2021 年第 3 期 第 16 卷

癃清片对行输尿管镜碎石术并留置输尿管支架管患者导管相关感染防治效果及支架管细菌生物膜形成的影响

Effect of prevention and treatment of catheter-related infection of Longqing tablets on patients undergoing ureteroscopic lithotripsy with indwelling ureteral stent tube and its influence on bacterial biofilm formation in stent tube

作者：杜震1郑国洋1蔡青2陈山1乔庐东1

英文作者：Du Zhen1 Zheng Guoyang1 Cai Qing2 Chen Shan1 Qiao Ludong1

单位：1首都医科大学附属北京同仁医院泌尿外科100730；2首都医科大学医学实验与测试中心100069

英文单位：1Department of Urology Surgery Beijing Tongren Hospital Capital Medical University Beijing 100730 China; 2Medical Experiment and Test Center Capital Medical University Beijing 100069 China

关键词：导管相关性感染；细菌生物膜；输尿管支架管；癃清片 

英文关键词：Catheter-relatedinfections;Bacterialbiofilm;Ureteralstentstube;Longqingtablets

• 摘要：

• 目的 观察癃清片对行输尿管镜碎石术并留置输尿管支架管患者导管相关感染防治效果及支架管细菌生物膜形成的影响。方法 选取2018年6月至2019年6月于首都医科大学附属北京同仁医院泌尿外科行经尿道输尿管镜碎石取石术并留置输尿管支架管的男性患者120例，采用随机数字表法分为A、B、C、D组，各30例。A组术后第2天至拔管前不服用任何抗菌药物，B组术后第2天至拔管前2 d口服左氧氟沙星，C组术后第2天至拔管前2 d口服癃清片，D组术后第2天至拔管前2 d口服左氧氟沙星和癃清片。比较4组带管期间脓尿、菌尿阳性率，发热发生率以及尿路刺激症状、尿痛、腰痛等症状评分。拔除输尿管支架管后，于扫描电镜下观察4组支架表面生物膜形成情况并进行评分。结果 B组、C组和D组患者带管期间尿路刺激症状评分、尿痛评分均低于A组［4(2，6)、5(3，7)、3(2，6)分比9(6，11)分，2.5(2.0，4.0)、2.5(1.0，3.0)、2.0(1.0，3.0)分比3.5(2.0，5.0)分］（均P<0.05）；B组、C组和D组间两两比较差异均无统计学意义（均P>0.05）。4组腰痛评分、发热发生率、脓尿阳性率、菌尿阳性率和支架管培养阳性率组间两两比较差异均无统计学意义（均P>0.05）。扫描电镜观察显示C组生物膜呈点状散在分布，具有连接膜、基底膜及表层膜完整三层结构。B组、C组和D组患者生物膜评分、生物膜分布评分、生物膜结构评分均低于A组（均P<0.05）；B组、C组和D组间两两比较差异均无统计学意义（均P>0.05）。结论 癃清片可缓解带管期间的尿路刺激症状和尿痛症状，并且能抑制输尿管支架管表面细菌生物膜的形成。

• Objective To observe the effect of prevention and treatment of catheter-related infection of Longqing tablets on patients undergoing ureteroscopic lithotripsy with indwelling ureteral stent tube and its influence on bacterial biofilm formation in stent tube. Methods From June 2018 to June 2019, 120 male patients who underwent transurethral ureteroscopic lithotripsy with indwelling ureteral stent tube in Department of Urology Surgery, Beijing Tongren Hospital, Capital Medical University were selected. They were divided into group A, group B, group C and group D by random number table method, with 30 cases in each group. Group A did not take any antibiotics from the second day after operation to before extubation. Group B was given levofloxacin orally from the second day after operation to 2 d before extubation. Group C was given Longqing tablets orally from the second day after operation to 2 d before extubation. Group D was given levofloxacin and Longqing tablets orally from the second day after operation to 2 d before extubation. The positive rates of pyuria and bacteriuria, the fever incidence and urinary tract irritation, urinary pain and low back pain were compared among the four groups. After removing the ureteral stent tube, the biofilm formation on the stent surface under scanning electron microscope and the corresponding scores were observed and compared among the four groups. Results The scores of urinary tract irritation and urinary pain in group B, group C and group D were lower than those in group A［4(2，6), 5(3，7), 3(2，6) vs 9(6，11); 2.5(2.0，4.0), 2.5(1.0，3.0), 2.0(1.0，3.0) vs 3.5(2.0，5.0)］(all P<0.05); there were no significant differences in pairwise comparisons among group B, group C and group D(all P>0.05). There were no significant differences in low back pain score, fever incidence, pyuria positive rate, bacteriuria positive rate and stent tube culture positive rate among the four groups(all P>0.05). Scanning electron microscopy showed that the biofilms in group C were scattered in the form of dots, with a complete three-layer structure of connective membrane, basement membrane and surface membrane. The scores of biofilm, biofilm distribution and biofilm structure in group B, group C and group D were lower than those in group A(all P<0.05), and there was no significant difference in pairwise comparisons among group B, group C and group D(all P>0.05). Conclusion Longqing tablets can relieve the symptoms of urinary tract irritation and urinary pain, and inhibit the formation of bacterial biofilm on the surface of ureteral stent tube.