心血管介入诊疗中污染导管的生物负载清除效果研究

目的 研究通过规范的清洗和灭菌方法对污染的心脏电生理导管微生物负载清除效果.方法 将心脏电生理导管使用HBV血液进行污染,分为5组,每组40根导管,A组采用多酶清洗,B组采用加去污剂清洗,C组采用多酶加去污剂清洗,D组采用去污剂和多酶清洗后环氧乙烷低温灭菌,E组术进行任何处理,作为阳性对照组；再将每段分为各5 mm的两节,其中一节采用PCR检测各组HIV核酸阳性数；另一节与人肝细胞共同培养收集培养上清液检测HBsAg和HBeAg;观察人肝细胞的存活情况.结果 A组检出HBV-DNA阳性39根,阳性率为97.5％,人肝细胞大量死亡；B组检出HBV-DNA阳性37 根,阳性率92.5％,人肝细胞生长状况不良;C组检出HBV-DNA阳性37根,阳性率92.5％,人肝细胞大量死亡;D组未检出 HBV-DNA,入肝细胞生长状况良好；E组检出HBV-DNA阳性40根,阳性率100.0％,人肝细胞大量死亡.结论 清洗(去污剂+酶液)+环氧乙烷低温灭菌法可有效清除心脏电生理导管的HBV污染,从消除导管生物负载的角度为今后探索导管复用、为取得相关政策的支持提供了科学依据.

Effect of cardiovascular interventional treatment on clearance of biological load on contaminated catheter

OBJECTIVE To study the effect of the standardized cleaning and sterilization methods on the clearance of the bacterial load on the contaminated cardiac electrophysiology catheter.METHODS The cardiac electrophysiology catheters with HBV blood pollution were divided into five groups with 40 in each,the group A was treated with multiple enzymes,the group B with detergents for cleaning,the group C with detergent plus multi-enzyme,the group D with ethylene oxide for low temperature sterilization after using multiple enzymes and detergent,the group E without any treatment as the positive control group;then each section were divided into two 5 mm-segments,one was detected the positive HBV nucleic acid with PCR;the other was measured for the HBsAg and HbeAg with the combined culture with human liver cells for supernatants.The survival of the human liver cells was observed.RESULTS There were 39 cases detected with HBV DNA in group A with the positive rate of 97.5% and huge mount of apoptotic human liver cells;there were 37 cases detected with HBV DNA in group B with positive rate of 92.5% and the poor growth of the human liver cells;there were 37 cases detected with HBV DNA in the group C with the positive rate of 92.5% and huge mount of apoptotic human liver cells;there were no HBV DNA detected in the group D with the good growth of human liver cells;there were 40 cases with HBV DNA detected with the positive rate of 100% and huge mount of apoptotic human liver cells.CONCLUSION The cleaning(detergent plus multi-enzyme solution) plus ethylene oxide low temperature sterilization can effectively remove the HBV contamination of cardiac electrophysiology catheter;from the perspective of elimination of catheter bacterial load,it provides supports for the exploration of recycle use of catheter as well as the scientific bases for obtaining the support of relevant policies.