青少年特发性脊柱侧凸后路融合术后尿潴留的影响因素

Influencing factors of urinary retention after posterior fusion for adolescent idiopathic scoliosis

目的 探讨青少年特发性脊柱侧凸(adolescent Idiopathic Scoliosis, AIS)患者行后路融合术后发生尿潴留(postoperative urinary retention, POUR)的影响因素。方法 选择2015年1月至2020年12月在我院接受后路融合术的137例AIS患者作为研究对象,记录患者性别、年龄、主弯Cobb角、融合节段数、手术时间、估算失血量(estimated blood loss, EBL)、标准化失血量(normalized blood loss, NBL)、拔导尿管日吗啡等效阿片剂量(简称“吗啡当量剂量”)、累积吗啡当量剂量等资料,观察术后POUR发生率及影响POUR的风险因素。结果 137例患者中,33例发生POUR,POUR发生率为24.09%。单因素分析显示,POUR和非POUR组患者的年龄、术中输液量、EBL、NBL、手术时间、活动状态、步行距离、拔导尿管日吗啡当量剂量、累积吗啡当量剂量、术后拔导尿管时间相比,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,拔导尿管日吗啡当量剂量和术后拔导尿管时间是POUR的风险因素(P<0.05),累积吗啡当量剂量和行动距离是POUR的保护性因素(P<0.05)。结论 AIS患者后路融合术后的POUR发生率较高,等待拔除导尿管直至患者合理恢复活动,给予合理麻醉用量,可能是减少POUR的有效策略。

Objective To explore the influencing factors of postoperative urinary retention(POUR) in adolescent idiopathic scoliosis(AIS) patients after posterior fusion. Methods From January 2015 to December 2020, 137 AIS patients who received posterior spinal fusion(PSF) in our hospital were selected in this research. Gender, age, Cobb angle of main curve, number of fusion segments, operation time, estimated blood loss(EBL), normalized blood loss(NBL), daily equivalent opioid dose and cumulative opioid consumption were recorded, and the incidence of postoperative POUR and risk factors affecting POUR were observed. Results Of 137 cases, 33 cases had POUR, and the incidence rate of POUR was 24.09%. There were significant differences in age, intraoperative fluid, EBL, NBL, operation time, activity state, walking distance, daily morphine equivalent dose, cumulative morphine equivalent dose and postoperative catheter removal time between the two groups(P<0.05). Multivariate logistic analysis showed that morphine equivalent dose and postoperative extubation time were risk factors of POUR(P<0.05), and cumulative morphine equivalent dose and distance of action were protective factors of POUR(P<0.05). Conclusion The incidence of POUR in AIS patients after PSF is high. Waiting for the removal of the catheter until the children recover reasonably, and giving reasonable anesthesia dosage may be effective strategy to reduce POUR.