ICU患者留置导尿管后尿路感染的防护与人文关怀策略

Urinary Tract Infection Protectionand Humanistic Care Strategy of ICU Patient Indwelling Catheter

目的提高对患者的人文关怀,探究重症监护患者留置尿管更换时间、膀胱冲洗频率与尿路感染的相关性,为临床侵入性操作所致尿路感染的防护提供理论依据。方法对2014年1—12月入住某院重症监护病房需留置导尿患者465例患者,按年龄和性别因素随机分入留置尿管1周更换组和不更换(除非必要)组,进一步将纳入各组的患者随机分入不行膀胱冲洗组、膀胱冲洗1次/周组及膀胱冲洗2次/周组进行护理,比较各组尿路感染率。结果留置导尿管1周更换组尿路感染率明显低于留置导尿管不更换组(P<0.05);膀胱冲洗1次/周组尿路感染率明显低于不行膀胱冲洗组及膀胱冲洗2次/周组(P<0.05);膀胱冲洗2次/周组尿路感染率与不行膀胱冲洗组相比无统计学差异(P>0.05);各亚组女性尿路感染率明显高于男性(P<0.05);各亚组≥60岁患者尿路感染率明显高于<60岁患者。结论在人文关怀策略的指导下,每周1次更换导尿管加1次/周膀胱冲洗可以有效降低重症监护患者留置导尿管后尿路感染率。

Objectives To explore the relationship of the replacement time and the flushing frequency of bladder with the urinary tract infections among ICU patients indwelling catheter,and to provide theoretical basis for protection of clinical urinary tract infection caused by invasive procedures.Methods Between January and December in2014,465 cases in ICU in our hospital needed indwelling catheter.They were randomly assigned into group of replacing urinary catheter weekly and group that did not replace urinary catheter by age and gender,then they were further randomly assigned into group that did not flushing bladder and groups that flushing bladder one time per week and two times/week.The rate of urinary tract infection was compared among groups.Results The rate of urinary tract infection of the group of replacing urinary catheter weekly was significantly lower than that of the group that did not replace urinary catheter（P〈0.05）,while the rate of the group that flushing bladder one time per week was significantly lower than that of the group that did not flushing bladder and the group that flushing bladder two times/week（P〈0.05）.In the sub groups,urinary tract infection rates of the female and the age over 60 years old were significantly higher than the other groups.Conclusions Replacing catheter and flushing bladder once a week can effectively reduce the rate of urinary tract infection after detaining urethral catheter for patients in ICU.