翻译稿：Recognition and prevention of nosocomial vascular device and related bloodstream infections in the intensive care unit”。 Crit Care Med 2010;38[Suppl.]:S363–S372
——粘贴原文段落后附翻译。
因时间仓促，只能逐块进行翻译，万望见谅！
第一部分 abstract and introduction
【摘要】Central venous catheters have become a mainstay in the care of critically ill patients but, unfortunately, are associated with a significant risk of bloodstream infections. There are 80,000 catheter- related bloodstream infections that occur annually in the United States, with a high human and financial cost. This paper reviews the main tools for prevention and diagnosis of central venous catheter-related bloodstream infections in the intensive care unit. We discuss specific aspects of prevention, including education, hand hygiene, sterile technique, skin cleansing, choice of catheter site, antimicrobial-impregnated catheters, catheter site dressings, antibiotic lock solutions, anticoagulation, catheter changes, and needleless connection devices. An analysis of studies evaluating the use of catheter “bundles” is also included. Diagnostic methods discussed include how to obtain blood cultures, when to culture catheter tips, how to interpret culture results, and the best methods for diagnosis. 中央静脉导管在ICU病患中逐渐不可或缺，但不幸的是，却显著增加了血液感染的风险。据估计，在美国每年约有80,000例CR-BSI的病患，显著增加了人力和财力成本。本文综述了目前ICU中主要预防和诊断中央静脉导管相关血液感染的手段。我们探讨具体的预防方面，包括教育，手卫生，无菌技术，皮肤清洁，选择导管插入点，抗菌浸渍导管，插管点包被，抗生素封锁方法，抗凝，导管置换，无针连接装置。本综述也包括了评价导管“bundle“运用研究的分析。诊断方法主要探讨如何获得血培养，何时培养导管尖端，如何描述培养结果，以及寻求最好的诊断方法。 Few innovations in medicine have been as important to the care of the critically ill patient as the development of intravascular catheters. These devices allow for the administration of intravenous fluids, medications, blood products, and parenteral nutrition, as well as provide hemodynamic monitoring and access for hemodialysis. Unfortunately, they are also associated with multiple complications, the most important being infection. The majority of these infections are associated with central venous catheters (CVCs). It is estimated that 80,000 CVC-related bloodstream infections occur each year in intensive care units (ICUs) in the United States. Although estimates of attributable mortality vary, a conservative figure puts the number of deaths at about 14,000 per year (1). Those who do survive typically have their hospital stay prolonged by 1 wk(2). The financial cost of one catheterrelated bloodstream infection (CRBSI) has been estimated to be as high as $45,000 making the overall cost of these infections as much as $3 billion annually. The prevention of these infections is thus of paramount importance both from a medical and a financial standpoint and has only been amplified by the loss of Medicare reimbursement for such infections. This article will review the basic methods for prevention and recognition of CRBSI. 在医学上，很少有技术革新像血管内导管发展那样，对重症病患具有相同的重要性。这些器件可用来管理静脉输液、输药，血液制品和肠外营养，并提供血流动力学监测和血液透析通路。不幸的是，他们还伴随多种并发症，其中最重要的是感染，其中大部分是与CVCs感染。据估计，美国ICU中每年有80,000例CVC感染发生。虽然归因死亡率的估计存在变化，但是一个保守的数字表明每年把约（1）14,000例病患死于CVC感染。CVC感染的病患常常会增加一周的入院时间（2）。在病患感染治疗成本构成中，仅仅因为CRBSI，一例病患的入院成本可高达45000美元，全年所有的CVC感染约耗费30亿美元成本。这些感染的预防是至关重要，无论从医疗还是财务的观点来考虑；并且预防这些感染的重要性因为取消报销此类感染而被放大。本文将探讨预防和确诊CRBSI的基本方法。
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