不同膀胱冲洗频率对长期留置导尿管患者尿路感染及细菌定植的影响分析

摘要

目的：探讨不同膀胱冲洗频率对长期留置导尿管患者尿路感染及细菌定植的影响。方法选取长期留置导尿管患者275例，随机分为A、B、C、D 4组，所有患者均以同样的方式进行膀胱冲洗，A组冲洗频率为每天2次，B组每天1次，C组每周2次，D组不进行冲洗。于置管后3、7、14、21 d对4组患者尿路感染发生率进行统计，于置管后21 d行中段尿细菌分离和培养，记录菌落数。结果在3、7、14、21 d时 A 组患者尿路感染率分别为2．99％、10．45％、16．42％和35．82％；B组为0．00％、10．14％、20．29％和33．33％；C组为0．00％、2．86％、10．00％和17．14％；D组为0．00％、10．14％、23．19％和40．58％。治疗后3 d4组患者感染率差别不大，差异无统计学意义（ P＞0．05）；治疗后7、14、21 d时C组患者尿路感染率明显低于其他组，而D组患者明显高于其他组，组间比较差异有统计学意义（P＜0．05）。C组患者大肠杆菌、变形杆菌、克雷伯菌、粪链球菌以及其他病原菌菌落数分别为（9．38±0．87）、（6．33±0．54）、（4．97±0．38）、（2．12±0．24）和（0．92±0．06），明显少于其他3组，差异有统计学意义（P＜0．05）。结论膀胱冲洗可有效降低长期留置导尿管患者尿路感染的发生率，但是频繁冲洗并不可取，每周2次膀胱冲洗是较为合适的膀胱冲洗频率。%Objective To investigate the effect of different bladder irrigation frequency on urinary tract infec‐tions and bacterial colonization of patients with catheterization .Methods A total of 275 patients with long‐term in‐dwelling catheterization were recruited in this study ,and divided into group A ,B ,C ,D randomly .All patients were carried out bladder irrigation in the same manner ,group A (n=67) with flushing frequency 2 times a day ,group B (n=69) with 1 times a day ,group C (n=70) with 2 times per week ,group D (n=69) without flushing .The inci‐dence of urinary tract infections after placing the catheter 3 ,7 ,14 ,21 d of the four groups were recorded ,after placing the catheter 21 d ,isolation and culture of bacteria from midstream urine were conducted ,the number of colonies were recoded .Results The incidence of urinary tract infections in group A after placing the catheter 3 ,7 ,14 ,21 d were 2 .99% ,10 .45% ,16 .42% and 35 .82% ,those of group B were 0 .00% ,10 .14% ,20 .29% and 33 .33% ,those of group C were 0 .00% ,2 .86% ,10 .00% and 17 .14% ,those of group D were 0 .00% ,10 .14 % ,23 .19% and 40 .58% . The infection rate of four groups after treating 3 d had no statistical difference (P> 0 .05);The infection rate in group C after treating 7 ,14 ,21 d was significant lower than other groups ,while those of the group D were significant higher than other groups ,the differences were statistical significant (P<0 .05) .The pathogens colonies of Escherichia coli ,Proteus ,Klebsiella ,Streptococcus faecalis and other pathogens were (9 .38 ± 0 .87) ,(6 .33 ± 0 .54) ,(4 .97 ± 0 .38) ,(2 .12 ± 0 .24) and (0 .92 ± 0 .06) ,which were significant less than the other three groups(P<0 .05) .Conclu‐sion The bladder irrigation could effectively reduce the incidence rate of urinary tract infection of patients with long‐term indwelling catheterization ,but frequent washing isn′t good ,the frequency of bladder irrigation as twice a week is appropriate .