上消化道肿瘤患者颈内静脉穿刺置管的细菌学调查

目的：为进一步减少上消化道肿瘤患颈内静脉穿刺置管所致感染和导管堵塞,并找出预防感染和堵塞的有效护理方法。方法：对93例上消化道肿瘤患颈内静脉穿刺置管的导管出皮肤处、导管接口、拔管前的血培养和拔管后的导管末端共504个样本进行了细菌学调查。本组分高营养组35例,非高营养组58例,对两组发生导管堵塞的情况进行比较。结果：发现四个检测部位的感染与导管留置时间都有密切关系（P＜0．05）,高营养组导管堵塞的发生率明显高于非高营养组（P＜0．05）。结论：颈内静脉穿刺置管的留置时间愈长,导致感染的机会愈大。使用高营养的患必须注意在输注高营养前后都须用生理盐水冲洗导管,正确封管对防止导管堵塞也非常重要。从细菌学监测得出的细菌菌群和药敏分析,合理使用抗生素势在必行。

Investigation on Bacteriology of Internal Jugular Vein Intubation in Patients with Upper Gastrointesti nal Tumor

Abstract:Objective To decrease infection and duct obstruction induced by in patients with uppergastrointestinal tumor induced by,and try to find effective nursing strategies to prevent such infec-tion and obstruction. Methods A total of 504 samples from 93 patients with upper gastrointestinaltumors were tested for bacteriology. The samples were from the intubation duct out of skin, thejunction between the ducts, the blood culture before extubation and the end of duct after extuba-tion. The patients were divided into two groups: high nutrition group(n = 35) and non-high nutri-tion group(n =58). Duct obstruction was compared between the two groups. Results Infectionwas closely related to the time of intubation at all 4 different sampling sites(P<0.05). Occur-rence of duct obstruction of the high nutrition group was higher than that of the non-high nutritiongroup(P<0.05). Conclusion The longer the internal jugular vein intubation is, the more risk ofinfection would be; the intubation duct used for patients who receive high nutrition should bewashed carefully before and after infusing nourishment,and the way of how to block the tube is ofprimary importance in preventing duct obstruction. Rational use of antibiotics should be enforcedon the basis of bacteriological and drug sensitive tests.