髋膝关节置换患者术后尿潴留发生率及危险因素的Meta分析

Incidence and risk factors of postoperative urinary retention in patients undergoing hip or knee arthroplasty:a meta-analysis

目的系统评价国内外髋膝关节置换患者术后尿潴留发生率及危险因素,为医护人员提前评估并识别高危人群提供理论依据。方法计算机检索PubMed、Embase、Cochrane Library、Medline、中国知网、万方、维普、中国生物医学文献数据库,搜索从建库至2023年1月关于髋膝关节置换患者术后尿潴留发生率及危险因素的文献。由2位研究人员独立筛选研究,提取资料,评估研究质量。采用Stata 14.0软件进行Meta分析。结果共纳入21篇文献,包括9041例髋膝关节置换患者。Meta分析结果显示,髋膝关节置换患者术后尿潴留发生率为26%[95%置信区间(confidence interval,CI)(19%,32%)]。从危险因素来看,年龄[比值比(odds ratio,OR)=1.03,95%CI(1.00,1.05),P=0.03]、男性[OR=2.68,95%CI(1.72,4.18),P<0.001]、术日输液量[OR=2.17,95%CI(1.08,4.35),P=0.030]、椎管内麻醉[OR=1.72,95%CI(1.29,2.30),P<0.001]、尿潴留/尿道狭窄病史[OR=1.84,95%CI(1.35,2.49),P<0.001]、使用镇痛泵[OR=4.73,95%CI(2.29,9.78),P<0.001]、使用格隆溴铵[OR=2.79,95%CI(1.53,5.11),P=0.001]是髋膝关节置换患者术后尿潴留的危险因素。结论髋膝关节置换患者术后尿潴留发生率较高,年龄、男性、术日输液量、椎管内麻醉、尿潴留/尿道狭窄病史、使用镇痛泵、使用格隆溴铵是发生术后尿潴留的危险因素。医护人员应针对相关因素进行风险识别,提前采取干预,以减少术后尿潴留发生。

Objective To systematically review the incidence and risk factors of postoperative urinary retention(POUR)in patients undergoing hip or knee arthroplasty,and provide a theoretical basis for medical staff to assess and identify high-risk groups in advance.Methods PubMed,Embase,the Cochrane Library,Medline,China National Knowledge Infrastructure,Wanfang Data,VIP database,and SinoMed were electronically searched from the establishment of the databases to January 2023,for literature on the incidence and risk factors of POUR in patients undergoing hip or knee arthroplasty.Two researchers independently screened studies,extracted data,and assessed study quality.Meta-analysis was performed using Stata 14.0 software.Results A total of 21 articles were included,including 9041 patients undergoing hip or knee arthroplasty.The results of meta-analysis showed that the incidence of POUR in patients undergoing hip or knee arthroplasty was 26%[95%confidence interval(CI)(19%,32%)].Age[odds ratio(OR)=1.03,95%CI(1.00,1.05),P=0.03],male[OR=2.68,95%CI(1.72,4.18),P<0.001],infusion volume[OR=2.17,95%CI(1.08,4.35),P=0.030],spinal anesthesia[OR=1.72,95%CI(1.29,2.30),P<0.001],history of urinary retention/urethral stricture[OR=1.84,95%CI(1.35,2.49),P<0.001],use of analgesic pump[OR=4.73,95%CI(2.29,9.78),P<0.001],use of glycopyrronium bromide[OR=2.79,95%CI(1.53,5.11),P=0.001]were risk factors for POUR in patients undergoing hip or knee arthroplasty.Conclusions The incidence of POUR in patients undergoing hip or knee arthroplasty is relatively high.Age,male,infusion volume,spinal anesthesia,history of urinary retention/urethral stenosis,use of analgesia pump,and use of glycopyrronium bromide are causes of POUR.It is suggested that medical staff should identify the risk of related factors and take early intervention to reduce the occurrence of POUR.