术前留置导尿对逆向开通冠状动脉慢性完全闭塞病变患者的影响

The effectiveness of preoperative indwelling urethral catheterization on patients with revascularization of coronary artery chronic total occlusion via retrograde approach

目的评价术前留置导尿对逆向开通冠状动脉慢性完全闭塞病变(CTO)患者的影响。方法选取首都医科大学附属北京安贞医院心内科2017年1月至2018年4月收治的95例逆向开通CTO患者为常规组,2018年5月至2020年12月收治的95例逆向开通CTO患者为干预组。常规组接受常规护理,干预组在常规护理的基础上增加留置导尿。观察患者术中血压波动、血管活性药物使用率和迷走神经反射发生率,记录患者留置导尿相关并发症及尿潴留发生情况及逆向开通CTO闭塞段介入手术时间。结果干预组术中血压波动发生率、血管活性药物使用率及迷走神经反射发生率均明显低于常规组,差异均有统计学意义(均P<0.05)。干预组术后均未发生留置导尿相关并发症。干预组尿潴留发生率明显低于常规组,差异有统计学意义(P=0.002)。干预组介入手术时间明显短于常规组[(154±6)min比(159±6)min],差异有统计学意义(P=0.018)。结论术前留置导尿可以使逆向开通CTO患者获益,尤其是对稳定术中血压、减少围术期并发症发生率和缩减患者介入手术时间均产生了积极意义。

Objective To evaluate the effectiveness of preoperative indwelling urethral catheterization on patients with revascularization of coronary artery chronic total occlusion(CTO)via retrograde approach.Methods Totally 95 patients with revascularization of CTO via retrograde approach in Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University from January 2017 to April 2018 were selected as the routine group,and 95 patients with revascularization of CTO via retrograde approach from May 2018 to December 2020 were selected as the intervention group.The routine group received routine nursing,and the intervention group received indwelling urethral catheterization on the basis of routine nursing.Intraoperative blood pressure fluctuation,vasoactive drug utilization rate and vagus reflex rate of patients were observed.The complications of indwelling urinary catheterization,urinary retention and the time of interventional operation in revascularization of CTO via retrograde approach were recorded.Results The intraoperative blood pressure fluctuation rate,vasoactive drugs utilization rate and vagus reflex rate in the intervention group were significantly lower than those in the routine group(all P<0.05).No complications related to indwelling urethral catheterization occurred in intervention group.The incidence of urinary retention in the intervention group was significantly lower than that in the routine group(P=0.002).The intervention time in the intervention group was significantly shorter than that in the routine group[(154±6)min vs(159±6)min](P=0.018).Conclusion Preoperative indwelling urethral catheterization can benefit patients with revascularization of CTO via retrograde approach,especially in stabilizing intraoperative blood pressure,reducing the incidence of perioperative complications and shortening the interventional operation time.