膀胱冲洗不同频率对长期留置导尿管患者尿路感染及细菌定植影响的临床研究

Clinical study on the effects of different frequency bladder irrigation on urinary tract infection and catheter colonization in patients with long-term indwelling urinary catheter

目的 探讨膀胱冲洗不同频率对长期留置导尿管患者尿路感染及细菌定植的影响,为长期留置导尿患者选择最佳的冲洗频率.方法 选取长期留置导尿管患者275例,按数字表法随机分为4组：A组67例,每天冲洗2次;B组69例,每天冲洗1次;C组70例,每周冲洗2次;D组69例,不进行冲洗.均采用相同的膀胱冲洗方式进行.于置管后3、7、14、21 d统计4组患者尿路感染发生率,置管后21 d行中段尿细菌分离和培养,记录菌落数.结果 在3、7、14、21 d时A组患者尿路感染率分别为2.99％、10.45％、16.42％和35.82％;B组分别为0、10.14％、20.29％和33.33％;C组分别为0、2.86％、10.00％和17.14％;D组分别为0、10.14％、23.19％和40.58％.治疗后3d4组患者感染率差别不大（P＞0.05）;治疗后7、14、21d时C组患者尿路感染率明显低于其他组,而D组患者明显高于其他组（P＜0.05）.C组患者大肠杆菌、变形杆菌、克雷伯菌、粪链球菌以及其他病原菌菌落数分别为（9.38±0.87）、（6.33±0.54）、（4.97±0.38）、（2.12±0.24）和（0.92±0.06）,明显少于其他3组（P＜0.05）.结论 膀胱冲洗可以有效降低长期留置导尿管患者尿路感染的发生率,但是频繁冲洗并不可取,每周2次进行膀胱冲洗的长期留置导尿管患者尿路感染的发生率明显低于其他患者,是较为合适的膀胱冲洗频率.

Objective To investigate the effects of different frequency bladder irrigation on urinary tract infection and catheter colonization in patients with long-term indwelling urinary catheter and to select ideal irrigation frequency,so as to reduce infection.Methods Two hundred and seventy-five patients with long-term indwelling catheterization were randomly divided into 4 groups：group A （n =67） had bladder irrigation twice a day,group B （n =69） had bladder irrigation once a day,group C （n =70） had bladder irrigation twice a week,and group D （n =69） had no bladder irrigation at all.All the patients in the former 3 groups had exactly the same mode of bladder irrigation.After 3,7,14 and 21 days of catheterization,incidence rates of urinary tract infection for the four groups were statistically analyzed,and at day 21 bacterial isolation and culture in the midstream urine were performed and colony counting was recorded.Results At days 3,7,14 and 21,rates of incidence for the patients in group A were respectively 2.99％,10.45％,16.42％ and 35.82％ ; rates of incidence for the patients in group B were 0,10.14 ％,20.29％ and 33.33％ ; those for the patients in group C were 0,2.86 ％,10.00％ and 17.14％ and those for the patients in D group were 0,10.14 ％,23.19％ and 40.58％.No significant differences could be seen in the rates of incidence among the patients of the 4 groups after 3 days of treatment （P ＞ 0.05）.After 7,14 and 21 days of treatment,incidence of urinary tract infection in the patients of group C was significantly lower than that of the other groups,while incidence for the patients in group D was significantly higher than that of the other groups （P ＜ 0.05）.Colony counting of Escherichia coli,proteus,Klebsiella,Streptococcus faecalis and other pathogens in the patients of group C were （9.38 ±0.87）,（6.33 ±0.54）,（4.97 ±0.38）,（2.12 ± 0.24） and （0.92 ±0.06） respectively,which were significantly lower than that of the other 3 groups （P ＜ 0.05）.Conclusions Bladder irrigation could effectively reduce the incidence of urinary tract infection in patients with long-term indwelling catheterization,and frequent irrigation in our opinion was no good.With bladder irrigation twice a week,incidence rate of urinary tract infection for the patients with long-term indwelling catheterization was significantly lower than that of other patients,and it was indicated that irrigation twice a week was a more appropriate irrigation frequency.