脊柱麻醉下股骨头置换术后尿液潴留发病率及风险因素

Incidence and risk factors of postoperative urinary retention in hemiarthroplasty implemented under spinal anesthesia

目的探讨经椎管麻醉进行人工股骨头置换术,术后发生尿液潴留的几率及可能的风险因素。方法回顾性分析2015年2月至2018年4月期间,在海南省人民医院使用椎管麻醉(硬膜外麻醉、蛛网膜下腔麻醉)下行初次股骨头置换术共164个患者,168例股骨头置换的资料。纳入标准:年龄大于18岁,言语表达清晰。排除标准:拒绝参与者;术前间断插尿管者,目前仍留置尿管者;透析患者;既往前列腺、尿道及肾脏的手术病史者;骨肿瘤患者。患者术前均可自行排尿,均未留置尿管。所有的患者都详细记录身体质量指数(BMI)、性别、美国麻醉师协会(ASA)分级、手术时间、术后口服止痛药物,尿失禁与多尿症病史,术后尿液排泄与潴留情况(包括尿液的颜色、体积、腹部症状,体征,并使用膀胱超声确认膀胱中的剩余尿量)。使用卡方检验分析分类变量,使用t检验分析连续变量。结果最终纳入161名患者,5名患者要求麻醉后留置尿管而被排除,38名患者术后出现了尿液潴留,需使用尿管进行导尿。共计有17个病人留置导尿管3~5 d,5位患者因拒绝导尿而出现尿路感染,使用尿管导尿的患者有3例最后发生了尿路感染。术后尿液潴留与既往潴留病史(t=8.935,P<0.05)及术中的输液量(t=6.213,P<0.05)呈正比例相关。未发现留置尿管与BMI指数,性别,ASA分级,手术时间、术后口服止痛药物,尿失禁与多尿症病史存在明显的相关性(P>0.05)。结论椎管麻醉下进行人工股骨头置换术,既往尿液潴留病史及手术过程中输入较多的液体量是术后发生尿液潴留的高风险因素。

Objective To evaluate the odds and risk factors of postoperative urinary retention(POUR)after hemiarthroplasty by spinal anesthesia.Methods Consecutive patient informations(164 patients and 168 hips)that performed a primary hemiarthroplasty with spinal anesthesia(epidural anesthesia or subarachnoid anesthesia)were recollective investigated from February 2015 to April 2018 in Hainan General Hospital.Inclusion criteria:age older than 18 years and ability of clear conversation.Exclusion criteria:the patients who refused to participation,and the patients in whom preoperative intermittent catheterization was applied till the present,dialysis patients,patients with a history of uriological surgery,and patients with bone tumor.All the patients were voided autonomously and without any indwelling catheter.All the patients were recorded body mass index(BMI),gender,American Society of Anesthesiologists(ASA)grade,and operative duration,postoperative oral acesodyne apply,history of incontinence or polyuria andpostoperatively for urinary retention including urine colour,volume,abdomen symptoms and signs,bladder ultrasound scan was also performed to identify the residual urinary capacity.Categorical variables were analyzed with chi-square testing and continuous variables were analyzed with the Student t test.Results One hundred and sixty one patients were collected into the study eventually.Five patients were excluded for demanding indwelling catheterization in the operative survey.Thirty-eight patients suffered POUR and required immediate catheterization.Seventeen patients finally demanded detaining catheterization for 3-5 d.Five patients who refused to catheterized developed to urinary tract infection and three patients who catheterized were underwent urinary tract infection.POUR was significantly associated with a history of urinary retention and intraoperative fluid volume(t=8.935,P<0.05;t=6.213,P<0.05,respectively).No significant association was showed between catheterization and BMI,gender,ASA grade,operative duration,postoperative oral acesodyne apply,history of incontinence or polyuria(P>0.05).Conclusion Patients who have a history of prior urinary retention and those who receive high volumes of intraoperative fluid are at higher risk for POUR following hemiarthroplasty conducted under spinal anesthesia.