单孔腹腔镜术前脐部清洁的探讨

单孔腹腔镜术前脐部清洁的探讨 碘伏用于腹腔镜术前脐部消毒时间的探讨 杭州市第一人民医院 倪敏洁 【摘要】 目的 探讨5%碘伏消毒时间对腹腔镜术前脐部消毒的效果。方法 将入住妇科需行腹腔镜手术患者280例随机分为观察组和对照组各140例，对照组采用石蜡油浸泡脐部后，先备皮后清洁脐部，最后用5%碘伏棉签消毒一次。观察组采用同样方法清洁脐部，最后用5%碘伏棉签按压于脐部5分钟。结果 两组脐部清洁效果均较好,术后4天均未出现脐部切口感染;但术前细菌培养显示观察组140例均无细菌生长，对照组均有不同程度的表皮葡萄球菌和棒状杆菌的生长;术后15天电话回访观察组术后脐部皮肤红肿流液发生率显著低于对照组(P<0.01)。结论 5%碘伏棉签消毒并按压脐部5分钟用于腹腔镜术前脐部皮肤清洁对皮肤刺激性小，安全，能更有效地预防脐部创口皮肤感染。 【关键词】 脐 碘伏 消毒时间 腹腔镜手术因其具有创伤小、出血少，恢复快等优点，临床已广泛应用。腹腔镜手术的入口之一是脐孔，术前对脐部的清洁要求也较传统开腹手术高，但目前的教科书中没有腹腔镜手术脐部消毒的特别 规定 关于下班后关闭电源的规定党章中关于入党时间的规定公务员考核规定下载规定办法文件下载宁波关于闷顶的规定 ，只是沿用常规皮肤准备的方法:脐部采用石蜡油清除污垢，再用5%碘伏消毒一次。在临床实践中发现病人术后4天脐部未出现感染现象，但在术后15天电话回访中有8%的病人自述出现不同程度的脐部红肿、流液现象，建议此类病人来院复查，确定有感染现象，予5%碘伏棉球敷与脐部，每日更换一次，一周后复查均治愈。鉴此，ncluding based life support (BLS), and senior heart life support (ACLS), and based trauma life support (BTLS) and senior trauma life support (ATLS) of based knowledge; common emergency technology of application; common emergency of causes identification, and clinical performance and the processing specification; common emergency auxiliary check of select refers to levy, and results judge and the clinical meaning; Indications, effects of common emergency drugs, side effects, as well as specific applications (medicine, for expansion of vasoactive drugs, cardiac diuretic, antispasmodic and anti-asthmatic drugs, analgesic drugs, Hemostatic, antiarrhythmic drugs, such as Cortina). Understand: the new development of the theory of life support; cardiac respiratory and cardiopulmonary resuscitation after cardiac syndrome etiology, pathophysiology, clinical manifestations, diagnosis, and treatment. 2. basic requirements (1) species and cases of study requirements: disease disease fever acute abdominal pain chest pain and difficulty breathing faint coma shock in acute poisoning with cardiac respiratory arrest bleeding (hemoptysis, hematemesis, hematuria, etc) requires at least 45 cases of arrhythmia. (2) basic skills requirements name name heart lung 我科改进了腹腔镜手术患者术前的脐部消毒方法，即常规清洁脐部后用5%碘伏棉签按压脐部 5分钟，效果满意， 报告 软件系统测试报告下载sgs报告如何下载关于路面塌陷情况报告535n,sgs报告怎么下载竣工报告下载 如下。 1 资料与方法 1.1 一般资料 选择2009年1~9月入住妇科需行腹腔镜手术，无糖尿病等 合并症的患者280例，年龄15~45岁、平均25.0岁。其中卵巢囊 肿130例，不孕症50例，子宫肌瘤82例，其他18例。脐部浅型 (深度<0.5 cm,脐部平坦，肉眼可观脐孔底部)89例，中脐型(深度 0.5~1.0 cm,但肉眼可观脐孔底部)93例，深脐型(深度>1.0 cm,脐孔 较陷，肉眼无法直观脐孔底部)88例。将患者随机分为观察组及 对照组各280例，两组病种、年龄、脐部深浅比较，差异无显著 性意义(均P>0.05)，有可比性。 1.2 方法 1.2.1 脐部清洁方法:术前1 天观察组采用石蜡油浸泡脐部后先备皮后清洁脐部，最后用5%碘伏棉签按压脐部5分钟;对照组采用石蜡油浸泡脐部后先备皮后清洁脐部，用5%碘伏棉签消毒一次。 1.2.2 评价 LEC评价法下载LEC评价法下载评价量规免费下载学院评价表文档下载学院评价表文档下载 方法: 1.2.2.1脐部清洁后即刻观察脐部皮肤不良反应(脐部红肿、疼痛)发生情况。 1.2.2.2术后15天脐部皮肤不良反应(脐部出现红肿、流液等)发生情况及术后脐部切口感染情况。 ncluding based life support (BLS), and senior heart life support (ACLS), and based trauma life support (BTLS) and senior trauma life support (ATLS) of based knowledge; common emergency technology of application; common emergency of causes identification, and clinical performance and the processing specification; common emergency auxiliary check of select refers to levy, and results judge and the clinical meaning; Indications, effects of common emergency drugs, side effects, as well as specific applications (medicine, for expansion of vasoactive drugs, cardiac diuretic, antispasmodic and anti-asthmatic drugs, analgesic drugs, Hemostatic, antiarrhythmic drugs, such as Cortina). Understand: the new development of the theory of life support; cardiac respiratory and cardiopulmonary resuscitation after cardiac syndrome etiology, pathophysiology, clinical manifestations, diagnosis, and treatment. 2. basic requirements (1) species and cases of study requirements: disease disease fever acute abdominal pain chest pain and difficulty breathing faint coma shock in acute poisoning with cardiac respiratory arrest bleeding (hemoptysis, hematemesis, hematuria, etc) requires at least 45 cases of arrhythmia. (2) basic skills requirements name name heart lung 1.2.2.3观察组脐部5%碘伏棉签按压5分钟后用消毒棉签蘸生理盐水擦拭脐部后送细菌培养;对照组脐部5%碘伏棉签消毒后用同样方法送细菌培养。培养皿为沙保弱氏培养皿。 1.2.3 统计学方法:采用χ2检验和四格表确切概率法。 2 结果 2.1 见表1两种方法脐部消毒后脐部不良反应及脐部感染比较 组别 即刻 术后15天 合计 观察组 12 1 13 对照组 14 15 29 合计 26 16 42 χ2=7.38, P<0.01,差异有显著性意义。两组术后4天脐部切口均无感染。 2.2 两种方法脐部消毒后细菌培养结果比较:观察组均无细菌生长，有效率为100%;而对照组均有不同程度的表皮葡萄球菌和棒状 -86杆菌生长。经确切概率法计算得P=6.1*10,远小于0.01，差异有显著性意义。 3 讨论 3.1脐部存在大量表皮葡萄球菌和棒状杆菌。 通过电话回访和复查发现腹腔镜术后15天发生脐部红肿、流液的病人较多，而腹腔镜其他创口无此现象，分析可能的原因认为:较多人对脐部清洁的错误认识和术前脐部消毒不彻底造成的，认为脐ncluding based life support (BLS), and senior heart life support (ACLS), and based trauma life support (BTLS) and senior trauma life support (ATLS) of based knowledge; common emergency technology of application; common emergency of causes identification, and clinical performance and the processing specification; common emergency auxiliary check of select refers to levy, and results judge and the clinical meaning; Indications, effects of common emergency drugs, side effects, as well as specific applications (medicine, for expansion of vasoactive drugs, cardiac diuretic, antispasmodic and anti-asthmatic drugs, analgesic drugs, Hemostatic, antiarrhythmic drugs, such as Cortina). Understand: the new development of the theory of life support; cardiac respiratory and cardiopulmonary resuscitation after cardiac syndrome etiology, pathophysiology, clinical manifestations, diagnosis, and treatment. 2. basic requirements (1) species and cases of study requirements: disease disease fever acute abdominal pain chest pain and difficulty breathing faint coma shock in acute poisoning with cardiac respiratory arrest bleeding (hemoptysis, hematemesis, hematuria, etc) requires at least 45 cases of arrhythmia. (2) basic skills requirements name name heart lung 窝是身体的要害，是保存元气的地方，平时不刻意去清洁，积垢较多，有研究表明，术前脐部细菌检出率为100%，菌种共15种，其中以 [1]金黄色葡萄球菌、表皮葡萄球菌占多数。本文结果对照组均有不同程度的表皮葡萄球菌和棒状杆菌生长，以大量的表皮葡萄球菌为主。表皮葡萄球菌是滋生于生物体表皮上的一种细菌。在人体的皮肤，阴道等部位寄生，属正常菌群类型。是一群革兰氏阳性球菌，葡萄球菌是最常见的化脓性球菌，是医院交叉感染的重要来源。由此可见，加强术前脐部皮肤护理，保证脐部皮肤清洁、干燥在预防腹腔镜术后脐部感染中尤其重要。 3.2碘伏用于腹腔镜术前脐部消毒的时间长短是预防脐部感染的关键。碘伏又称聚维酮碘,是聚乙烯吡洛烷酮与碘的复合物,含有效碘5%.碘伏原液深棕色,气味小,水溶性好,着色浅,性质稳定; 通过释放单质碘(I2),结合菌体蛋白质的氨基酸使细菌变性.同时氧化细菌原浆 [2]蛋白的活性基团,导致微生物死亡。具有广谱、高效杀菌作用、且低毒、使用方便，它对病毒、细菌、真菌、芽胞、原虫及霉菌、孢子都有较强的杀灭作用;同时碘伏还有止血消肿、促进创面干燥、组织 [3]再生功能;其在局部可形成一层灭菌保护膜，防止创面感染的发生;本文结果1提示，观察组和对照组在用碘伏后分别有12例和14例患者局部皮肤发红，结果相近。分析其原因是患者脐孔较深、污垢较多，擦拭时用力较大所致。临床观察表明，对此类患者，取较多石蜡油浸泡，使污垢完全浸软后再轻柔擦拭，可防止因为外力因素造成的皮肤红肿。本文结果提示，两组术前脐部细菌培养结果和术后15天电话ncluding based life support (BLS), and senior heart life support (ACLS), and based trauma life support (BTLS) and senior trauma life support (ATLS) of based knowledge; common emergency technology of application; common emergency of causes identification, and clinical performance and the processing specification; common emergency auxiliary check of select refers to levy, and results judge and the clinical meaning; Indications, effects of common emergency drugs, side effects, as well as specific applications (medicine, for expansion of vasoactive drugs, cardiac diuretic, antispasmodic and anti-asthmatic drugs, analgesic drugs, Hemostatic, antiarrhythmic drugs, such as Cortina). Understand: the new development of the theory of life support; cardiac respiratory and cardiopulmonary resuscitation after cardiac syndrome etiology, pathophysiology, clinical manifestations, diagnosis, and treatment. 2. basic requirements (1) species and cases of study requirements: disease disease fever acute abdominal pain chest pain and difficulty breathing faint coma shock in acute poisoning with cardiac respiratory arrest bleeding (hemoptysis, hematemesis, hematuria, etc) requires at least 45 cases of arrhythmia. (2) basic skills requirements name name heart lung 回访发生脐部不良反应，观察组脐部均显著低于对照组(P<0.01)。有研究数据表明，用布片作染菌载体进行碘伏杀菌的效果试验，结果示:以含有效碘600 mg/L的碘伏溶液,对布片上金黄色葡萄球菌、大 [4]肠杆菌作用5分钟,杀灭率达100,。于本文结果相同。 4 小结 5%的碘伏适用于腹腔镜术前的脐部消毒，而5分钟的碘伏消毒时间是有效杀灭脐部细菌和预防术后脐部感染的关键。 【参考文献】 [1] 禹跃海.术前备皮与腹部切口感染的探讨[J].青海医药杂志，1996，26(3):15 16. [2]王长虹 强力碘稳定性的实验考察 1994(02) [3] 陈嘉凤.碘伏在儿科皮肤护理中的应用[J].南方护理学报，2002，9(1):49. [4] 薄玉霞 王歆宇 刘吉起，等 .两种方法检测碘伏杀菌效果的比较 中国消毒学杂志, 2002-04-014 ncluding based life support (BLS), and senior heart life support (ACLS), and based trauma life support (BTLS) and senior trauma life support (ATLS) of based knowledge; common emergency technology of application; common emergency of causes identification, and clinical performance and the processing specification; common emergency auxiliary check of select refers to levy, and results judge and the clinical meaning; Indications, effects of common emergency drugs, side effects, as well as specific applications (medicine, for expansion of vasoactive drugs, cardiac diuretic, antispasmodic and anti-asthmatic drugs, analgesic drugs, Hemostatic, antiarrhythmic drugs, such as Cortina). Understand: the new development of the theory of life support; cardiac respiratory and cardiopulmonary resuscitation after cardiac syndrome etiology, pathophysiology, clinical manifestations, diagnosis, and treatment. 2. basic requirements (1) species and cases of study requirements: disease disease fever acute abdominal pain chest pain and difficulty breathing faint coma shock in acute poisoning with cardiac respiratory arrest bleeding (hemoptysis, hematemesis, hematuria, etc) requires at least 45 cases of arrhythmia. (2) basic skills requirements name name heart lung