全子宫切除术后留置导尿管拔除时机的Meta分析

Meta analysis of the time for removal of indwelling catheter after total hysterectomy

目的探讨全子宫切除术后留置导尿管的最佳拔管时机。方法计算机检索PubMed、EMBASE、Cochrane Central Register of Controlled Trials(CENTRAL)、CINAHL、中国生物医学文献数据库(CBM)、中国学术期刊全文数据库(CNKI)、维普中文期刊全文数据库(VIP)、万方数据库,收集全子宫切除术后留置导尿管不同拔管时机的随机对照试验,经筛选文献,提取资料和文献质量评价后,用RevMan 5.3软件进行Meta分析。结果共纳入12篇文献,英文文献9篇,中文文献3篇,共1758名患者。Meta分析结果显示,与术后立即拔管相比,术后6 h拔管对有症状的尿路感染发生率没有影响[RR=0.29,95%CI(0.06,1.35),P=0.11],但可显著降低重置尿管发生率[RR=7.85,95%CI(2.13,28.84),P=0.002];与术后立即拔管相比,术后24 h拔管可降低重置尿管发生率[RR=3.46,95%CI(1.81,6.63),P=0.0002],但有症状的尿路感染发生率更高[RR=0.39,95%CI(0.22,0.69),P=0.001];与术后24 h拔管相比,术后48 h拔管对重置尿管发生率没有影响[RR=0.75,95%CI(0.17,3.29),P=0.70],但有症状的尿路感染发生率更高[RR=0.39,95%CI(0.21,0.72),P=0.003]。结论术后6~24 h是全子宫切除术后留置导尿管的最佳拔管时机。

Objective To evaluate the best timing of removing indwelling catheter for patients undergoing total hysterectomy.Methods We searched databases including PubMed,EMBASE,Cochrane Central Register of Controlled Trials(CENTRAL),CINAHL,CBM,CNKI,VIP and Wangfang.All randomized controlled trials(RCTs)that reported the different time to remove indwelling urinary catheter for patients undergoing total hysterectomy was included.After literature selection,data extraction and literature quality evaluation,meta analysis was carried out with Revman 5.3 software.Results A total of 12 references,9 in English and 3 in Chinese were included in this meta-analysis,with a total of 1758 patients.Meta-analysis results showed that compared with immediate postoperative catheter removal,6 h postoperative catheter removal had no effect on the rate of symptomatic urinary tract infection[RR=0.29,95%CI(0.06,1.35),P=0.11],but could significantly reduce the incidence of reset catheter[RR=7.85,95%CI(2.13,28.84),P=0.002].Compared with immediate postoperative catheter removal,catheter removed at 24 h postoperatively can reduce the rate of incidence of reset catheter[RR=3.46,95%CI(1.81,6.63),P=0.0002],but the rate of symptomatic urinary tract infection is higher[RR=0.39,95%CI(0.22,0.69),P=0.001].Compared with 24 h postoperatively,catheter removed at 48 h postoperatively had no effect on the rate of incidence of reset catheter[RR=0.75,95%CI(0.17,3.29),P=0.70],but the rate of symptomatic urinary tract infection is higher[RR=0.39,95%CI(0.21,0.72),P=0.003].Conclusion 6~24 h after operation is the best timing of removing indwelling catheter for patients undergoing total hysterectomy.