体位和插入留置导尿管的深度对并发症的影响

Effects of patient position and depth of urinary catheterization on complications

目的探讨体位和插导尿管的深度对一次过置管的影响。方法将2010年8月至2011年8月在神经内科和肾内科住院的132例需要留置尿管的男性老年患者分为对照组（68例）和实验组（64例）。对照组按常规导尿法导尿，并留置导尿管。实验组在对照组的基础上注重体位姿势：协助患者取平仰卧位，臀高（10—20cm）屈膝，可在其臀部垫一软枕，双下肢保持弯屈曲呈钝角微向外展位，以患者舒适为宜。和改变插尿管深度：直插导尿管20～22cm，见尿液流出，再继续插至尿管三叉分头处才注水入囊，再将尿管往外拉至不动为止。观察两组一次过管率。结果观察组插入导尿一次置管率为98．4％，对照组为92．6％，经Wileoxon秩和检验，z=2．489。结论男性老年患者在插导尿管时稍注意体位姿势和将插尿管至三叉分头处才注水入囊，可以提高一次过置管率。

Objective To explore the effect of patient position and depth of urinary catheterization on primary catheter placement. Methods 132 elderly patients who had been hospitalzed during August 2010 to August 2011 in the Department of Neurology and Department of Nephrology who needed urinary catheterization were divided into control group （ 68 patients ） and study group （ 64 patients ）. The control group received conventional urinary catheterization with indwelling catheter. The study group improved postural position, the patient in flat supine with hip elevation （ 10 - 20cm ） and knee bend using a soft pillow under their buttom; the lower limbs remaining bent at an obtuse angle with slight abduction, making patients. The depth of the inserted catheter was changed with a depth of 20 - 22cm. Aftera a flow of urine occurred, the catheter continued to be inserted into the trigeminal ends and water was injected into the sac, then the catheter was pulled until it did not moved. The primary rate of catheterization was observed in the two groups. Results The primary rate of catheterization was 98.4% in the study group and 92.6% in the control group. The Wilcoxon rank-sum test showed Z = 2.489. Conclusions Proper postural position and water injection to the sac of a catheter inserted to its trigeminal ends can increase the primary urinary catheterization in elderly male patients.