不同拔管时机对全麻术后留置尿管患者下尿路症状和尿控恢复情况的影响

Effects of different timing of extubation on lower urinary tract symptoms and urinary control recovery of patients with indwelling catheter after general anesthesia

目的探讨不同拔管时机对全麻术后留置尿管患者尿管相关下尿路症状和拔管后尿控恢复情况的影响。方法分层随机选取2018年1月—2019年7月首都医科大学附属北京友谊医院行全麻手术患者术后留置尿管患者198例,采用数字表法随机分为观察组101例和对照组97例。两组患者均采用经过循证护理论证,及院内尿管材质、型号进行的水囊测定试验结果制订的拔管方法。对照组拔管时机为膀胱空虚、患者没有尿意情况下拔除尿管,等尿意出现时,再协助排尿;观察组拔管时机为膀胱处于充盈状态且患者有尿意时,借助腹压使尿管随尿液自然排出。比较两组患者尿管相关下尿路症状和拔管后尿控恢复情况。结果观察组排尿成功率高于对照组,核心下尿路症状评分、尿频、尿急及急性尿潴留发生率低于对照组,差异有统计学意义(P<0.05)。观察组最大膀胱测压容量和残余尿量低于对照组,拔管后72 h控尿率和最大尿流率高于对照组,差异有统计学意义(P<0.05)。结论待全麻术后留置尿管患者膀胱充盈且有尿意时拔管可以降低尿管相关下尿路症状的发生率和严重程度,有助于患者恢复膀胱功能,提高尿控能力。

Objective To explore effects of different timing of extubation on catheter-related lower urinary tract symptoms and urinary control recovery after extubation in patients with indwelling catheter after general anesthesia.Methods Using the stratified random selection method,a total of 198 patients who underwent indwelling catheter after general anesthesia in Beijing Friendship Hospital affiliated to Capital Medical University were selected from January 2018 to July 2019.Using the random number table method,they were randomly divided into the observation group(101 cases)and the control group(97 cases).In both groups,the extubation method was established by evidence-based nursing demonstration and the water sac test results of the material and model of urinary duct in the hospital.In the control group,the timing of extubation was to remove the catheter when the bladder was empty and the patient had no urination intention,and then assist urination when the urination intention appeared.In the observation group,the time of extubation was when the bladder was in a full state and the patient had the intention to urinate,the urinary duct was naturally discharged with urine by abdominal pressure.The lower urinary tract symptoms associated with urinary tube and the recovery of urinary control after extubation were compared between the two groups.Results The success rate of urination in the observation group was higher than that of the control group,the core lower urinary tract symptom score and incidences of frequency of urination,urgency and acute urinary retention were lower than those of the control group,and the differences were statistically significant(P<0.05).The maximum bladder pressure measurement volume and residual urine volume in the observation group were lower than those in the control group,and the urine control rate and maximum urine flow rate at 72 h after extubation were higher than those in the control group,and the differences were statistically significant(P<0.05).Conclusions Extubation in patients with bladder filling and urination after general anesthesia can reduce the incidence and severity of lower urinary tract symptoms associated with the catheter,which help patients recover bladder function and improve urinary control ability.