对妇科全身麻醉手术患者留置导尿时机的研究

Investigation on the ideal timing of urinary catheterization for perioperative gynecological patients under general anesthesia

目的:研究妇科全身麻醉患者留置导尿的最佳时机。方法:对导尿管的插管时机进行对比研究,将100例行择期妇科全身麻醉下手术患者随机分为三组,即全身麻醉诱导前导尿组,全身麻醉诱导中导尿组,全身麻醉诱导后导尿组,观察各组留置导尿时患者舒适度、血压、心率变化,以及麻醉苏醒期躁动发生率、术后患者整体舒适度等。结果:全身麻醉诱导后导尿组血流动力学变化少,与全身麻醉诱导前导尿组比较,差异有统计学意义(P<0.05);全身麻醉诱导后导尿组与全身麻醉诱导中导尿组比较,差异有统计学意义(P<0.05),全身麻醉诱导中导尿组心率最快;三组在麻醉苏醒期躁动发生率无区别,差异无统计学意义(P>0.05);术后24小时和术后48小时对留置导尿的舒适度评分比较差异无统计学意义(P>0.05)。结论:妇科全身麻醉手术患者插导尿管的最佳时机是在全身麻醉诱导后,因此建议妇科全身麻醉手术患者留置导尿应选择在全身麻醉诱导后插导尿管。

Objective To determine the ideal timing of urinary catheterization for perioperative gynecological patients under general an- esthesia. Method Total 100 patients sehedualed for elective gynecological procedure under general anesthesia were randomized into 3 groups based on the time of urinary catheter indwelling group before, during or after general anesthesia induction. The degree of comfort which was evaluated with visual analog score （VAS）, blood pressure and heart rate were observed during and after catheteriza- tion. Emergence delirium was also observed for all patients. Results Hemodynamic was more stable in the patients who were catheterized ＂af- ter anesthesia induction compared with the patients catheterized before anesthesia induction （ P 〈 0. 05 ）. The heart rate was changed most significantly in the patients catheterized during anesthesia induction among groups （ P 〈 0. 05 ） ; No differences in emergence delirium and degree of comfort at 24 h and 48 h after operation were found among groups （ P 〉 0.05）. Conclusion Urinary catheterization after anesthe- sia induction minimizes the hemodynamic changes and increases the degree of comfort, and do not increase the rate of emergence deliri- um. Whereas heart rate changes happens more frequently in patients catheterized during anesthesia induction. The time after anesthesia in- duction is recommended as an ideal timing of urinary catheterization for perioperative gynecological patients under general anesthesia.