超声下膀胱容量评估在危重患者留置尿管早期拔管中的应用研究

Research on the application of bladder volume evaluation under ultrasound radiography for early removal of indwelling catheter in critical patients

目的探讨床旁超声对危重患者长期留置导尿管后拔管及膀胱功能恢复的影响。方法采用方便抽样法,选择2018年10-12月入住ICU的92例患者作为研究对象,采用随机数字表法随机分为观察组和对照组各46例。患者留置尿管72 h后常规夹闭尿管,对照组日间每3小时开放尿管1次,夜间每4小时开放1次;观察组应用超声诊断仪于夹闭尿管后评估膀胱容量,当尿液接近300 ml时开放尿管,选择每例患者最短的膀胱充盈时间作为导尿管开放与夹闭间隔时间,夜间适当增加1 h。比较2组患者漏尿发生率、首次排尿时间、首次尿量、膀胱残余尿、尿管重置、自行排尿等指标。结果观察组患者漏尿发生率为7.14%(3/42),低于对照组25.58%(11/43),差异有统计学意义(χ2=5.251,P<0.05);膀胱残余尿量的中位数(四分位数)为16(8.50,37.00)ml,低于对照组的41(13.75,130.25)ml,差异有统计学意义(t=2.103,P<0.05);自行排尿率为57.15%(24/42),高于对照组34.88%(15/43),差异有统计学意义(χ2=4.24,P<0.05);观察组尿潴留发生率、诱导排尿率、尿管重置率分别为7.14%(3/42)、11.9%(5/42)、30.95%(13/42),与对照组9.30%(4/43)、16.28%(7/43)、48.84%(21/43)比较,差异无统计学意义(χ2=0.131、0.335、2.832,P>0.05);首次排尿时间为(144.66 ± 66.13)min,与对照组(179.55 ± 87.50)min比较,差异无统计学意义(t=1.623,P>0.05)。结论应用床旁超声对留置导尿管的危重患者进行膀胱容量评估有助于患者早期拔管,促进膀胱功能的恢复。

Objective To evaluate the influence of bedside ultrasound on indwelling catheter removal and bladder function recovery for critically ill patients with long-term indwelling catheter. Methods Use random sampling to choose 92 patients during October 2018 to December 2018 as research objects, objects were allocated into observation group and control group by random digits table method with 46 cases each. All patients had their indwelling catheter clamped 72 hours after insertion as per routine practice, control group had clamp opened and indwelling catheter drained third hourly during the day and fourth hourly through the night;for patients in observation group, bladder volume were evaluated with USS scanner hourly, indwelling catheter was opened and drained when bladder urine volume was about 300 ml, use the shortest bladder-filling time as the interval for indwelling catheter opening time, increasing the interval by one hour through the night. the leakage rate, first urination time, first urination volume, bladder residual volume, indwelling catheter reinsertion rate, voluntary urination rate for patients from two groups were compared. Results The incidence of urinary leakage in the observation group was 7.14%(3/42),which lower than that in the control group (25.58%, 11/43), the difference was statistically significant (χ2=5.251, P<0.05). The residual urine volume in the bladder was 16 (8.50, 37.00) ml in the observation group, which lower than that in the control group 41 (13.75, 130.25) ml, the difference was statistically significant (t=2.103, P<0.05). The rate of self-urination was 57.15%(24/42) in the observation group, which higher than that in the control group (34.88%,15/43), the difference was statistically significant (χ2=4.24, P<0.05). Induced urination rate and urethral replacement rate were 7.14%(3/42), 11.9%(5/42), 30.95%(13/42) in the observation group and 9.3%(4/43), 16.28%(7/43), 48.84%(21/43) in the control group respectively. There was no significant difference between the two groups (χ2= 0.131, 0.335, 2.832, P > 0.05). The first urination time was (144.66± 66.13) in the observation group and (179.55± 87.50) in the control group, respectively. There was no significant difference between the two groups(t= 1.623, P > 0.05). Conclusions The use of bedside USS scan to evaluate the bladder volume of critical patients with indwelling catheter can help facilitate early indwelling catheter removal and encourage patients to regain bladder function.