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剖胸术后下呼吸道菌群变化的分析及护理 |
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李艳春1 张淑香1 关亚欣1 刘智鑫2
1 白求恩医科大学第一临床学院，长春 130031
2 中国人民解放军第208医院，长春 130062
摘要 对37例剖胸手术患者术前及术后第3 d痰标本进行细菌培养。结果表明，术前37例在气管插管前后，取下呼吸道分泌物作细菌培养，无1例致病菌或条件致病菌生长；而术后第3 d取痰培养，17例阳性，占45.9%。其中有革兰氏阴性杆菌12例，占菌种的70.6%，革兰氏阳性球菌5例，占29.4%。以重度吸烟及有慢性支气管炎病史者阳性率更高。据此制定出相应护理措施，加强术前、术后呼吸道管理，减少了下呼吸道感染机率。
关键词 剖胸手术； 下呼吸道感染； 细菌培养； 护理
Observation on the Flora Changes in Lower Respiratory Tract
after Thoracotomy and Nursing
Li Yanchun Zhang Shuxiang Guan Yaxin Liu Zhixin
The First Clinical Hospital of Norman Bethune University of
Medical Sciences, Changchun 130031
Abstract The sputum bacteria culture of 37 patients with thoracotomy was performed before operation, and at the postoperative 3rd day. The samples were obtained from the secretion in lower respiratory tract through the insertion of a endotrachea tube. It was found that no pathogenic or conditioned pathogenic bacteria was grown in the culture in the 37 patients before the operation. However, after the operation, bacteria culture were positive in 17 cases(45.9%). The cultured bacteria included gram-positive in 12 cases (70.6%) and gram-negative in 5 cases (29.4%). The patients with chronic bronchitis and smoking had a higher positve rate. According to the results, appropriate nursingmeasures were worked out, including strengthening themanagement of lower respiratory tract pre- and post-operatively to reduce the opportunity of infection of lower respiratory tract.
Key words thoracotomy; infection of lower respiratory tract; bacteria culture; nursing
下呼吸道感染是胸部手术后常见并发症之一，我院1995年2～6月，对37例剖胸手术患者采集术前及术后第3 d痰标本分别进行细菌培养分析，根据下呼吸道菌群变化情况，有针对性地治疗护理，为有效防治剖胸术后发生下呼吸道感染提供依据。报告如下。
1 临床资料与方法
1.1 观察对象 37例中男25例，女12例，年龄21～75岁。有慢性支气管炎病史者10例，但全组病例术前均无肺内感染的临床表现，术前未用抗生素，术后常规预防感染用氨基苄青霉素，6g/d，分2次静脉点滴或用先锋霉素Ⅴ，5g/d，静脉点滴。
1.2 标本采集方法 ①术前标本采集。行剖胸手术前，全身麻醉下行气管插管后，立即将长约50 cm的细塑料管插入气管插管内40～50 cm，然后将纤维支气管镜配套使用的支气[1] [2] 下一页
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