拔除导尿管时间对骨科术后患者排尿情况及舒适度的影响

Influence of extubation time of urinary catheter on post-operational urination and comfort degree of patients with orthopedic surgery

目的 探讨拔除导尿管时间对骨科术后患者排尿情况及舒适度的影响,明确骨科术后患者拔除导尿管的最佳时机.方法 采用方便抽样法,选取2016年4—6月河北医科大学第三医院骨科收治并行手术的900例患者为研究对象,按照拔除导尿管时间分为A、B、C三组,每组300例.A组患者手术次日晨（术后12~24 h）拔除导尿管,B组患者术后6 h拔除导尿管,C组患者术后2 h拔除导尿管,比较三组患者拔除导尿管后排尿成功率、膀胱刺激征及急性尿潴留发生率、留置导尿管舒适度.结果 三组患者排尿成功率、尿频、尿急、尿痛及急性尿潴留的发生率,差异均有统计学意义（P〈0.05）,两两比较结果显示,A组、B组患者排尿成功率高于C组,急性尿潴留发生率低于C组,差异均有统计学意义（P〈0.05）,A组患者尿频、尿急、尿痛发生率高于B组、C组,差异有统计学意义（P〈0.05）;三组患者留置导尿管舒适度差异有统计学意义（P〈0.05）,两两比较结果显示,B、C组患者Ⅱ度不舒适发生率小于A组,C组患者Ⅲ度不舒适发生率小于A、B组,差异均有统计学意义（P〈0.05）.结论 骨科患者术后6 h是拔除导尿管的最佳时机,可以提高排尿成功率,降低置管尿道刺激症状,减少拔管后的膀胱刺激征.

Objective To explore the influence of extubation time of urinary catheter on post-operational urination and comfort degree of patients with orthopedic surgery, so as to and make clear the best extubation time of urinary catheter for them. Methods 900 patients treated with operation in Department of Orthopaedics in the Third Hospital of Hebei Medical University from April to June in 2016 were selected by convenience sampling and divided, according to extubation time of urinary catheter, into group A, B and C, each with 300 cases. For patients in group A, urinary catheters were removed in the morning the day after the operation（12~24 h after operation）, while in group B, 6 h after, and in group C, 2 h after. Rate of successful urination after extubation of urinary catheter, bladder discomfort, incidence rate of acute urinary retention and comfort degree of indwelling catheter in the three groups were compared. Results Difference in rate of successful urination and incidence rate of frequent micturition, urgent urination, micturition pain and acute urinary retention of patients in the three groups showed statistic significance （P〈0.05）. It was shown in pairwise comparison that rates of successful urination in group A and B were higher than that in group C, while incidence rates of acute urinary retention were lower （P 〈 0.05）, and that incidence rate of frequent micturition, urgent urination and micturition pain in group A was higher than that in group B and C （P〈0.05）. Difference in comfort degree of indwelling catheter in the three groups showed statistic significance （P 〈 0.05）. Incidence rates of discomfort in degree Ⅱ in group B and C were less than that in group A, while incidence rate of discomfort in degree Ⅲ in group C was less than that in group A and B （P〈0.05）. Conclusions For orthopedic patients,the best extubation time of urinary catheter is 6 h after the operation, which helps to raise rate of successful urination, lower urethra irritative symptoms due to cathetering, and reduce bladder discomfort after extubation.