紫色尿袋症候群：5個案例報告及文獻回顧

Purple Urine Bag Syndrome: A Report of 5 Cases and Review of the Literature

紫色尿袋症候群（purple urine bag syndrome, PUBS）是導尿管留置一段時間後尿袋及尿管變紫色或藍色的現象，此一現象常引起照護者的不安。本文報告4位女性及1位男性居家護理照護病患（平均年齡80歲），長期臥床並合併有慢性便秘及導尿管留置，每2-4星期更換尿管一次，採用塑膠與矽質2種材質，於更換尿管後約5-7天出現紫色尿袋。其尿液本身呈黃褐色，pH值介於7.0-8.0，尿液培養出多重菌種包含：Pseudomonas aeruginosa, Morganella morganii, Escherichia coli, Klebsiella pneumoniae等。五位病患皆未使用抗生素治療，僅予以加強泌尿道照護及改善排便習慣、充足的水份攝取，於出現紫色尿袋立即更換尿管並將更換次數改為2星期一次，PUBS在更換2次後隨即消失。PUBS本身並不是一個疾病，僅是一種現象，可能反應出病人的照護方式極可能有需要加強的地方，如：泌尿道照護是否確實，便秘之處置是否恰當，水份攝取是否充足等。一般僅需針對其危險因子加以處理即可，抗生素之使用咸認並不需要。正確的認識紫色尿袋症候群之後，應可避免許多不必要的抗生素使用及檢驗，建立良好的照護知能才是最好的預防方針。

Purple urine-bag syndrome (PUBS) is a phenomenon in which the contents of urine bags and urinary catheters turn purple or blue following patient catheterization. The condition often causes caregivers tremendous distress. Here we present a case series of such patients: 4 female and 1 male home nursing care patients (mean age=80 years) who were chronically constipated and bed ridden with urinary catheterization, experiencing PUBS for the first time. Urines initially appeared yellowish-brown and had pH values between 7.0 and 8.0. Urine culture yielded multiple bacterial isolates including Pseudomonas aeruginosa, Morganella morganii, Escherichia coli, Klebsiella pneumoniae, etc. These five patients were given additional urinary tract care and bowel care, adequate hydration, and more frequent changes of urinary catheters and bags once PUBS developed. The purple discoloration disappeared after our intervention without antibiotic use. It is apparent that PUBS is not a disease per se. Rather, it is a phenomenon that may reflect the need for review of the patient’s care such as urinary tract and bowel issues and adequate hydration. In general, the best management of PUBS is to focus on eliminating its risk factors. The use of antibiotics is not routinely suggested. With adequate knowledge of PUBS, unnecessary use of antibiotics and laboratory tests can be avoided. Developing good care skills and knowledge is the best prevention strategy for avoiding PUBS.