初次髋膝关节置换术中不留置尿管的可行性和安全性研究

doi:10.3877/cma.j.issn.1674-134X.2018.03.009

中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (03) : 350 -355. doi: 10.3877/cma.j.issn.1674-134X.2018.03.009

所属专题：文献；

临床论著

初次髋膝关节置换术中不留置尿管的可行性和安全性研究

陈有荣¹, 文鹏飞¹, 郭万首¹^,^†(

), 王卫国², 刘朝晖², 张启栋², 丁冉²

^1. 100029　北京大学中日友好临床医学院；100029　北京，中日友好医院
^2. 100029　北京，中日友好医院

收稿日期:2017-08-14 出版日期:2018-06-01
通信作者: 郭万首
基金资助:
国家自然科学基金面上项目(项目编号：81673776)

Feasibility and safety of non-indwelling urinary catheter in patients received primary hip or knee arthroplasty

Yourong Chen¹, Pengfei Wen¹, Wanshou Guo¹^,^†(), Weiguo Wang², Zhaohui Liu², Qidong Zhang², Ran Ding²

^1. Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China; China-Japan Friendship Hospital, Beijing 100029, China
^2. China-Japan Friendship Hospital, Beijing 100029, China

Received:2017-08-14 Published:2018-06-01
Corresponding author: Wanshou Guo
About author:
Corresponding author: Guo Wanshou, Email: guowanshou@263.net

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引用本文：

陈有荣, 文鹏飞, 郭万首, 王卫国, 刘朝晖, 张启栋, 丁冉. 初次髋膝关节置换术中不留置尿管的可行性和安全性研究[J]. 中华关节外科杂志(电子版), 2018, 12(03): 350-355.

Yourong Chen, Pengfei Wen, Wanshou Guo, Weiguo Wang, Zhaohui Liu, Qidong Zhang, Ran Ding. Feasibility and safety of non-indwelling urinary catheter in patients received primary hip or knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(03): 350-355.

目的

探讨单侧初次髋或膝关节置换术中不常规留置尿管的可行性及安全性，以减少不必要的导尿，提高患者就医舒适度和满意度。

方法

本文回顾性分析中日友好医院骨关节外科2015年11月至2016年10月期间109例无明显尿潴留高危因素、无术前尿路感染、无尿路刺激征及重度肝肾功能不全、且接受单侧初次髋或膝关节置换术、术中不留置尿管(NIC)患者的资料。根据配对条件，与同期行常规术前留置尿管(IC)的单侧初次髋或膝关节置换患者按照1 ∶1进行配对研究，应用SPSS 19.0统计学软件对正态分布计量资料采用配对t检验，非正态分布计量资料采用Wilcoxon符号秩和检验，计数资料采用χ²检验分析比较两组患者术后的尿潴留、二次尿潴留、尿管相关膀胱不适、尿路刺激症、尿路感染、不良事件发生率，以及术后住院时间及患者满意度，分析并评价不留置尿管在单侧初次髋、膝关节置换术中的可行性及安全性。

结果

两组患者术后尿潴留、二次尿潴留、尿路感染发生率比较，差异无统计学意义(P>0.05)，NIC组术后尿管相关膀胱不适、尿路刺激征、不良事件发生率及术后住院时间均明显低于IC组，而患者满意度高于IC组，两组比较差异有统计学意义(χ²＝10.844，P<0.05),单侧初次髋或膝关节置换术中不必要的导尿高达81.7%。

结论

初次髋或膝关节置换术中不常规留置尿管安全可靠，能有效减少尿管相关膀胱不适、尿路刺激征及不良事件的发生，同时可缩短术后住院时间，提高患者早期满意度。

关键词: 导尿管, 髋, 膝, 关节成形术, 尿潴留

Objective

To evaluate the feasibility and safety of non-indwelling urinary catheter in the patients who receive unilateral primary hip or knee arthroplasty.

Methods

A retrospective study was carried out to analyze 109 patients who received unilateral primary hip or knee arthroplasty during Nov 2015 to Oct 2016 in China-Japan Friendship Hospital with non-indwelling catheter (NIC) and without obvious risk factors for urinary retention, preoperative urinary tract infection, urinary tract irritation or severe hepatorenal insufficiency. According to 1 ∶1 matching pair principle, they were paired with patients who received unilateral primary hip or knee arthroplasty with indwelling catheter (IC) during the same period. The feasibility and safety of non-indwelling urinary catheter was analyzed and evaluated by comparing the incidence of postoperative urinary retention, urinary retention recurrence, catheter-related bladder discomfort, urinary irritation symptoms, urinary tract infection, adverse events, postoperative hospitalization time and patient satisfaction between the NIC and IC groups. The SPSS19.0 statistics software was used to test the measurement data of normal distribution by paired t test, the measurement data of non-normal distribution by Wilcoxon signed rank sum test and the enumeration data by χ² test.

Results

There was no significant difference (P>0.05) in terms of postoperative urinary retention, urinary retention recurrence or urinary tract infection between the two groups. The incidence of catheter-related bladder discomfort, urinary irritation symptoms, adverse events and postoperative hospitalization time in NIC group was significantly less and patient satisfaction was significantly higher than IC group (χ²=10.844, P<0.05). The rate of unnecessary catheterization in the patients who receive unilateral primary hip or knee arthroplasty was 81.7%.

Conclusion

Non-indwelling urinary catheter in patients who received primary hip or knee arthroplasty is safe and reliable, which could reduce the incidence of catheter-related bladder discomfort, urinary irritation symptoms and adverse events effectively, and shorten the postoperative hospitalization time, improve early patient satisfaction.

Key words: Urinary catheters, Hip, Knee, Arthroplasty, Urinary retention

图1 膀胱容积监测流程图

表1 两组患者术前基本资料比较

组别	例数	年龄[岁，(±s)]	BMI[kg/m^2, (±s)]	ASA分级(例)			残余尿量[ml, (±s)]	禁水时间[h, (±s)]	术前补液量[ml, M(P25，P75)]
组别	例数	年龄[岁，(±s)]	BMI[kg/m^2, (±s)]	Ⅰ级	Ⅱ级	Ⅲ级	残余尿量[ml, (±s)]	禁水时间[h, (±s)]	术前补液量[ml, M(P25，P75)]
NIC组	109	61.9±10.6	25.8±3.7	4	91	14	31.8±24.2	7.0±1.7	0(0, 500)
IC组	109	62.2±10.6	25.8±3.8	6	87	16	29.0±22.2	7.0±1.7	0(0, 500)
统计值	?	t＝－1.122	t＝－0.235	χ²＝0.623			t＝0.845	t＝0.390	Z＝－0.308
P值	?	>0.05	>0.05	>0.05			>0.05	>0.05	>0.05

表1 两组患者术前基本资料比较

组别	例数	年龄[岁，(±s)]	BMI[kg/m^2, (±s)]	ASA分级(例)			残余尿量[ml, (±s)]	禁水时间[h, (±s)]	术前补液量[ml, M(P25，P75)]
组别	例数	年龄[岁，(±s)]	BMI[kg/m^2, (±s)]	Ⅰ级	Ⅱ级	Ⅲ级	残余尿量[ml, (±s)]	禁水时间[h, (±s)]	术前补液量[ml, M(P25，P75)]
NIC组	109	61.9±10.6	25.8±3.7	4	91	14	31.8±24.2	7.0±1.7	0(0, 500)
IC组	109	62.2±10.6	25.8±3.8	6	87	16	29.0±22.2	7.0±1.7	0(0, 500)
统计值	?	t＝－1.122	t＝－0.235	χ²＝0.623			t＝0.845	t＝0.390	Z＝－0.308
P值	?	>0.05	>0.05	>0.05			>0.05	>0.05	>0.05

表2 两组患者术中及术后检测计量指标比较

组别	例数	补液总量[ml, (±s)]	术中失血量[ml, M(P25，P75)]	术中输血量[ml, M(P25，P75)]	手术时间[min, (±s)]	术后即刻膀胱容积/尿量[ml, (±s)]	术后VAS评分(±s)	术后住院时间[d，(±s)]
NIC组	109	1640.7±323.0	200.0(120，350)	0(0，180)	95.1±26.1	226.1±100.6	2.6±1.1	6.3±2.5
IC组	109	1673.8±346.1	210.0(100，300)	0(0，150)	94.5±26.4	238.3±136.0	2.8±1.5	7.5±3.1
统计值	?	t＝－1.076	Z ＝－0.799	Z ＝－0.790	t＝0.202	t＝0.940	t＝－0.946	t＝－3.132
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.01

表2 两组患者术中及术后检测计量指标比较

组别	例数	补液总量[ml, (±s)]	术中失血量[ml, M(P25，P75)]	术中输血量[ml, M(P25，P75)]	手术时间[min, (±s)]	术后即刻膀胱容积/尿量[ml, (±s)]	术后VAS评分(±s)	术后住院时间[d，(±s)]
NIC组	109	1640.7±323.0	200.0(120，350)	0(0，180)	95.1±26.1	226.1±100.6	2.6±1.1	6.3±2.5
IC组	109	1673.8±346.1	210.0(100，300)	0(0，150)	94.5±26.4	238.3±136.0	2.8±1.5	7.5±3.1
统计值	?	t＝－1.076	Z ＝－0.799	Z ＝－0.790	t＝0.202	t＝0.940	t＝－0.946	t＝－3.132
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.01

表3 两组患者术中及术后检测计数指标比较

组别	例数	尿管相关膀胱不适(例)		尿路刺激征(例)	尿路感染(例)	不良事件(例)	术后尿潴留(例)	患者满意度(例)
组别	例数	中度不适	重度不适	尿路刺激征(例)	尿路感染(例)	不良事件(例)	术后尿潴留(例)	满意	非常满意
NIC组	109	12	0	5	0	3	20	57	41
IC组	109	55	3	22	2	10	13	49	30
统计值	?	χ²＝44.53		χ²＝12.217	－	χ²＝4.008	χ²＝1.750	χ²＝10.844
P值	?	<0.01		<0.01	0.498^a	<0.05	>0.05	<0.01

表3 两组患者术中及术后检测计数指标比较

组别	例数	尿管相关膀胱不适(例)		尿路刺激征(例)	尿路感染(例)	不良事件(例)	术后尿潴留(例)	患者满意度(例)
组别	例数	中度不适	重度不适	尿路刺激征(例)	尿路感染(例)	不良事件(例)	术后尿潴留(例)	满意	非常满意
NIC组	109	12	0	5	0	3	20	57	41
IC组	109	55	3	22	2	10	13	49	30
统计值	?	χ²＝44.53		χ²＝12.217	－	χ²＝4.008	χ²＝1.750	χ²＝10.844
P值	?	<0.01		<0.01	0.498^a	<0.05	>0.05	<0.01

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