聚维酮碘膀胱灌注预防经尿道前列腺切除术后尿路感染的疗效观察

Efficacy of bladder perfusion with povidone iodine in prevention of postoperative urinarytract infections in patients undergoing transurethral prostatectomy

目的研究观察聚维酮碘膀胱灌注预防经尿道前列腺切除术(RURP)后尿路感染的疗效,以降低医院感染率。方法自2012年8月-2015年8月,选择接受RURP术治疗136例患者进行研究,根据随机数字法将患者分成观察组及对照组,每组68例,两组患者均给予硬膜外麻醉后,在放置电切镜之前5min为观察组从患者的尿道口注进0.25%的聚维酮碘20ml,对照组注进生理盐水20ml,而后行RURP术,术后拔除尿管当日进行中段尿的细菌培养,对比两组术后尿细菌培养阳性者的感染病原菌分布,对比术前留置尿管者发生术后尿路感染的情况。结果观察组共有3例患者发生术后尿路感染,占4.41%,显著低于对照组13例,占19.12%,差异有统计学意义(χ2=7.083,P=0.008);观察组术后白细胞升高及尿细菌培养阳性者的比例显著少于对照组,差异有统计学意义(P<0.05);两组共16例术后感染患者共检测出28株病原菌,其中大肠埃希菌12株,占42.86%,肺炎克雷伯菌8株,占28.57%;观察组术前留置尿管并发生术后尿路感染者的白细胞升高、发热及尿细菌培养阳性的比例显著低于对照组,差异有统计学意义(P<0.05)。结论 RURP术后患者发生尿路感染的病原菌主要为大肠埃希菌,利用聚维酮碘膀胱灌注预防感染的疗效明显,能明显降低患者的感染率,值得推广。

OBJECTIVE To observe the efficacy of bladder perfusion with povidone iodine in prevention of postoperative urinary tract infections in patients undergoing transurethral prostatectomy so as to reduce the incidence of nosocomial infections.METHODS A total of 136 patients who underwent the transurethral prostatectomy from Aug2012 to Aug 2015 were enrolled in the study and randomly divided into the observation group and the control group,with 68 cases in each group.After the two groups of patients were given epidural anesthesia,the observation group was treated with transurethral infusion of 20 ml of 0.25% at 5min before resectoscope was placed,the control group was treated with infusion of 20 ml of normal saline,then the patients underwent the transurethral prostatectomy,the midstream urine specimens were collected for bacterial culture on the day of extubation,the distribution of pathogens causing the postoperative infections was compared between the two groups of patients who were positive for urine culture,and the incidence of postoperative urinary tract infections was compared among the patients who were treated with preoperative urinary catheterization.RESULTS The postoperative urinary tract infections occurred in 3（4.41%）patients in the observation group,significantly less than 13（19.12%）patients in the control group（χ^2=7.083,P=0.008）.The proportion of the patients with postoperative increased WBC counts and positive urine culture was significantly lower in the observation group than in the control group（P〈0.05）.Totally 28 strains of pathogens were isolated from 16 patients with postoperative infections in the two groups,of which 42.86%（12strains）were Escherichia coli,and 28.57% 8strains were Klebsiella pneumoniae.The proportion of the preoperative urinary catheterization patients complicated with postoperative infections who presented the increased WBC counts,fever,and positive urine culture was significantly lower in the observation group than in the control group（P〈0.05）.CONCLUSION E.coli is the predominant species of pathogen causing the postoperative urinary tract infections in the patients undergoing transurethral prostatectomy.The bladder perfusion with povidone iodine can achieve remarkable effect on prevention of the infections and significantly reduce the infection rate,and it is worthy to be promoted.