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发表于 2007-5-6 01:40:44
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原帖由 楚楚 于 2007-8-19 14:24 发表 
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各位大虾，能否与大家分享一下您对这段话的理解？
四、预防血管内导管相关感染的一般措施
(二)穿刺点的选择
穿刺部位皮肤细菌密度是CRBSI重要危险因素。为了降低感染率，建议选择锁骨下静脉穿刺留置CVCs，尽 ...
感觉还是翻译和理解的问题。对照原文，可以这样说“成人中颈内静脉优于股静脉，儿童中感染发生率两者一样但股静脉引起的机械损伤要少些”。
Site of Catheter Insertion
The site at which a catheter is placed influences the subsequent risk for catheter-related infection and phlebitis. The influence of site on the risk for catheter infections is related in part to the risk for thrombophlebitis and density of local skin flora.
Phlebitis has long been recognized as a risk for infection. For adults, lower extremity insertion sites are associated with a higher risk for infection than are upper extremity sites (49--51). In addition, hand veins have a lower risk for phlebitis than do veins on the wrist or upper arm (52).
The density of skin flora at the catheter insertion site is a major risk factor for CRBSI. Authorities recommend that CVCs be placed in a subclavian site instead of a jugular or femoral site to reduce the risk for infection. No randomized trial satisfactorily has compared infection rates for catheters placed in jugular, subclavian, and femoral sites. Catheters inserted into an internal jugular vein have been associated with higher risk for infection than those inserted into a subclavian or femoral vein (22,53,54).
Femoral catheters have been demonstrated to have relatively high colonization rates when used in adults (55). Femoral catheters should be avoided, when possible, because they are associated with a higher risk for deep venous thrombosis than are internal jugular or subclavian catheters (56--60) and because of a presumption that such catheters are more likely to become infected. However, studies in pediatric patients have demonstrated that femoral catheters have a low incidence of mechanical complications and might have an equivalent infection rate to that of nonfemoral catheters (61--63). Thus, in adult patients, a subclavian site is preferred for infection control purposes, although other factors (e.g., the potential for mechanical complications, risk for subclavian vein stenosis, and catheter-operator skill) should be considered when deciding where to place the catheter. In a meta-analysis of eight studies, the use of bedside ultrasound for the placement of CVCs substantially reduced mechanical complications compared with the standard landmark placement technique (relative risk [RR] = 0.22; 95% confidence interval [CI] = 0.10--0.45) (64). Consideration of comfort, security, and maintenance of asepsis as well as patient-specific factors (e.g., preexisting catheters, anatomic deformity, and bleeding diathesis), relative risk of mechanical complications (e.g., bleeding and pneumothorax), the availability of bedside ultrasound, and the risk for infection should guide site selection.
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谢谢！辛苦啦！
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