膀胱冲洗频率与导尿管更换时间对导尿管内腔生物膜的影响  

Influence of frequency of bladder irrigation and catheter replacement cycle on biofilm forming in inner side of catheter

作　　者：袁展望[1] 李武平[1] 史皆然[1] 付菊芳[1] 刘冰[1] 孙惠英[1] 白艳玲[1] 杨凡[1] 

机构地区：[1]第四军医大学西京医院感染管理科,陕西西安710032

出　　处：《中华医院感染学杂志》2014年第20期5079-5081,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(30872155);国家科技重大专项基金资助项目(2013ZX 10004805-003);全军医学科技"十二五"科研基金资助项目(AWS11L009;11BJZ01)

摘　　要：目的探讨膀胱冲洗、导尿管更换周期对导尿管内腔生物膜的影响,以期为临床治疗提供科学依据。方法2013年3-12月对ICU 157例危重患者尿液及导尿管送检标本进行病原菌培养及菌落计数,并采用电镜扫描观察,根据是否进行膀胱冲洗与更换导尿管,分为冲洗组76例,未冲洗组81例;数据采用SPSS19.0软件进行分析,计数资料采用χ2检验。结果膀胱冲洗组患者尿培养阳性26例,阳性率34.21%,未冲洗组尿培养阳性27例,阳性率33.33%;导尿管1周更换阳性23例阳性率31.08%、两周更换阳性30例阳性率36.14%,差异无统计学意义;导尿管内腔共培养82株病原菌,其中革兰阴性菌以大肠埃希菌居多,占26.83%;革兰阳性球菌以粪肠球菌居多,占24.39%;当细菌定量≥10 000/μl时,导尿管内腔均形成成熟的生物膜。结论膀胱冲洗不能抑制导尿管内腔细菌定植和预防生物膜的形成;危重患者两周内可不更换导尿管,但当尿沉渣尿细菌定量≥10 000/μl时需更换导尿管。OBJECTIVE To explore the impact of the bladder irrigation and catheter replacement cycle on the biofilm forming in the inner side of catheter so as to provide guidance for clinical treatment .METHODS The urine and catheter specimens were collected from 157 critically ill patients who were treated in ICU from Mar 2013 to Dec 2013 ,then the culture of pathogens and the bacterial colony counts counting were carried out and observed by using electroscope;the participants were divided into the irrigation group with 76 cases and the non-irrigation group with 81 cases according to the status of bladder irrigation and catheter replacement ;the data were statistically analyzed with the use of SPSS19 .0 software ,and the count data were analyzed by means of chi-square test .RESULTS The urine was cultured positive in 26 cases in the irrigation group with the positive rate of 34 .21%and was cultured positive in 27 cases in the non-irrigation group with the positive rate of 33 .33% .The urine was cultured positive in 23 cases in the participants who were with the catheter replacement cycle of one week with the positive rate of 31 .08% and was cultured positive in 30 cases in the participants who were with the catheter replacement cycle of two weeks with the positive rate of 36 .14% ,there was no statistically significant difference . A total of 82 strains of pathogens have been cultured from the inner sides of the catheters ;the Escherichia coli was the predominant species of gram-negative bacteria ,accounting for 26 .83% ;the Enterococcus f aecalis was dominant among the gram-positive cocci ,accounting for 24 .39% ;the mature biofilm formed inside the catheter lumen when the bacterial quantitative was no less than 10 000/μl .CONCLUSIONS The bladder irrigation can neither inhibit the bacterial colonization in the inner sides of catheter nor prevent the formation of biofilm ;the critically ill patients do not need to change the catheters within two weeks but need to change when the bacterial quantitative in urinary sediment w

关 键 词：膀胱冲洗 尿管更换时间 菌落计数 生物膜 

分 类 号：R181.32[医药卫生—流行病学]