脑梗死后神经源性膀胱留置尿管相关性尿路感染的研究

Research on neurogenic bladder indwelling catheter-related urinary tract infections after cerebral infarction

目的分析脑梗死后神经源性膀胱留置尿管相关性尿路感染的病原菌特点及相关因素,为预防尿路感染提供理论依据。方法采用回顾性调查的方法,对2009年10月-2011年9月康复科收治96例脑梗死后神经源性膀胱留置尿管患者的资料,分析留置尿管期间引起尿路感染的病原菌特点及主要原因,探讨控制措施。结果 96例脑梗死后神经源性膀胱患者早期进行留置尿管,1个月中发生尿路感染病例60例,分离出85株病原菌,革兰阴性杆菌49株,占57.7%,以大肠埃希菌为主;革兰阳性球菌16株,占18.8%,以肠球菌属为主;真菌20株,占23.5%,以白色假丝酵母菌为主;感染原因主要有4方面:抗菌药物过度使用;医护人员与陪护人员的手卫生不规范;糖尿病患者血糖控制不理想;留置尿管时间长。结论脑梗死后神经源性膀胱留置尿管期间应合理使用抗菌药物;积极控制血糖;加强医护人员与陪护人员手卫生;早日解除留置导尿改为间歇导尿方法,积极锻炼膀胱功能,尽早建立反射性膀胱是关键;降低尿路感染的发生率,从而提高患者的生活质量。

OBJECTIVE To analyze the pathogens causing catheter-related urinary tract infections in neurogenic bladder after cerebral infarction and the related factors so as to provide theoretical bases for the prevention of urinary tract infections.METHODS A retrospective investigation was conducted for the data of 96 patients with indwelling neurogenic bladder catheter after cerebral infarction who were enrolled in rehabilitation department from Oct 2009 to Sep 2011;the pathogens causing urinary tract infections and the related causes were analyzed so as to propose control measures.RESULTS Of 96 patients with neurogenic bladder after cerebral infarction who underwent indwelling catheterization,urinary tract infections occurred in 60 cases within one month;of totally 85 strains of pathogens isolated,there were 49（57.6%） strains of gram-negative bacilli,among which Escherichia coli was dominant,there were 16（18.8%）strains of gram-positive cocci,among which Enterococcus was dominant,and there were 20（23.6%） strains of fungi among which Candida albicans was dominant,there were 4 causes for the infections,including the overuse of antibiotics,medical staff and nursing staff＇s neglecting hand hygiene,poor control of the blood glucose of the diabetic patients as well as the long duration of indwelling catheterization.CONCLUSION The patients with indwelling neurogenic bladder catheter after cerebral infarction should pay attention to the reasonable use of antibiotics;to actively control the blood glucose,strengthen the hand hygiene of the medical staff,switch from the indwelling urethral catheterization into intermittent catheterization as early as possible,actively exercise of bladder function and create reflex bladder in early stage is crucial to decrease the incidence of urinary tract infections,thereby improving the quality of the life of the patients.