加速康复流程下人工全膝关节置换术后留置尿管的危险因素分析

Risk factors for postoperative indwelling catheter following enhanced recovery after total knee arthroplasty

目的探讨加速康复流程下人工全膝关节置换术(total knee arthroplasty,TKA)患者术后留置尿管的危险因素。方法以2017年1月-2018年8月全麻下初次单侧TKA患者为研究对象,其中205例符合选择标准纳入研究。收集患者临床资料,包括年龄、性别、体质量指数,术前关节活动度、美国特种外科医院(HSS)评分、美国麻醉医师协会(ASA)评分、疾病类型、合并症、血红蛋白、血细胞比容、血容量,手术时间及时刻、术后是否留置引流管、术中失血量、总失血量,术前、术中、术后补液量以及手术当天总补液量,手术当天小便量。采用单因素及logistic回归分析术后留置尿管的危险因素。同时,比较留置或未留置尿管患者术后住院时间以及围术期并发症发生情况,包括肌间静脉血栓、下肢深静脉血栓、肺栓塞形成,切口红肿渗出,电解质紊乱,恶心呕吐,尿路感染。结果205例患者中41例术后留置尿管,发生率为20.0%。单因素分析显示,年龄、性别、术后留置引流管、手术当天总补液量和小便量是初次单侧TKA术后留置尿管的影响因素(P<0.05)。多因素分析显示,男性和手术当天小便量多是初次单侧TKA术后留置尿管的危险因素(P<0.05)。与留置尿管组相比,未留置尿管组患者术后住院时间明显缩短、尿路感染发生率明显降低,差异有统计学意义(P<0.05);两组其他围术期并发症发生率差异均无统计学意义(P>0.05)。结论加速康复流程下,男性和手术当天小便量更多的患者在全麻初次单侧TKA后需留置尿管的风险更高。

Objective To evaluate the risk factors for postoperative indwelling catheter following enhanced recovery after primary unilateral total knee arthroplasty(TKA)under general anesthesia.Methods Patients who underwent primary unilateral TKA under general anesthesia between January 2017 and August 2018 were enrolled in the study.Among them,205 patients who met the selection criteria were included in the study,and the clinical data were collected,including gender,age,body mass index,preoperative range of motion,Hospital for Special Surgery(HSS)score,American Society of Anesthesiologists(ASA)score,disease type,comorbidity,hemoglobin,hematocrit,blood volume,length of operation and operation time,whether to keep drainage after surgery,intraoperative blood loss,total blood loss,and preoperative,intraoperative,postoperative fluid infusions,and total fluid infusion on the day of surgery,urine volume on the day of surgery.Univariate analysis and logistic regression analysis were used to screen the risk factors for postoperative indwelling catheter.Length of stay and incidences of complications(intermuscular vein thrombosis,deep vein thrombosis,pulmonary embolism,incision swelling and exudation,electrolyte disorder,nausea and vomiting,and urinary tract infection)were compared between the patients with or without indwelling catheter.Results Indwelling catheter occurred in 41(20%)of 205 patients.Single factor analysis showed that the influence factors were age,gender,keeping drainage after surgery,total fluid infusion and urine volume on the day of surgery(P<0.05).The multiple factors analysis showed that the males and more urine volume on the day of surgery were the significant risk factors for indwelling catheter after primary TKA(P<0.05).In addition,postoperative length of stay was shorter and the incidence of urinary tract infection was lower in non-indwelling catheter group than in indwelling catheter group,showing significant differences(P<0.05).Conclusion The male patients with more urine on the day of surgery have higher risk for indwelling catheter after primary unilateral TKA under general anesthesia with an enhanced recovery program.