夹管训练降低短期留置导尿相关并发症效果的Meta分析

Bladder training by clamping prior to removal urinary catheters reduces short-term urinary retention:a Meta-analysis

目的评价夹管训练降低短期留置尿管患者相关并发症发生率的效果。方法检索PubMed、Cochrane Library、Medline、Embase、CINAHL、Scopus、中国知网、万方数据库,检索短期留置尿管患者尿管拔除前进行夹管训练和自然引流的随机对照试验文献,以RevMan5.3.5软件进行统计分析。结果共纳入文献20篇,共计3 899例患者。夹管训练在尿管拔除后发生尿潴留[RR=0.33,95%CI(0.16,0.70),P<0.01]、尿管重置[RR=0.50,95%CI(0.38,0.67),P<0.01]、拔管后排尿困难[RR=0.31,95%CI(0.14,0.71),P<0.01]、患者自我感知的排尿相关不适[RR=0.56,95%CI(0.36,0.86),P<0.01]的风险显著低于开放引流。夹管训练组发生尿路感染的风险是开放引流组的1.11倍[RR=1.11,95%CI(0.71,1.74)],但差异无统计学意义(P>0.05)。结论夹管训练可降低尿潴留、尿管重置、排尿困难的风险,但对导管相关尿路感染发生率影响的证据不足。对于有拔管指征的患者,建议尽早拔除导尿管。现有证据尚不能认为夹管训练对于短期留置导尿患者是无意义的,仍须大样本、多中心的联合研究、统一标准的客观指标来评价夹管训练的作用。

Objective To evaluate the effect of bladder training by clamping prior to removal urinary catheters on the incidences of complications associated with short-term indwelling urinary catheters.Methods A computerized search in PubMed,Cochrane Library,Medline,Embase,CINAHL,Scopus,China National Knowledge Infrastructure(CNKI)and Wan Fang Data were performed to retrieve randomized controlled trials(RCTs)on bladder training by clamping versus free drainage prior to removal of urinary catheters for patients with short-term indwelling urinary catheters.Meta-analysis of the trials was conducted using RevMan 5.3.5 software.Results A total of 20 studies were included,adding up to 3 899 patients.Compared to the free drainage group,the risks of urinary retention after catheter removal[RR=0.33,95%CI(0.16,0.70),P<0.01]],urinary catheter reinsertion[RR=0.50,95%CI(0.38,0.67),P<0.01],voiding dysfunction[RR=0.31,95%CI(0.14,0.71),P<0.01],and patient perceived voiding-related discomfort[RR=0.56,95%CI(0.36,0.86),P<0.01]were significantly lower in the clamping group.The risk of catheter-associated urinary tract infections(CAUTI)in the clamping group was 1.11 times that of the free drainage group[RR=1.11,95%CI(0.71,1.74)],without statistical significance(P>0.05).Conclusion Bladder training by clamping could lower the post-catheter-removal risks of urinary retention,urinary catheter reinsertion,and voiding dysfunction,though evidence on the increased risk of urinary tract infection by clamping is limited.It is recommended that catheters be removed as soon as possible if the patient is indicated for removal.The current evidence cannot rule out that bladder training by clamping is meaningless.Large sample,multi-centered trials,and objective outcome measures are still needed to evaluate the role of bladder training by clamping.