切换至 "中华医学电子期刊资源库"

中华关节外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (05) : 541 -546. doi: 10.3877/cma.j.issn.1674-134X.2019.05.005

所属专题: 文献

临床论著

脊柱麻醉下股骨头置换术后尿液潴留发病率及风险因素
杜秀藩1, 潘富文2, 沈宁江1, 方业汉1, 熊小龙1, 黄晖1, 黄春行1, 王广积1,()   
  1. 1. 570311 海口,海南省人民医院运动医学科
    2. 572000 三亚,海南省第三人民医院骨科
  • 收稿日期:2019-02-01 出版日期:2019-10-01
  • 通信作者: 王广积
  • 基金资助:
    海南省自然科学基金(310122)

Incidence and risk factors of postoperative urinary retention in hemiarthroplasty implemented under spinal anesthesia

Xiufan Du1, Fuwen Pan2, Ningjiang Shen1, Yehan Fang1, Xiaolong Xiong1, Hui Huang1, Chunxing Huang1, Guangji Wang1,()   

  1. 1. Hainan General Hospital, Haikou 570311, China
    2. The third hospital of Hainan, Sanya 572000, China
  • Received:2019-02-01 Published:2019-10-01
  • Corresponding author: Guangji Wang
  • About author:
    Corresponding author: Wang Guangji, Email:
引用本文:

杜秀藩, 潘富文, 沈宁江, 方业汉, 熊小龙, 黄晖, 黄春行, 王广积. 脊柱麻醉下股骨头置换术后尿液潴留发病率及风险因素[J/OL]. 中华关节外科杂志(电子版), 2019, 13(05): 541-546.

Xiufan Du, Fuwen Pan, Ningjiang Shen, Yehan Fang, Xiaolong Xiong, Hui Huang, Chunxing Huang, Guangji Wang. Incidence and risk factors of postoperative urinary retention in hemiarthroplasty implemented under spinal anesthesia[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(05): 541-546.

目的

探讨经椎管麻醉进行人工股骨头置换术,术后发生尿液潴留的几率及可能的风险因素。

方法

回顾性分析2015年2月至2018年4月期间,在海南省人民医院使用椎管麻醉(硬膜外麻醉、蛛网膜下腔麻醉)下行初次股骨头置换术共164个患者,168例股骨头置换的资料。纳入标准:年龄大于18岁,言语表达清晰。排除标准:拒绝参与者;术前间断插尿管者,目前仍留置尿管者;透析患者;既往前列腺、尿道及肾脏的手术病史者;骨肿瘤患者。患者术前均可自行排尿,均未留置尿管。所有的患者都详细记录身体质量指数(BMI)、性别、美国麻醉师协会(ASA)分级、手术时间、术后口服止痛药物,尿失禁与多尿症病史,术后尿液排泄与潴留情况(包括尿液的颜色、体积、腹部症状,体征,并使用膀胱超声确认膀胱中的剩余尿量)。使用卡方检验分析分类变量,使用t检验分析连续变量。

结果

最终纳入161名患者,5名患者要求麻醉后留置尿管而被排除,38名患者术后出现了尿液潴留,需使用尿管进行导尿。共计有17个病人留置导尿管3~5 d,5位患者因拒绝导尿而出现尿路感染,使用尿管导尿的患者有3例最后发生了尿路感染。术后尿液潴留与既往潴留病史(t =8.935,P <0.05)及术中的输液量(t =6.213,P<0.05)呈正比例相关。未发现留置尿管与BMI指数,性别,ASA分级,手术时间、术后口服止痛药物,尿失禁与多尿症病史存在明显的相关性(P >0.05)。

结论

椎管麻醉下进行人工股骨头置换术,既往尿液潴留病史及手术过程中输入较多的液体量是术后发生尿液潴留的高风险因素。

Objective

To evaluate the odds and risk factors of postoperative urinary retention (POUR) after hemiarthroplasty by spinal anesthesia.

Methods

Consecutive patient informations (164 patients and 168 hips) that performed a primary hemiarthroplasty with spinal anesthesia(epidural anesthesia or subarachnoid anesthesia)were recollective investigated from February 2015 to April 2018 in Hainan General Hospital. Inclusion criteria: age older than 18 years and ability of clear conversation. Exclusion criteria: the patients who refused to participation, and the patients in whom preoperative intermittent catheterization was applied till the present, dialysis patients, patients with a history of uriological surgery, and patients with bone tumor.All the patients were voided autonomously and without any indwelling catheter.All the patients were recorded body mass index (BMI), gender, American Society of Anesthesiologists (ASA) grade, and operative duration, postoperative oral acesodyne apply, history of incontinence or polyuria andpostoperatively for urinary retention including urine colour, volume, abdomen symptoms and signs, bladder ultrasound scan was also performed to identify the residual urinary capacity. Categorical variables were analyzed with chi-square testing and continuous variables were analyzed with the Student t test.

Results

One hundred and sixty one patients were collected into the study eventually. Five patients were excluded for demanding indwelling catheterization in the operative survey. Thirty-eight patients suffered POUR and required immediate catheterization. Seventeen patients finally demanded detaining catheterization for 3-5 d. Five patients who refused to catheterized developed to urinary tract infection and three patients who catheterized were underwent urinary tract infection. POUR was significantly associated with a history of urinary retention and intraoperative fluid volume (t =8.935, P <0.05; t =6.213, P <0.05, respectively). No significant association was showed between catheterization and BMI, gender, ASA grade, operative duration, postoperative oral acesodyne apply, history of incontinence or polyuria(P >0.05).

Conclusion

Patients who have a history of prior urinary retention and those who receive high volumes of intraoperative fluid are at higher risk for POUR following hemiarthroplasty conducted under spinal anesthesia.

图1 尿管处理比例图
表1 病人基本特征与潜在的风险因素
表2 ASA分级、IPSS评分与潜在的风险因素(例)
表3 围手术期管理情况
表4 多变量线性回归分析
[1]
Kaplan SA, Wein AJ, Staskin DR, et al. Urinary retention and post-void residual urine in men: separating truth from tradition[J]. J Urol, 2008, 180(1): 47-54.
[2]
Balderi T, Carli F. Urinary retention after total hip and knee arthroplasty[J]. Minerva Anestesiol, 2010, 76(2): 120-130.
[3]
Shadle B, Barbaro C, Waxman K, et al. Predictors of postoperative urinary retention[J]. Am Surg, 2009, 75(10): 922-924.
[4]
Baldini G, Bagry H, Aprikian A, et al. Postoperative urinary retention anesthetic and perioperative considerations[J]. Anesthesiology, 2009, 110(5): 1139-1157.
[5]
Farag E, Dilger J, Brooks P, et al. Epidural analgesia improves early rehabilitation after total knee replacement[J]. J Clin Anesth, 2005, 17(4): 281-285.
[6]
Oishi CS, Williams VJ, Hanson PB, et al. Perioperative bladder management after primary total hip arthroplasty[J]. J Arthroplasty, 1995, 10(6):732-736.
[7]
O’Riordan JA, Hopkins PM, Ravenscroft A, et al. Patient-controlled analgesia and urinary retention following lower limb joint replacement: prospective audit and logistic regression analysis[J]. Eur J Anaesthesiol, 2000,17(7):431-435.
[8]
Matsuura S, Downie JW. Effect of anesthetics on reflex micturition in the chronic cannula-implanted rat[J]. Neurourol Urodyn, 2000, 19(1): 87-99.
[9]
Combrisson H, Robain G, Cotard JP. Comparative effects of xylazine and propofol on the urethral pressure profile of healthy dogs[J]. Am J Vet Res, 1993, 54(12): 1986-1989.
[10]
Kamphuis, Ionescu TI, kuipers PW, et al. Recovery of storage and emptyingfunctions of the urinary bladder after spinal anesthesia with lidocaine and with bupivacaine in men[J]. Anesthesiology, 1998, 88(2): 310-316.
[11]
Axelsson K, Mollefors K, Olsson JO, et al. Bladder function in spinal anaesthesia[J]. Acta Anaesthesiol Scand, 1985, 29(3): 315-321.
[12]
Balderi T, Mistraletti G, D’Angelo E, et al. Incidence of postoperative urinary retention (POUR) after joint arthroplasty and management using ultrasound-guided bladder catheterization[J]. Minerva Anestesiol, 2011,77(11):1050-1057.
[13]
Bjerregaard LS, Bogø S, Raschou S, et al. Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty[J]. Acta Orthop, 2015, 86(2): 183-188.
[14]
Griesdale DG, Neufeld J, Dhillon D, et al. Risk factors for urinary retention after hip or knee replacement: a cohort study[J]. Can J Anaesth, 2011, 58(12): 1097-1104.
[15]
Kieffer WK, Kane TP. Predicting postoperative urinary retention after lower limb arthroplasty[J]. Ann R Coll Surg Engl, 2012, 94(5): 356-358.
[16]
Kotwal R, Hodgson P, Carpenter C. Urinary retention following lower limb arthroplasty: analysis of predictive factors and review of literature[J]. Acta Orthop Belg, 2008, 74(3): 332-336.
[17]
Sarasin SM, Walton MJ, Singh HP, et al. Can a urinary tract symptom score predict the development of postoperative urinary retention in patients undergoing lower limb arthroplasty under spinal anaesthesia? A prospective study[J]. Ann R Coll Surg Engl, 2006, 88(4): 394-398.
[18]
Michelson JD, Lotke PA, Steinberg ME. Urinary-bladder management after total joint replacement surgery[J]. N Engl J Med, 1988, 319(6): 321-326.
[19]
Lampe HI, Sneller ZW, Rijnberg WJ. Urination problems following total hip arthroplasty: insertion or not of an indwelling catheter?[J]. Ned Tijdschr Geneeskd, 1992; 136(17):827-831.
[20]
Scholten R, Kremers K. Van de groes SAW, et al. Incidence and risk factors of postoperative urinary retention and bladder catheterization in patients undergoing Fast-Track total joint arthroplasty:a prospective observational study on 371 patients[J]. J Arthroplasty, 2018, 33(5): 1546-1551.
[21]
Loftus T, Agee C, Jaffe R, et al. A simplified pathway for total knee arthroplasty improves outcomes[J]. J Knee Surg, 2014, 27(3): 221-228.
[22]
Iorio R, Healy WL, Patch DA, et al. The role of bladder catheterization in total knee arthroplasty[J]. Clin Orthop Relat Res, 2000, 12(380): 80-84.
[23]
Nyman MH, Gustafsson M, Langius-Eklof A, et al. Intermittent versus indwelling urinary catheterisation in hip surgery patients: a randomised controlled trial with cost-effectiveness analysis[J]. Int J Nurs Stud, 2013, 50(12): 1589-1598.
[24]
Meddings J, Rogers MA, Krein SL, et al. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review[J]. BMJ Qual Saf, 2014, 23(4): 277-289.
[25]
Choi S, Awad I. Maintaining micturition in the perioperative period: strategies to avoid urinary retention[J]. Curr Opin Anaesthesiol, 2013, 26(3): 361-367.
[26]
Peel TN, Cheng AC, Liew D, et al. Direct hospitalcost determinants following hip and knee arthroplasty[J]. Arthritis Care Res (Hoboken), 2015, 67(6): 782-790.
[27]
Zhang W, Liu A, Hu DC, et al. Indwelling versus intermittent urinary catheterization following total joint arthroplasty: a systematic review and meta-analysis [J/OL]. PLoS One, 2015, 10(7): e0130636. doi: 10.1371/journal.pone.0130636. eCollection 2015
[28]
陈有荣,文鹏飞,郭万首,等.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/CD].中华关节外科杂志(电子版),2018,12(3):350-355.
[29]
顾新丰,郑昱新,王海生,等.AAOS髋膝关节置换术后假体周围感染诊断指南解读[J/CD].中华关节外科杂志(电子版),2014,8(1):127-128.
[30]
Fernandez MA, Karthikeyan S, Wyse M, et al. The incidence of postoperative urinary retention in patients undergoing elective hip and knee arthroplasty[J]. Ann R Coll Surg Engl, 2014 , 96(6):462-465.
[1] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[2] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[3] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[4] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[5] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[6] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[7] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[8] 许杰, 李亚俊, 冯义文. SOX新辅助化疗后腹腔镜胃癌D2根治术与常规根治术治疗进展期胃癌的近期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 647-650.
[9] 康婵娟, 张海涛, 翟静洁. 胰管支架置入术治疗急性胆源性胰腺炎的效果及对患者肝功能、炎症因子水平的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 667-670.
[10] 付成旺, 杨大刚, 王榕, 李福堂. 营养与炎症指标在可切除胰腺癌中的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 704-708.
[11] 刘柏隆, 周祥福. 女性尿失禁吊带手术并发症处理的经验分享[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 127-127.
[12] 嵇振岭, 陈杰, 唐健雄. 重视复杂腹壁疝手术并发症的预防和处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 601-606.
[13] 江志鹏, 钟克力, 陈双. 复杂腹壁疝手术后腹腔高压与腹腔间室综合征的预防和处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 612-615.
[14] 王学虎, 赵渝. 复杂腹壁疝手术中血管损伤并发症的预防和处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 616-619.
[15] 马东扬, 李斌, 陆安清, 王光华, 雷文章, 宋应寒. Gilbert 与单层补片腹膜前疝修补术疗效的随机对照研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 629-633.
阅读次数
全文


摘要