胸腔感染与一次性水封瓶更换时间长短的临床意义

The clinical significances between thoracic infection and the replacing time of one-off water seal bottle

目的探讨胸腔感染与一次性水封瓶更换时间长短的临床意义。方法对196例行胸腔闭式引流且排除胸腔感染者使用随机数字表分为4组,即每天更换水封瓶(A组)、每3天更换(B组)、每周更换(C组)、超过1周用至拔管(D组),追踪监测一次性水封瓶内生理盐水和胸腔引流液作细菌培养,有细菌生长则对该病例停止试验;同时对196例患者的胸腔内胸液或胸腔引流管前端2 cm进行细菌培养,最后进行统计学分析。结果一次性水封瓶生理盐水的细菌培养均为阴性,4组水封瓶中胸腔引流液的细菌培养结果阳性共13例,共检出细菌8种,水封瓶内引流液中细菌出现最早的为A组中第4次(即第4天)更换,出现最迟的为C组中第2次(即第14天)更换。各组比较差异均无显著性(P>0.05);对196例患者的胸腔内胸液或胸腔引流管前端2 cm进行细菌培养,其结果1例与一次性水封瓶内胸腔引流液相一致,1例与一次性水封瓶内胸腔引流液不一致,余194例无细菌生长。结论一次性水封瓶的更换时间与胸腔感染无直接关系;水封瓶更换时间与水封瓶内细菌定植无明显相关性,在严格无菌操作下,对于胸腔引流管留置时间较长的患者,一次性水封瓶以每周更换一次较为合适。

Objective To investigate the clinical significance between thoracic infections and the replacing time of one-off water seal bottle. Methods 196 cases with closed chest drainage and without thoracic infections were randomly divided into 4 groups, i.e. Group A.. to replace the water seal bottle every day; Group B： to replace it every 3 days; Group C： to replace it every week; Group D.- to replace it over a week until removing the tube. The normal saline in the one-off water seal bottle and the drainage fluid are cultured separately, and the case who has been found bacterium should be stopped. When bacterium were found in the drainage fluid, the thoracic transudates and the fluid in the previous 2 cm part of the tube should be cultured simultaneously. All the results should be analyzed statistically. Results All the bacterium cultures of normal saline in the one-off water seal bottle turn to be negative. 13 cases were found positive in bacterium cultures of drainage fluid, with 8 kinds of bacterium. The bacterium were first found in Group A at the fourth time （on the fourth day） the one-off water seal bottle was replaced, and latest found in Group C at the second time （on the fourteenth day ） the one-off water seal bottle was replaced. There was no sig- nificant difference among the four groups （P〉0.05）. At the same time, the thoracic transudates and the fluid in the previous 2cm part of the tube of 196 cases are cultured. The result shows that one case was the same with the drainage fluid in the one-off water seal bottle while one was different, and no bacterium have been found in the other 194 cases. Conclusions The replacing time of one-off water seal bottle had no obvious relation with bacterium cultured in the one-off water seal bottles. Under strict aseptic operations, it was the best to replace the one-off water seal bottle every week for those tubes with long retention time.