胸腔术后引流液病原菌检测及预防措施

Drainage Fluid Infection after Thoracic Operation:Microbiological Examination and Preventive Measures

目的了解胸腔术后留置引流病原菌感染现状,探讨预防感染的措施。方法在拔管前以无菌操作从负吸瓶上段引流管内抽取引流液送检,检出的病原菌用ATB细菌仪鉴定到种。结果2006-2007年行胸腔手术并术后留置引流的患者共174例,174份引流液标本中有51份培养阳性,总阳性率29.3%;3类手术患者的阳性检出率差异无统计学意义(2χ=0.38,P>0.05);共检出病原菌57株,以革兰阴性杆菌和革兰阳性球菌为主,分别占50.9%和40.3%,真菌占8.8%;患者免疫防御屏障削弱,无菌操作不严格,皮肤消毒不严密,引流不通畅等均是导致引流液染菌的主要原因。结论有指征地使用抗菌药物,严格无菌操作,加强引流全过程的护理巡视,确保引流通畅,以及加强患者的营养支持,是预防胸腔术后引流感染的主要对策。

OBJECTIVE To understand the present condition of germ infection in drainage fluid after thoracic operation,and to dicuss its preventive measures.METHODS Fluid samples for microbiological examination were aspirated and gathered to the collection bottle（before tube removing）.The categery of germ cultured was identified by ATB germ identify apparatus.RESULTS Clinical data of 174 patients with thoracic drainage tube after thoracic operation during 2006-2007 were reviewed,including 73 patients with primary lung cancer,64 patients with primary esophegeal cancer,and 37 patients with tumor in mediastinum.Bacteria or fungi were cultured in 51 of 174 samples.The positive rate of culture in all samples was 29.3%.There were no significant statiatical differences among three groups of patients with various primary diseases mentioned above（χ^2=0.38,P〉0.05）.In all 57 strains of germ cultured,50.9% were Gram-negative bacilli,40.3% were Gram-positive cocci,and the other 8.8% were fungi.Causes of infection included impaired immunity defense,mistake in aseptic procedure or unstrictness of skin sterilizing,inadequate drainage,etc.CONCLUSIONS Reasonable in choice of antibiotics,strictness in aseptic procedure,adequate drainage and good nursing help are the main preventive measures to prevnt drainage fluid infection after thoracic operation.