
Results The positive rates of bacterial culture in samples from the skin swabbing fluid around the puncture site, the subcutaneous segment of the catheter, and the catheter tip were 22.0%, 7.3%, and 8.7%, respectively. Staphylococcus epidermidis was the predominant colonizing bacterial species. Spearman correlation coefficient analysis showed a significant correlation between the results of bacterial culture from the skin around the puncture site and catheter tip colonization (r=0.47, P < 0.01). ROC curve analysis revealed that the area under the curve of bacterial culture results from the skin around the puncture site in predicting catheter tip bacterial colonization was 0.843, with a sensitivity of 84.9% and a specificity of 84.6%.
Conclusion Bacterial migration along the catheter is the main pathway for catheter tip bacterial colonization, and the results of bacterial culture from the skin around the puncture site are an effective predictive factor for the risk of bacterial colonization.

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