留置导尿管的拔管时机对降低尿路感染的分析

Effect of timing for extubation of indwelling catheters on reduction of incidence of urinary tract infections

目的比较分析全麻术后留置尿管患者有尿意时拔除尿管与随机拔管的效果,为更好地预防术后留置尿管拔管后排尿困难和尿潴留,减少再次导尿导致尿路感染的发生概率。方法选取2012年1-6月120例全麻术后留置尿管的患者,随机分为试验组和对照组,每组各60例,对照组采取在患者膀胱空虚、无尿意时拔除留置尿管,试验组再随机分为A组和B组,每组各30例,A组在患者有尿意时立即拔除尿管;B组在患者膀胱完全充盈、有强烈尿意时拔除尿管,采用SPSS软件对所有数据进行统计分析。结果两组患者拔除留置尿管后发生尿潴留试验组2例发生率为3.3%,对照组8例发生率为13.3%,试验组尿潴留的发生率明显低于对照组,差异有统计学意义(P<0.05);试验组中A组患者发生尿潴留2例,B组患者无尿潴留发生;A组患者拔管后首次排尿<3h有27例,恢复率为90.0%,B组患者拔管后首次排尿<3h有30例,恢复率为100.0%,B组拔管方法明显优于A组,两组差异有统计学意义(P<0.05)。结论拔除尿管的最佳时机应选择在患者膀胱完全充盈、有强烈尿意时,可有效预防尿潴留,避免再次留置尿管给患者带来痛苦。

OBJECTIVE OBJECTIVE To compare with the effect of extubation when the catheter indwelling patients undergoing general anesthesia feel to urinate and the effect of random extubation so as to prevent postop- erative dysuria and urinary retention and reduce the incidence of urinary catheter-induced infections. METHODS A total of 120 patients who underwent catheter indwelling under general anesthesia from Jan 2012 to Jun 2012 were enrolled in the study and randomly divided into the experimental group and the control group, with 60 cases in each; the patients in the control group were extubated when they felt empty of bladders or did not feel to urinate; the experimental group was further divided into the group A and the group B, with 30 cases in each; the patients in the group A were extubated immediately when having the feelings to urinate, the patients in the group B were extubated when they had the bladders completely filled and had the strong feeling to urinate, and all the data were statistically analyzed with the use of SPSS software. RESULTS After the extubation of indwelling catheter, the uri- nary retention occurred in 2 cases in the experimental group with the incidence of 3.3 % and in 8 cases in the con- trol group with the incidence of 13.3%, the incidence of urinary retention was significantly lower in the experi- mental group than in the control group, the difference was significant （P〈0.05）. In the experimental group, the urinary retention occurred in 2 cases in the group A but did no occur in the control group. There were 27 （90.0%） patients in the group A who urinated for the first time within 3 hours after the extubation and 30 （100.0%） pa- tients in the group B, the extubation method of the group B was significantly better than that of the group A, the difference between the two groups was significant （P〈0.05）. CONCLUSION The optimal timing for the extuba- tion of urinary catheters is at the time when the patients have the bladders completely filled and have the strong feelings to urinate, which can effectively prevent the urinary retention and protect the patients from pain due to the catheter indwelling.