肺部围手术期导尿管管理策略的前瞻性研究

Pulmonary perioperative catheter management strategy:aprospective cohort study

目的探讨加速康复外科(ERAS)实践中肺部围手术期患者的导尿管管理策略。方法前瞻性纳入2017年3—5月在浙江大学医学院附属第一医院普胸外科行胸腔镜辅助手术(VATS)的肺叶切除术患者45例。根据患者入院时住院号随机分为对照组(留置导尿管,n=21)和实验组(包括术中导尿和术后麻醉苏醒前拔除导尿管、围手术期无导尿管,n=24),比较两组患者术前基本资料以及术中(手术时间、输液量和出血量)、术后(尿潴留、尿失禁和尿路感染发生率以及舒适度、下床活动时间和平均住院时间)观察指标的差异。结果两组患者术前基本资料和手术时间、术中输液量比较,差异均无统计学意义(P>0.05);但对照组患者术中出血量明显多于实验组,差异有统计学意义[(83±29)ml vs(60±19)ml,P=0.003]。两组患者术后均无尿潴留情况发生,尿失禁、尿路感染发生率和下床活动时间比较差异也无统计学意义(P>0.05)。实验组患者全身麻醉苏醒后诉尿道刺激发生率明显低于对照组,差异有统计学意义(16.7%vs 47.6%,P=0.025)。实验组术后舒适患者比例显著高于对照组(87.5%vs 42.9%,P=0.002),有尿道症状者比例明显低于对照组(12.5%vs 52.4%,P=0.002),平均住院时间明显短于对照组[(5.0±1.6)d vs(6.3±2.1)d,P=0.021]。结论肺部手术患者围手术期无留置导尿或者仅术中导尿未增加尿潴留及尿失禁的发生率,并且可缩短住院天数,提高患者的术后舒适度和快速康复。

Objective To explore the management strategy of urinary perioperative catheter in Enhanced Recovery After Surgery(ERAS)practice.Methods A total of 45 patients underwent thoracoscopic surgery(VATS)with lobectomy in the General Hospital of Zhejiang University Medical College from March to May in 2017.The patients were divided into control group(n=21)and experimental group(n=24).The two groups indicators of intraoperative(operation time,infusion volume and bleeding volume)and postoperative(Urinary retention,urinary incontinence and urinary tract infection incidence and comfort,time to get out of bed and average hospital stay)were observed and compared.Results There was no statistical significant difference between the two groups in the basic data operation time and intraoperative infusion volume(P>0.05).However,the blood loss in the control group was significantly higher than that in the experimental group,the difference was statistically significant[(83 ± 29)ml vs(60 ± 19)ml,P = 0.003].There was no urinary retention in the two groups,and the incidence of urinary incontinence,urinary tract infection and time of getting out of bed were not statistically significant(P>0.05).The incidence of urinary tract irritation was significantly lower in the experimental group than that in the control group(16.7%vs 47.6%,P=0.025;87.5%vs42.9%,P=0.002).The proportion of patients with urethral symptoms was significantly lower than that of the control group(12.5% vs 52.4%,P= 0.002),and the average hospitalization time was significantly higher than that of the control group(5.0±1.6)d vs(6.3±2.1)d,P=0.021].Conclusions Urinary retention and urinary incontinence are not increased for the experimental group and the number of days of hospitalization can be shortened,and the postoperative comfort and rapid rehabilitation can be improved.