膀胱内注药联合脉冲按摩预防拔管后尿潴留的临床研究

Clinical study on intra-bladder medication infusion combined with pulse massage to prevent on urine retention of patients after catheter pull-out

[目的 ]探讨预防和减少留置尿管病人拔管后尿潴留的方法。 [方法 ]将 94例留置尿管病人随机分为两组。对照组按传统方法进行拔管 ;观察组在拔管前夹闭导尿管使膀胱充盈 ,病人感到腹胀后放尿 10 0mL～ 15 0mL ,再次夹闭尿管 ,用电脑脉冲按摩治疗仪按摩 2 0min后放空膀胱内尿液 ,将2 %利多卡因 2 .5mL、氧氟沙星 0 .2g加入 0 .9%氯化钠 10 0mL中全部滴入膀胱 ,消毒尿道口 ,拔管。 [结果 ]观察组排尿顺利和较顺利者为97.3 6% ,对照组则为 70 .2 1% ,两组比较有统计学意义 (χ2 =13 .41,P <0 .0 0 5 ) ;拔管后首次排尿时间 <3h的病人 ,观察组比对照组多 ,两组比较有统计学意义 (χ2 =19.66,P <0 .0 0 5 )。拔管后排尿伴尿道口疼痛症状观察组明显少于对照组 ,两组比较有统计学意义 (χ2 =17.84,P <0 .0 0 5 )。 [结论 ]留置尿管拔管前采取膀胱内注药和电子脉冲按摩 ,能消除或减轻排尿时尿道口伴随的疼痛或不适 ,有效地预防和减少留置尿管拔管后尿潴留的发生。

Objective: to probe into the way on preventin g and reducing urine rete ntion for patients after catheter pulling-out. Method: a total of 94 cases with indwelling catheter were divided into test and control groups randomly. Patients of control group pulled out the catheter in traditional way. While patients of test group would keep their bladder engorging before pulling-out catheter. Until patients felt abdominal distension, 100 mL～150 mL urine was discharged, cathet er was re-clipped.Then computer pulse massage therapy apparatus was used t o massage the lower abdomen of patients for 20 minutes after fully emptied their bladder. Afterwards, 2% lidocaine 2.5 mL, Ofloxacin 0.2 g mixed with 0.9% natri um chloride 100 mL were dripped into bladder.Urethral orifice of patients was di si nfected and then catheter was pulled out. Result: 97.36% of cases in test group had voided smoothly. Only 70.21% of control group cases passed urine smoothly. T here was statistical difference between the two groups (χ2=13 .41,P<0.005). Comparatively more patients in test group passed u rine within 3 hours after pulling out of catheter. There was statistical differe nce between the two groups(χ2=19.66,P<0.005). Less patients of test group de veloped accompanying urethral orifice pain as they were voiding. There was stati stical significance compared to control group (χ2=17.84, P<0.0 05). Conclusion: for patients with indwelling catheter, to give intra-bladder me dication infusion combined with pulse massage before catheter pulling-out could red uce or even eliminate their urethral orifice pain and indisposition as they pass ing urine. It could effectively prevent or reduce urine retention of them after the pulling out of catheter.