经尿道前列腺切除术后尿路感染危险因素的Meta分析

Meta-analysis on risk factors for urinary tract infection after transurethral prostate resection

目的系统评价经尿道前列腺切除术后患者发生尿路感染的危险因素。方法检索PubMed、Embase、the Cochrane Library、Web of Science、CBM、CNKI、维普和万方数据库,自建库至2020年1月31日公开发表的经尿道前列腺切除术后患者发生尿路感染的前瞻性研究和回顾性研究。两名评价者按照纳入与排除标准对所获文献独立进行文献筛选、资料提取,采用NOS量表进行质量评价,应用Stata14.0软件进行Meta分析。结果共纳入15项研究,样本量2707例。Meta分析结果显示:年龄[OR=1.93,95%CI(1.24~3.00),P=0.003]、糖尿病[OR=2.83,95%CI(2.34~3.44),P<0.001]、手术时间[OR=3.22,95%CI(1.39~7.44),P=0.006]、术前使用抗菌药物[OR=2.14,95%CI(1.12~4.12),P=0.022]、术前行导尿术[OR=4.06,95%CI(2.81~5.85),P<0.001]、术后留置导尿管时间[OR=4.08,95%CI(3.34~4.99),P<0.001]、术者初学经验[OR=2.17,95%CI(1.69~2.77),P<0.001]、一般常规护理干预[OR=2.66,95%CI(1.31~5.42),P=0.007]、尿液密闭引流系统断开[OR=24.17,95%CI(8.28~70.62),P<0.001]是经尿道前列腺切除术后尿路感染的危险因素。结论经尿道前列腺切除术后尿路感染危险因素较多,医护人员应重视患者的术前评估,加强对高危人群的管理;医生应提高技术水平,注意把控手术时间;术后护理人员应重视导尿管留置的适应证,做好有效的护理干预,以预防控制尿路感染的发生。

Objective To systematically evaluate the risk factors for urinary tract infection(UTI)in patients after transurethral prostate resection.Methods Prospective and retrospective studies on UTI in patients after transurethral prostate resection published from the establishment of the database to January 31,2020 were searched from PubMed,Embase,the Cochrane Library,Web of Science,China Biology Medicine(CBM),China National Know-ledge Infrastructure(CNKI),VIP and Wanfang database.Two reviewers independently screened the literatures and extracted the data according to the inclusion and exclusion criteria,quality of literatures was evaluated by Newcastle-Ottawa scale(NOS),Meta-analysis was performed by Stata14.0 software.Results A total of 15 studies with 2707 cases were included in analysis.Meta-analysis results showed that age(OR=1.93,95%CI[1.24-3.00],P=0.003),diabetes(OR=2.83,95%CI[2.34-3.44],P<0.001),operation time(OR=3.22,95%CI[1.39-7.44],P=0.006),pre-operative antimicrobial use(OR=2.14,95%CI[1.12-4.12],P=0.022),pre-operative urinary catheterization(OR=4.06,95%CI[2.81-5.85],P<0.001),post-operative indwelling urinary cathe-terization time(OR=4.08,95%CI[3.34-4.99],P<0.001),the initial experience of surgeons(OR=2.17,95%CI[1.69-2.77],P<0.001),general routine nursing intervention(OR=2.66,95%CI[1.31-5.42],P=0.007),disconnection of closed urinary drainage system(OR=24.17,95%CI[8.28-70.62],P<0.001)were risk factors for UTI after transurethral prostate resection.Conclusion There are multiple risk factors for UTI after transurethral prostate resection,health care workers should pay attention to the pre-operative evaluation of patients,strengthen the management of high-risk population;doctors should improve the technical level,pay attention to the control of operation time;post-operative nursing staff should pay attention to the indications of urinary catheter indwelling,and conduct effective nursing intervention to prevent and control the occurrence of UTI.