CAJ | 학술논문

目的：探讨骨科手术患者术后血浆引流袋最佳更换时间，以降低引流管细菌滋生率，从而控制或减少导管相关性切口感染率。方法以方便采样法选择2012年9月-2013年8月行手术治疗、术后置引流管并接一次性血浆引流袋的非感染性患者100例作为观察对象。以抽签法随机分为对照组（A组，33例）和观察组（B组，32例；C组，35例）。3组患者均于术后每24小时计量后排空引流袋，A组常规每天更换一次引流袋；B组每48小时更换一次引流袋；C组不更换引流袋。分别取各组橡皮引流管外口内侧及引流袋内引流液行一般细菌培养，观察一般细菌培养阳性率、患者术后体温变化及切口感染率情况。结果术后24 h，3组一般细菌培养结果均为阴性。术后48 h，A组引流袋内液及引流管内口一般细菌培养阳性结果均为6例，阳性率均为18．1％；B组两部位一般细菌培养阳性结果均有2例，阳性率均为6．4％；C组引流袋内液一般细菌培养结果阴性，差异有统计学意义（χ2＝10．32，P＜0．05）。术后72 h， A、B、C 3组一般细菌培养阳性结果分别均为8例、2例和0例，阳性率分别均为24．2％，6．4％，0．0％，差异有统计学意义（χ2＝11．82，P＜0．05）。 A、B、C 3组术后切口感染率分别为15．1％（5/33），6．3％（2/32），0．0％（0/35），差异有统计学意义（χ2＝11．18，P＜0．05）。各组间术后体温变化比较差异无统计学意义（F＝7．53，P＞0．05）。结论随着血浆引流袋更换频次的增加，不但引流袋内液与引流管内口一般细菌培养阳性率随之增加，而且所滋生细菌菌种及术后切口感染率也随之增加，骨科患者术后应每24小时计量后排空血浆引流袋即可，不必每24小时或48小时更换一次。
목적：탐토골과수술환자술후혈장인류대최가경환시간，이강저인류관세균자생솔，종이공제혹감소도관상관성절구감염솔。방법이방편채양법선택2012년9월-2013년8월행수술치료、술후치인류관병접일차성혈장인류대적비감염성환자100례작위관찰대상。이추첨법수궤분위대조조（A조，33례）화관찰조（B조，32례；C조，35례）。3조환자균우술후매24소시계량후배공인류대，A조상규매천경환일차인류대；B조매48소시경환일차인류대；C조불경환인류대。분별취각조상피인류관외구내측급인류대내인류액행일반세균배양，관찰일반세균배양양성솔、환자술후체온변화급절구감염솔정황。결과술후24 h，3조일반세균배양결과균위음성。술후48 h，A조인류대내액급인류관내구일반세균배양양성결과균위6례，양성솔균위18．1％；B조량부위일반세균배양양성결과균유2례，양성솔균위6．4％；C조인류대내액일반세균배양결과음성，차이유통계학의의（χ2＝10．32，P＜0．05）。술후72 h， A、B、C 3조일반세균배양양성결과분별균위8례、2례화0례，양성솔분별균위24．2％，6．4％，0．0％，차이유통계학의의（χ2＝11．82，P＜0．05）。 A、B、C 3조술후절구감염솔분별위15．1％（5/33），6．3％（2/32），0．0％（0/35），차이유통계학의의（χ2＝11．18，P＜0．05）。각조간술후체온변화비교차이무통계학의의（F＝7．53，P＞0．05）。결론수착혈장인류대경환빈차적증가，불단인류대내액여인류관내구일반세균배양양성솔수지증가，이차소자생세균균충급술후절구감염솔야수지증가，골과환자술후응매24소시계량후배공혈장인류대즉가，불필매24소시혹48소시경환일차。
Objective To explore the correlation between the replacing time of plasma drainage bag and the bacterial growth rate among orthopaedic surgery patients , and to control or reduce the risk of catheter-related infection.Methods The convenient sampling method was used to select 100 patients with postoperative serum drainage tube and disposable drainage bag , from September 2012 to August 2013.Patients were randomly divided into the control group (group A, 33 cases) and the observation group (group B, 32 cases; group C, 35 cases).The amount of drainage were recorded every 24 hours of the three groups of patients , and then the drainage bags were emptied .Group A replaced the drainage bag regularly every day; Group B replaced the drainage bag every 48 hours;Group C did not replace the drainage bag .The outside mouth of the drainage tube and the drainage liquid were taken to bacterial culture . The positive rate of bacterial culture , patients'postoperative body temperature and the rate of incision infection were compared within groups .Results Twenty-four hours after operation, the results of bacterial culture among three groups were negative .However, after 48 hours, six patients (18.1%) in group A, two patients (6.4%) in group B showed positive results of the bacterial culture .None of the patients in group C had the positive results .The comparison among three groups was statistically significant (χ2 =10.32,P<0.05).After 72 hours, eight patients (24.2%) in group A, two patients (6.4%) in group B showed positive results of the bacterial culture .None of the patients in group C had the positive results.The comparison among three groups was statistically significant (χ2 =11.82,P<0.05). The incidence of incision infection of group A , group B and group C were 15.1%(5/33), 6.3%(2/32) and 0.0%(0/35), respectively.There was a significant difference among three groups (χ2 =11.18,P<0.05).The body temperature of the three groups showed no significant difference (F=7.53,P>0.05).Conclusions With the increase of drainage bag replacement frequency , the positive rate of bacterial culture , as well as the drainage bag and drainage tube mouth bacteria culture positive rate increase .Therefore, for orthopaedic patients , the plasma drainage tube and disposable drainage bag should be emptied every 24 hours after the measurement of drainage liquid, but do not have to be replaced every 48 hours or every 24 hours.