颅脑肿瘤患者术前留置尿管与术后拔除尿管的最佳时机探讨

A clinical investigation of its best indwelling and removal catheter time in patients with brain tumors

目的探讨颅脑肿瘤患者术前留置尿管与术后拔除尿管的最佳时机。方法将2009年11月至2012年11月就诊的颅脑肿瘤患者63例随机分为3组,每组21例。3组患者均术前留置尿管,其中A组患者留置尿管后不行常规会阴部冲洗,B组患者留置尿管后遵循医嘱常规行会阴部冲洗每天2次,C组患者留置尿管后在常规会阴部冲洗的基础上与尿管护理相结合,3组患者均在术后麻醉复苏前拔除尿管。术后主要观察尿潴留、膀胱刺激征是否发生以及术后1、3、7d尿中白细胞的改变。结果所有63例患者术后均能在拔除尿管后自行排尿,其中A组患者术后发生膀胱刺激征者8例,与术前比较,差异有统计学意义(P<0.05),术后1、3和7d,尿中白细胞>10/HP者分别为3、5和4例,与术前比较,差异无统计学意义(P>0.05)。B组患者术后发生膀胱刺激征者7例,与术前比较,有统计学意义(P<0.05),术后1、3和7d,尿中白细胞>10/HP者分别为2、4和4例,与术前比较,差异无统计学意义(P>0.05)。C组患者术后发生膀胱刺激征者3例,术后1、3和7d,尿中白细胞>10/HP者分别为2、3和1例,与术前比较,差异均无统计学意义(P>0.05)。结论颅脑肿瘤手术患者,术前麻醉后留置尿管、术后麻醉复苏前拔除尿管,不会对患者的自行排尿造成困难,且能最大限度的减少尿路感染的发生。其中留置尿管后在常规会阴部冲洗的基础上与尿管护理相结合可以进一步控制尿路感染。

Objective To investigate brain tumor patients before and after removal of catheter in- dwelling catheter and the best time. Methods From November 2009 to November 2012, 63 patients with intracranial tumors were randomly divided into three groups： three groups of patients had preoperative in- dwelling catheter, wherein A group of 21 patients with indwelling catheter after no routine perineal washing, B group of 21 patients with indwelling catheter after compliance conventional guild pudendal washing daily two times, C group of 21 patients after indwelling catheter in routine perineal irrigation based on combined with catheter care, three groups were in the postoperative recovery of anesthesia before removal of urinary catheter. The main postoperative urine retention, bladder irritation whether the occurrence and after 1, 3, 7d in urine white blood cell change. Results All the 63 patients were in the catheter itself after voiding, where A group of 21 patients the incidence of postoperative bladder irritation syndrome 8 cases, compared with the preoperative, with statistical significance （P 〈 0.05） , after 1, 3, 7d, urine leucocyte 〉 10/HP respectively is 3, 5, 4 cases, compared with the preoperative, no statistical significance （ P 〉 0. 05 ）, B group of 21 patients the incidence of postoperative bladder irritation syndrome 7 cases, compared with the preoperative, with statistical significance （P 〈 0. 05 ）, after 1,3, 7d, urine leucocyte 〉 10/HP respective- ly 2, 4, 4 cases, compared with the preoperative, no statistical significance （ P 〉0. 05）, C group of 21 patients the incidence of postoperative bladder irritation syndrome 3 cases, after 1, 3, 7d, urine leucocyte 〉 10＇ HP were 2, 3 and 1 cases, compared with the preoperative, no statistical significance （P 〉 0. 05 ）. Conclusions Brain tumor operation patients, preoperative indwelling catheter after anesthesia, postopera- tive recovery of anesthesia catheter for patients before, not self-propelled voiding difficulties, and can mini- mize the occurrence of urinary tract infection. Which after indwelling catheter in routine perineal washing basis with catheter care can be combined to further control of urinary tract infection.