乳癌根治术后留置引流的病原学调查及预防对策

Bacteriological Investigation of Drainage Tube after Modified Radical Mastectomy and Counter measures

目的了解乳癌改良根治术(MRM)后留置引流病原菌感染现状,分析其原因,并探讨预防对策。方法每例患者术后24 h分别从胸肋部和腋窝部留置管负吸瓶内抽取引流液做细菌培养,检出的病原菌用ATB细菌仪鉴定到种。结果2005-2007年接受MRM后留置引流管的患者152例,有52例患者的70份引流液标本培养阳性,总阳性率34.2%;共检出各种病原菌70株,病原菌构成以革兰阳性球菌为主(40株,占57.1%),其次是革兰阴性杆菌(24株,占34.3%)和真菌(6株,占8.6%);引流液染菌的原因包括患者免疫防御屏障削弱、引流管的设置给环境病原菌提供了入侵的机会,无菌操作不严格、皮肤消毒不严密、引流不通畅等。结论手术期间必须保持手术室无菌环境,严格无菌操作,引流通畅、有效,严格控制留管时间,是预防术后引流感染的主要对策。

OBJECTIVE To evaluate the present condition of bacteriological infection caused by drainage tube after modified radical mastectomy （MRM） and the prevention measure. METHODS Atotal of 152 patients with drainage tube after MRM during 2005-2007 were analyzed,bacteria culture of drainage fluid from breast wound or axillary wound were taken in 24 hours after operation. The bacteria or fungi were identified with ATB bacterial analysis apparatus. RESULTS Seventy specimens from 52 patients were positive （positive rate 34.2%）. Of 70 strains,40 were Gram-positive cocci, 24 were Gram-negative bacilli and the other 6 were fungi. The reasons of infection included subsided immunity defense system, drainage tube application, incorrect aseptic processing or disinfection procedure, and obstruction of drainage tube. CONCLUSIONS The important prevention measures of bacteria infection through drainage tube after MRM include maintenance of aseptic environment in operating room, strict aseptic processing, fluent drainage, and proper indwelling time of drainage tube.