下肢初次关节置换术中不留置导尿管的意义及研究现状

Research status of primary lower limb arthroplasty without indwelling urinary catheter

下肢关节置换术前常规导尿被广泛应用,但留置尿管作为一种侵入性操作,与尿路及关节假体感染密切相关,同时还可引起患者不适、妨碍早期活动、延长住院时间,增加尿道损伤、静脉血栓等并发症的风险。近年来,加速康复外科(enhanced recovery after surgery,ERAS)、麻醉及关节置换手术技术发展迅速,手术时间明显缩短,患者生命体征得到保障。多项研究表明,通过术前筛选尿潴留高危患者、卧床排尿训练、麻醉前排空膀胱、控制并监测术中及术后危险因素,同时结合膀胱扫描仪,在保证术后未留置尿管患者安全性的同时,可使绝大部分下肢初次关节置换患者避免导尿,这对减少不必要的导尿及其相关并发症具有重要临床意义。本文就近年来下肢初次关节置换术中不留置尿管的相关文献进行分析并展开综述。

Preoperative indwelling urinary catheter is widely used in joint replacement of lower limb, but it shows signifi- cant associations with urinary tract and periprosthetic joint infections as an invasive procedure. In addition, it can cause dis- comfort, prevent early activity, prolong hospital stays, and increase risks of urethral injury and venous thrombosis. With the development of enhanced recovery after surgery （ERAS）, anesthesia and operative techniques, surgical time is shortened and operative safety is guaranteed. So most of the urethral catheterization is becoming increasingly unnecessary. A number of studies have shown that, the vast majority of patients who received primary lower limb arthroplasty can safely avoid cath- eterization by excluding those with high risks of urinary retention before surgery, preoperative voiding training in bed, emp- tying their bladder before anesthesia, controlling intraoperative and postoperative risk factors, ultrasound scanner to monitor bladder volume. In this paper, we will summarize the current research on primary lower limb arthroplasty without indwell- ing urinary catheter by reviewing and analyzing literatures.