定压放尿与定时放尿在急诊重症监护病房老年昏迷患者留置导尿期间的应用效果比较

Comparison of effects of constant pressure urination and timed urination during indwelling catheterization in elderly patients with coma in emergency intensive care unit

目的探讨定压放尿与定时放尿在EICU老年昏迷患者留置导尿期间的应用效果比较。方法采用便利抽样法,选取2015 年1 月—2017 年6 月在湖州师范学院附属第一医院急诊重症监护病房(EICU)的昏迷患者100 例为研究对象。将2015 年1 月—2016 年3 月收治的49 例患者设为对照组, 2016 年4 月—2017 年6 月收治的51 例患者设为试验组。对照组每3~4 小时开放尿管放尿1 次,试验组患者通过压力监测装置持续膀胱压力监测,当压力升到12 cmH2O时开放尿管放尿。比较两组患者拔管后首次自主排尿时间、再次留置导尿率、留置导尿相关性尿路感染(CAUTI)发生率。结果试验组患者首次排尿时间、首次排尿量、拔管后再插管率等方面均优于对照组,差异有统计学意义(P< 0.05);两组患者CAUTI 发生率差异无统计学意义(P> 0.05)。试验组患者拔除导尿管后24、72、168 h 残余尿量少于对照组,差异有统计学意义(P< 0.05)。结论膀胱动态压力监测能有助于促进重症患者拔管后膀胱功能的恢复,值得临床推广。

Objective To compare the effects of constant pressure urination and timed urination during indwelling catheterization in elderly patients with coma in the emergency intensive care unit( EICU). Methods Totally 100 elderly patients with coma admitted in EICU, the First Affiliated Hospital of Huzhou University from January 2015 to June 2017 were selected by convenient sampling. The 49 patients admitted from January 2015 to March 2016 were included into the control group, while the 51 patients admitted between April 2016 and June 2017 were included into the treatment group. Patients in the control group were allowed urination every 3-4 hours, while patients in the treatment group were monitored for continuous bladder pressure using a pressure monitoring device and were allowed urination when the pressure reached 12 cmH2O. The time of first autonomic urination after tube removing, the rate of re-indwelling catheterization rate and the incidence rate of catheter-associated urinary tract infection( CAUTI) were compared between the two groups. Results The time and volume of first urination and the rate of re-intubation after tube removing were better in the treatment group than in the control group( P<0.05);there was no statistical difference in the incidence rate of CAUTI between the two groups( P>0.05). The residual urine volume at 24 h, 72 h and 168 h after catheter removing was less in the treatment group than in the control group( P<0.05). Conclusions Dynamic bladder pressure monitoring helps to facilitate the recovery of bladder function after catheter removing in critical patients, which is worth promoting in clinical practice.