择期手术留置导尿时机与术后尿路感染的临床观察

Clinical observation on impact of catheterization timing of elective surgery on postoperative urinary tract infections

目的观察择期手术患者全麻后导尿时机对插管成功率的影响,探讨减少导尿管相关尿路感染的方法,为预防和控制术后尿路感染提供理论依据。方法收集医院术前需留置导尿的患者共180例,随机分为两组,对照组90例,行常规尿道的外口及周围皮肤消毒,按常规无菌技术与麻醉前20min行导尿;试验组90例,常规操作同对照组,于麻醉后20 min行导尿术。结果试验组一次性插管成功率为100.00%,明显高于对照组的96.00%,两组差异有统计学意义(P<0.05);插管后两组患者血压、心率平均值差异均有统计学意义(P<0.01),试验组第2、5、7、10d尿路感染阳性率分别为2.30%、8.00%、23.80%、66.67%,明显低于对照组4.45%、9.30%、25.00%、68.18%,两组差异均有统计学意义(P<0.05),而导尿第13、15天的阳性率结果两组差异无统计学意义。结论麻醉后导尿可以提高插管成功率,是减少早期导尿管相关性尿路感染的一种简便有效的方法。

OBJECTIVE To observe the impact of the catheterization timing on the success of the catheterization of the patients undergoing the elective surgery under general anesthesia and explore the measures to reduce the incidence of the urinary tract infections so as to provide theoretical basis for the prevention and control of postoper-ative urinary tract infections. METHODS A total of 180 patients who needed the catheterization in the hospital were enrolled in the study and were randomly divided into two groups, totally 90 patients in the control group were treated with the conventional urethral mouth and surrounding tube skin disinfection according to conventional aseptic technique and anesthesia in 20 minutes before catheterization line, while 90 patients in the experimental group were treated with the routine operation as same as control group, then the patients were treated with cathe- terization 20 min after anesthesia. RESULTS The rate of successful disposable intubation of the experimental group was 100.00%, significantly higher than 96.00% of the control group , the difference was statistically significant （P〈0.05）. The difference in the blood pressure or the heart rate after the intubation between the two groups was statistically significant （P〈0. 01）. In the experimental group, the positive rates of the urinary tract infections on the 2nd, 5th, 7th, and 10th day were respectively 2.30%, 8. 00%, 23.80%, and 66. 67%, significantly lower than 4.45%, 9.30%, 25.00%, and 68. 18% of the control group, the difference between the two groups was statisticalIy significant （P〈0.05）, but the difference in the positive rate between the 13th and 15th day after the intubation was not statistically significant. CONCLUSION The catheterization after anesthesia can improve the success rate of intubation and is an effective way to reduce the incidence of early catheter-related urinary tract infections.