老年人工关节置换术后拔除尿管时间选择与感染的研究

Study of best timing of early extubation of urinary catheter to prevent urinary system infections in elderly population after joint replacement

目的探讨老年患者人工关节置换术后早期拔除尿管预防泌尿系感染的最佳时间,以降低老年人工关节置换术后患者泌尿系统的感染发生率。方法选取2011年9月-2012年4月住院行人工关节置换手术患者120例,随机分为3组,每组40例,分别在术后12、24、36h拔除尿管,拔管前2h夹闭尿管后拔除尿管,协助排尿;比较术后早期拔除尿管首次排尿情况和泌尿系统感染的发生率。结果术后36h拔除尿管40例患者中有3例发生泌尿系感染,发生率为7.5%,术后12h及24h拔除尿管组无泌尿系统感染发生,3组比较差异有统计学意义(P<0.05);40例患者中术后36h拔除尿管有3例再次导尿,发生率为7.5%,12h拔除尿管有2例再次导尿,发生率为5%,24h拔除尿管有1例再次导尿,再次导尿率为2.5%,差异无统计学意义。结论人工关节置换术后第12h及第24h拔除尿管与第36h拔管相比,可以明显降低患者泌尿系统感染率,人工关节置换手术后留置尿管时间可以缩短至术后第12h。

OBJECTIVE To investigate the best timing of early extubation in elderly population after artificial joint replacement so as to reduce the incidence of urinary tract infections after the artificial joint replacement.METHODS A total of 120 hospitalized patients,who underwent the artificial joint replacement from Sep 2011 to Apr 2012,were selected as the study objects and were randomly divided into three groups with 40 cases in each.The extubations of the indwelled urinary catheter of the three groups were conducted respectively at the 12 hours,24 hours and 36 hours after the operation.The catheters were extubated 2 hours before clipping the catheters so as to assist the urination.The first urination after the extubation of the catheters and the incidence rates of the urinary tract infections between the two groups were compared.RESULTS There were 3 patients with urinary tract infections among 40 patients with the catheters extubated 36 hours after the surgery,the incidence rate was 7.5%.There were no cases with urinary tract infections in the extubation group 12 hours or 24 hours after the surgery,the difference among the three groups was statistically significant（P0.05）.There were 3 of 40 cases who were taken with re-urination at 36 hours after the surgery with the incidence of 7.5%,2 cases taken with re-urination at 12 hours after the surgery with the incidence of 5%,and 1 case taken with re-urination at 24 hours after the surgery with the incidence of 2.5%,the difference was not statistically significant.CONCLUSION The early extubation of indwelled urinary catheter at 12 hours or 24 hours after the joint replacement can,as compared with the early extubation of indwelled urinary catheter at 36 hours,markedly reduce the incidence rate of the urinary tract infections,and the indwelling catheterization time can be shortened to 12 hours after the artificial joint replacement.