重危患者留置尿管表面生物被膜形成的观察

Observation on Formation of Biofilms Inside Urinary Catheters in Critical Patients

目的观察重危患者留置尿管表面生物被膜的形成情况,探讨有效的护理对策。方法对27例重危患者拔除的尿管进行细菌和真菌鉴定及扫描电镜下生物被膜的观察。结果27例尿管中细菌和(或)真菌培养阳性23例,占85.19%;培养阴性4例,占14.81%。扫描电镜下观察3例(11.11%)尿管表面呈现尿管正常纹路,未见任何物质附着;5例(18.52%)尿管表面见片状不定型基质物覆盖,伴或不伴少量细菌和(或)真菌附着;19例(70.37%)尿管表面见立体状生物被膜形成,大量细菌和(或)真菌聚集。结论重危患者留置尿管表面生物被膜的形成和成熟与多种因素有关。护理人员除做好常规的尿管护理外,还应努力研究有效的防治生物被膜的护理方法。

Objective To observe the formation of biofilms（BF） inside urinary catheters in critical patients and to explore effective nursing countermeasures. Methods Bacteria and epiphyte were detected in the 27 critical patients of urinary catheters meanwhile BF inside urinary catheters were observed by scanning electron microscopy（SEM）. Results Of the 27 urinary catheters, bacteria and（or） epiphyte were detected positive in 23 cases （85.19%） and negative in 4 cases（14.81%）. Obeservation by SEM showed that 3 cases（11. 11 %） of urinary catheters in the critical patients had taken on normal framework of urinary catheter. Five cases（18.52%） were covered with extracellular polymeric substances accompanying with a little bacteria and（or） epiphyte adhered or not. Nineteen cases（70.37%） were coated with tridimensional BF,accompanying a great deal of bacteria and（or） epiphyte adhered. Conclusion The formation and maturation of BF of urinary catheters in critical patients were related with the tubing time of urinary catheter,or other influencing factors. In addition to conventional nursing interventions, paramedics should investingate valid means to prevent and cure urinary catheter.