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目的了解乳癌改良根治术(MRM)后留置引流病原菌感染现状,分析其原因,并探讨预防对策。方法每例患者术后24 h分别从胸肋部和腋窝部留置管负吸瓶内抽取引流液做细菌培养,检出的病原菌用ATB细菌仪鉴定到种。结果2005-2007年接受MRM后留置引流管的患者152例,有52例患者的70份引流液标本培养阳性,总阳性率34.2%;共检出各种病原菌70株,病原菌构成以革兰阳性球菌为主(40株,占57.1%),其次是革兰阴性杆菌(24株,占34.3%)和真菌(6株,占8.6%);引流液染菌的原因包括患者免疫防御屏障削弱、引流管的设置给环境病原菌提供了入侵的机会,无菌操作不严格、皮肤消毒不严密、引流不通畅等。结论手术期间必须保持手术室无菌环境,严格无菌操作,引流通畅、有效,严格控制留管时间,是预防术后引流感染的主要对策。
Objective To understand the status of pathogens in indwelling drainage after modified radical mastectomy (MRM), analyze the causes and discuss the preventive strategies. Methods Twenty-four hours after operation, each patient was drained with drainage fluid from the suction tube of the thoracic and axillary branches, and the pathogen was detected by ATB bacteria instrument. Results In 2005-2007, 152 patients were admitted with drainage tube after MRM. In 70 of 52 patients, 70 samples of drainage fluid were positive for culture, with a total positive rate of 34.2%. A total of 70 pathogenic bacteria were detected and the pathogens were gram positive (40, accounting for 57.1%), followed by Gram-negative bacilli (24 strains, accounting for 34.3%) and fungi (6 strains, accounting for 8.6%). Drainage fluid causes include immunocompromised barrier weakening, The setting of the drainage tube provides opportunities for invasion of environmental pathogens, aseptic operation is not strict, skin disinfection is not tight, drainage is not smooth and so on. Conclusions During the operation, the aseptic environment of the operating room must be maintained. The strict aseptic operation, smooth drainage, effective control and strict control of the tube-keeping time are the main measures to prevent postoperative drainage and infection.