优化导尿管夹闭训练及气囊自动回缩导尿管拔除法对神经外科术后患者首次排尿的影响

Effects of optimized catheter clipping training and automatic balloon retraction ureteral catheter removal on first urination of patients after neurosurgery

目的:探讨优化导尿管夹闭训练及气囊自动回缩导尿管拔除法对神经外科术后患者首次排尿的影响,为该类患者术后排尿提供指导依据。方法:方便抽样选取2020年8月至2021年8月徐州医科大学附属医院神经外科行全身麻醉颅脑手术并留置导尿管的208例患者为研究对象,采用随机数字表法分为对照组69例,观察组A 69例,观察组B 70例。对照组采用常规导尿管夹闭训练和常规导尿管拔除法,观察组A采用优化导尿管夹闭训练和常规导尿管拔除法,观察组B采用优化导尿管夹闭训练和气囊自动回缩导尿管拔除法。观察并比较3组患者的首次排尿时间、首次排尿量、排尿情况、疼痛评分、尿路刺激征情况。结果:观察组A、B首次排尿时间分别为(11.58±6.59)、(10.06±5.91)min,均低于对照组的(37.14±13.74)min,差异有统计学意义(t=13.94、15.07,均P<0.05),观察组B与观察组A比较差异无统计学意义(P>0.05);对照组、观察组A、观察组B首次排尿量分别为(303.66±43.74)、(299.06±41.26)、(299.28±43.17)ml,3组比较差异无统计学意义(P>0.05);3组患者排尿情况(自行排尿、诱导排尿、尿潴留)发生率比较,观察组A优于对照组(χ^(2)=16.47),观察组B优于观察组A和对照组(χ^(2)=8.59、37.83),差异有统计学意义(均P<0.05);观察组A导尿管拔除时疼痛评分为(2.71±0.67)分,对照组为(2.87±0.78)分,2组比较差异无统计学意义(P>0.05),观察组B的疼痛评分为(1.41±0.65)分,低于对照组及观察组A,差异有统计学意义(t=11.93、11.62,均P<0.05);3组患者尿路刺激征(0级、1级、2级、3级)发生率比较,观察组A与对照组比较差异无统计学意义(P>0.05),观察组B低于对照组及观察组A,差异有统计学意义(t=38.81、25.27,均P<0.05)。结论:优化导尿管夹闭训练和气囊自动回缩导尿管拔除法有效缩短了神经外科术后患者首次排尿时间,减轻了导尿管拔除时的疼痛感及首次排尿时尿路刺激症状,并提高了首次自行排尿成功率,有效预防了尿潴留的发生。

Objective To investigate the effect of optimized catheter clipping training and automatic balloon retraction ureteral catheter removal on first urination of patients after neurosurgery,and provide guidance for postoperative micturition of these patients.Methods From August 2020 to August 2021,208 patients admitted to Department of Neurosurgery,the Affiliated Hospital of Xuzhou Medical University,undergoing craniocerebral surgery under general anesthesia and indurating catheter were selected as the study subjects by convenient sampling.They were divided into control group(n=69),observation group A(n=69)and observation group B(n=70)by random number table method.The control group received routine catheter clipping training and routine ureteral catheter removal,the observation group A received optimized catheter clipping training and routine ureteral catheter removal,and the observation group B received optimized catheter clipping training and automatic balloon retraction ureteral catheter removal.The first micturition time,first micturition volume,micturition circumstance,pain score and urethral irritation sign of the three groups were observed and compared.Results The first urination time in observation group A and B were(11.58±6.59)min and(10.06±5.91)min,respectively,lower than(37.14±13.74)min in control group,and the difference was statistically significant(t=13.94,15.07,both P<0.05);there was no significant difference between observation group B and observation group A(P>0.05).The first urine volume were(303.66±43.74)ml in control group,(299.06±41.26)ml in observation group A and(299.28±43.17)ml in observation group B,and the difference was not statistically significant(P>0.05).The incidence of urination(spontaneous urination,induced urination and urinary retention)in observation group A was better than control group(χ^(2)=16.47),while observation group B was better than observation group A and control group(χ^(2)=8.59,37.83),the differences were statistically significant(all P<0.05).There was no significant difference in pain score of ureteral catheter removal between observation group A(2.71±0.67)and control group(2.87±0.78)(P>0.05).The score of observation group B(1.41±0.65)was lower than that of control group and observation group A,the differences were statistically significant(t=11.93,11.62,both P<0.05).There was no significant difference of the incidence of urethral irritation(grade 0,1,2,and 3)between observation group A and control group(P>0.05).Observation group B was lower than control group and observation group A,the differences were statistically significant(t=38.81,25.27,both P<0.05).Conclusions Optimized catheter clipping training and automatic balloon retraction ureteral catheter removal can effectively shorten the first urination time of patients after neurosurgery,reduce the pain of ureteral catheter removal and urethral irritation during the first urination,improve the success rate of the first urination,and effectively prevent the occurrence of urinary retention.