男性患者全麻非泌尿外科术后导尿管相关膀胱不适的影响因素

Influencing factors of catheter-related bladder discomfort after general anesthesia in non-urological surgery male patients

目的基于有向无环图和倾向性评分匹配,分析男性患者全麻非泌尿外科术后导尿管相关膀胱不适(CRBD)的发生现状并探讨其相关影响因素。方法本研究为一项前瞻性观察研究。采取便利抽样法,收集2022年3—7月全麻下行非泌尿外科手术男性患者415例的临床资料,统计分析男性患者全麻非泌尿外科术后留置导尿管期间CRBD的发生情况。根据CRBD的分级标准将患者分为两组:A组(CRBD 0~1级)和B组(CRBD 2~3级)。采用有向无环图分析本研究中各变量间的因果关系,从而筛选出构建回归模型的自变量及混杂变量。采用倾向性评分匹配对本研究中不可干预的混杂变量进行控制,均衡矫正基线水平。采用Logistic回归法分析男性患者全麻非泌尿外科术后发生CRBD 2~3级的影响因素。结果男性患者全麻非泌尿外科术后留置导尿管期间CRBD发生率为77.3%,其中CRBD 2~3级发生率为53.0%。Logistic回归分析结果显示:健康宣教(95%CI 0.029~0.394,P=0.001)、全麻联合椎管内麻醉(95%CI 0.000~0.475,P=0.021)、全麻联合神经阻滞麻醉(95%CI 0.002~0.249,P=0.002)、右美托咪定复合咪达唑仑镇静(95%CI 0.001~0.129,P<0.001)、右美托咪定复合瑞马唑仑镇静(95%CI 0.000~0.027,P<0.001)、新斯的明复合阿托品催醒(95%CI 0.000~0.019,P<0.001)是术后CRBD的保护因素。结论男性患者全麻非泌尿外科术后CRBD的发生率较高,需采取有效预防措施。术前接受健康教育、全麻联合椎管内麻醉或腰腹部神经阻滞麻醉、右美托咪定复合咪达唑仑或瑞马唑仑镇静、术后药物催醒可有效降低CRBD 2~3级的发生风险。

Objective Based on directed acyclic graph and propensity score matching,the status of catheter-related bladder discomfort(CRBD)in different periods after general anesthesia in non-urological surgery male patients was analyzed and the relevant influencing factors were discussed.Methods This study was conducted as a prospective observational study.The convenience sampling method was adopted to collect the clinical data of 415 patients from March 2022 to July 2022.The occurrence of CRBD after general anesthesia was analyzed,and the patients were divided into two groups:group A(CRBD 0-1 grade)and group B(CRBD 2-3 grade)according to the classification of catheter-related bladder discomfort.The directed acyclic graph(DAG)was used to analyze the causal relationship between the variables in this study,so as to screen out the independent variables and confounding variables for the construction of the regression model.The propensity score matching(PSM)was used to control non-interventable multiple confounding variables in this study to equilibrate the baseline level and increase comparability between the two groups.Logistic regression was applied to analyze the influencing factors of CRBD 2-3 grade.Results The incidence of CRBD during indwelling urinary catheters in male patients after general anesthesia in non-urological surgery was 77.3%,with CRBD 2-3 grade being 53.0%.Logistic regression analysis showed health education(95%CI 0.029-0.394,P=0.001),general anesthesia combined with spinal anesthesia(95%CI 0.000-0.475,P=0.021),general anesthesia combined with nerve block anesthesia(95%CI 0.002-0.249,P=0.002),dexmedetomidine combined with midazolam(95%CI 0.001-0.129,P<0.001),dexmedetomidine combined with remimazolam(95%CI 0.000-0.027,P<0.001),neostigmine combined with atropine(95%CI 0.000-0.019,P<0.001)were protective factors for postoperative CRBD.Conclusion Male patients have a higher incidence of CRBD after general anesthesia in non-urological surgery,and effective preventive measure are required.Preoperative health education,compound spinal anesthesia or lumbar abdominal nerve block anesthesia,dexmedetomidine combined with midazolam or remimazolam,and postoperative drug awakening can effectively reduce the risk of CRBD 2-3 grade.