患者腰段硬膜外术后止痛硬膜外导管末端细菌培养  

Bacteria Culturing from Tips of Lumbar Epidural Catheters Used for Postopertaive Analgesia

作　　者：张岩[1] 王立水[2] 梁立双[3] 

机构地区：[1]山东大学齐鲁医院麻醉科,山东济南250012 [2]山东大学齐鲁医院检验科,山东济南250012 [3]山东大学齐鲁医院疼痛科,山东济南250012

出　　处：《中华医院感染学杂志》2009年第11期1367-1368,1399,共3页Chinese Journal of Nosocomiology

摘　　要：目的观察患者腰段硬膜外术后止痛硬膜外导管尖端细菌异生的情况。方法100例下肢骨科手术患者,ASAⅠ级或Ⅱ级,选取L1-2棘间隙在无菌条件下行硬膜外穿刺、置管,术后用低浓度局麻药及芬太尼行硬膜外术后止痛,3 d后在无菌条件下拔除硬膜外导管,剪取尖端2 cm送细菌培养。结果共有9例患者硬膜外导管尖端发生细菌异生(9.0%),检出表皮葡萄球菌6株(66.7%);肠球菌属、革兰阴性杆菌、酵母菌属各1株,各占11.1%;无1例患者出现硬膜外感染的征象。结论腰段硬膜外术后止痛的病原菌异生发生率较低,临床上未出现硬膜外感染征象,术后3 d内行硬膜外止痛可不考虑硬膜外感染的威胁,但对高危人群,仍以应用一定的预防措施为宜。OBJECTIVE To investigate the incidence of bacteria colonization on lumbar epidural catheter tips in post-operative analgesia patients. METHODS The catheter tips were cultured in 100 patients with ASA grade Ⅰ -Ⅱ undergoing lower extremity osteoarticular operation. Lumbar epidural catheters were placed in the operating room with aseptic technique. Diluted local anesthetic and fentanyl infusions were used for postoperative analgesia. The epidural catheter was removed with aseptic technique and the tips sent for microbiological culture after 3 days. RESULTS From 100 patients, bacteriological examination revealed bacteria colonization in 9 （9. 0%）, mainly Staphylococcus epidermidis （6; 66. 7%）, followed by Enterococcus （1; 11. 1%）, Gram-negative bacilli （1 ; 11.1%）, and yeasts（1 ; 11. 1 %）. No patient developd infectious complications. CONCLUSIONS Our results show that the risk of bacteria colonization associated with lumber postoperative analgesia in three days is low. No patient develops local or central nervous infection. Epidural postoperative analgesia can be routinely used without worry of infection in epidural space. But we recommend prophylactic measures should be applied in the high-risk groups.

关 键 词：硬膜外 置管 术后疼痛 病原菌 感染 

分 类 号：R181.32[医药卫生—流行病学]