开腹手术患者留置尿管拔管前膀胱冲洗预防尿路感染的效果评估

Effect of bladder irrigation before extubation of urinary catheter on prevention of urinary tract infection in patients undergoing open surgery

目的研究留置尿管拔管前膀胱冲洗对开腹手术患者尿路感染的预防控制效果,为临床开腹手术患者尿路感染的预防控制提供依据。方法选择2013年10月-2015年5月医院收治的开腹手术行留置尿管患者120例,将其随机分为研究组和对照组,每组各60例;对照组患者在拔除尿管前不进行膀胱冲洗,观察组在拔除尿管前进行膀胱冲洗;于护理3、7、14d时观察记录两组患者尿路感染的发生率及其不良反应;护理3、7、14d时进行细菌培养,记录各病原菌菌落数。结果治疗后7、14d时研究组患者尿路感染率分别为1.67%、3.33%,明显低于对照组的10.00%、23.33%,差异有统计学意义(P<0.05);研究组患者尿道口不良反应发生率为5.00%,对照组为45.00%;研究组患者大肠埃希菌、克雷伯菌属、变形杆菌属、粪肠球菌及其他病原菌菌落数明显少于对照组;留置导尿管后第8、12、16天时,研究组患者细菌培养阳性率显著低于对照组,差异有统计学意义(P<0.05)。结论膀胱冲洗可以有效的降低长期留置导尿患者尿路感染及尿道口不良反应发生率。

OBJECTIVE To explore the effect of bladder irrigation before extubation of urinary catheter on prevention and control of urinary tract infection in patients undergoing open surgery so as to provide guidance for prevention and control of the urinary tract infection in the patients undergoing the open surgery.METHODS A total of120 urinary catheter indwelling patients who underwent the open surgery from Oct 2013 to May 2015 were enrolled in the study and randomly divided into the study group and the control group,with 60 cases in each group.The control group was not treated with bladder irrigation before the extubation,while the observation group was given the bladder irrigation before the extubation.The incidence rates of urinary tract infections and adverse reactions in the two groups of patients were observed and recorded after the nursing for 3,7,and 14 days,the bacterial culture was carried out on day 3,7,and 14 of nursing,and the bacterial colony counts were recorded.RESULTS The incidence rate of urinary tract infection of the observation group was 1.67%after the treatment for 7days,significantly higher than 10.00% of the control group;the incidence rate of urinary tract infection of the observation group was 3.33% after the treatment for 14 days,significantly lower than 23.33% of the control group（P〈0.05）.The incidence of adverse reactions in urethral orifice was 5.00%in the study group,45.00%in the control group.The bacterial colony counts of Escherichia coli,Klebsiella spp,Proteus spp,Enterococcus faecalis,and other species of pathogens were significantly less in the study group than in the control group.The positive rate of bacterial culture of the study group was significantly lower than that of the control group on day 8,12,or 16 after the urinary catheter indwelling（P〈0.05）.CONCLUSION The bladder irrigation can effectively reduce the incidence of urinary tract infection and the incidence of urethral orifice adverse reactions in the long-term urinary catheter indwelling patients.