吻合器痔上黏膜环切术后尿潴留危险因素分析

Analysis on the risk factors of postoperative urinary retention after procedure for prolapse and hemorrhoids with stapler

目的探讨吻合器痔上黏膜环切术(PPH)术后尿潴留(POUR)的危险因素。方法回顾性分析2018年6月至2019年12月中山市人民医院、广州医科大学附属第二医院、南方医科大学附属珠江医院收治的726例PPH手术患者资料,根据有无发生POUR将患者分为尿潴留组与非尿潴留组。记录患者的年龄、性别、术前有无合并贫血、高血压、糖尿病、手术时间、术后疼痛等情况。结果POUR总发生率为33.88%(246/726),多因素logistic回归分析显示年龄每增加1岁,POUR的发生风险增加1.683倍,手术时间每增加1 min,POUR的发生风险增加1.863倍,术中麻醉时间每增加1 min,POUR的发生风险增加2.038倍;术后疼痛评分为4~7分的患者发生POUR的风险是疼痛1~3分患者的3.424倍,术后疼痛评分>7分的患者发生POUR的风险是疼痛1~3分患者的4.145倍。结论吻合器PPH术后POUR总发生率较高,年龄越大、手术时间越长、术中麻醉时间越长和术后疼痛评分越高,患者越容易有POUR发生风险,要加强对此类人群的术后重点护理和临床观察。

Objective To investigate the risk factors of postoperative urinary retention(POUR)after procedure for prolapse and hemorrhoids(PPH)with stapler.Methods A retrospective analysis of the date of 726 PPH patients admitted to Zhongshan People's Hospital,the Second Affiliated Hospital of Guangzhou Medical University,and Zhujiang Hospital of Southern Medical University from June 2018 to December 2019 was conducted.According to the occurrence of POUR,the patients were divided into the urinary retention group and the non-urinary retention group.The patients'age,gender,preoperative anemia,hypertension,diabetes,operation time and postoperative pain were recorded.Results The total incidence of POUR was 33.88%(246/726).Multivariate logistic regression analysis showed that the risk of POUR increased by 1.683 times for every year increase in age.The risk of POUR increased by 1.863 times for every minute increase in operation time.And the risk of POUR increased by 2.038 times for every minute increase in anesthesia during operation.The risk of POUR in patients with postoperative pain score from 4 to 7 points was 3.424 times that of patients with pain score from 1 to 3 points.And the risk of POUR in patients with postoperative pain distribution of more than 7 points was 4.145 times that of patients with pain from 1 to 3 points.Conclusion The total incidence of POUR after PPH with stapler is relatively high.The older the age,the longer the operation time,the longer the intraoperative anesthesia time and the higher the postoperative pain score,the more likely the patient are to have the risk of POUR.It is necessary to strengthen the postoperative key nursing and clinical observation of this kind of population.