术中不置尿管技术在单节段颈前路手术中的应用及临床观察
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摘要
目的观察颈前路单节段手术中不置尿管的结果。方法回顾性分析我院脊柱外科2015年1月-2016年12月因单节段颈椎间盘突出症行人工颈椎间盘置换术(ACDR)或颈前路减压融合内固定术(ACDF)患者95例。其中,对照组47例(麻醉后常规置尿管),试验组48例(麻醉后不置尿管)。观察两组患者麻醉苏醒时心律、血压的变化、躁动情况;记录患者术后对留置尿管的主观感受和膀胱充盈及刺激的感受;术后首次自行小便的时间;术后尿路感染率。结果所研究患者手术时间55～90分钟,术中失血量15～200 ml,术中输液量300～600 ml。试验组麻醉苏醒时心律、血压变化及躁动情况比对照组患者波动小,差异显著(P<0.01);术后随访全麻苏醒时及复苏后对照组安尿管后的主观感受舒适度明显低于试验组,术后试验组自我感受膀胱充盈度明显小于对照组(P<0.01)。结论单节段颈前路手术术中不置尿管可缓解患者术前对安置尿管的焦虑,提高患者全麻苏醒后及术后的舒适体验,减少术后尿路刺激征及尿路感染率。
Objective To observe the results of catheterization in the anterior cervical spine surgery.Methods Using retrospective analysis of spine surgery in a cervical treatment group from January 2015 to Decembe 2016,which in total 95 cases of disc resection decompression artificial disc replacement(ACDR)or cervical fusion and internal fixation(ACDF).In 47 cases,conventional catheterization was performed after anesthesia.In 48 patients,the catheter was not catheterized after anesthesia.The changes of heart rhythm and blood pressure(compared with the basic signs)and restlessness in those two groups of patients undergoing anesthesia resuscitation(postoperative half hour)were observed.The subjective feeling of the indwelling catheter,the feeling of filling and stimulation of the bladder after the resuscitation of the patients after operation,the time and feeling of first urination after surgery,posterior urethral mucosal injury and urinary tract infection rate were recorded.Results The vital signs were stable during the operation,the operation time was 55-90 minutes,the intraoperative blood loss was 15-200 ml,and the intraoperative transfusion volume was 300-600 ml.The changes of heart rhythm,blood pressure and restlessness in the experimental group were less than those in the control group,with significant difference(P<0.01).Postoperative follow-up after general anesthesia and recovery when they woke up in the control group,the urine tube after the subjective feeling of comfort levels significantly lower than the experimental group,self feels bladder filling degree of the postoperative experimental group was obviously less than the control group(P<0.01).Conclusion Anterior cervical single segmental surgery without conventional catheterization would relieve the anxiety in the patients with preoperative urine tube for resettlement,greatly improve the patients regained consciousness after general anesthesia and postoperative experience of comfort,reduce postoperative urinary irritation and urinary tract infection.
Objective To observe the results of catheterization in the anterior cervical spine surgery.Methods Using retrospective analysis of spine surgery in a cervical treatment group from January 2015 to Decembe 2016,which in total 95 cases of disc resection decompression artificial disc replacement(ACDR)or cervical fusion and internal fixation(ACDF).In 47 cases,conventional catheterization was performed after anesthesia.In 48 patients,the catheter was not catheterized after anesthesia.The changes of heart rhythm and blood pressure(compared with the basic signs)and restlessness in those two groups of patients undergoing anesthesia resuscitation(postoperative half hour)were observed.The subjective feeling of the indwelling catheter,the feeling of filling and stimulation of the bladder after the resuscitation of the patients after operation,the time and feeling of first urination after surgery,posterior urethral mucosal injury and urinary tract infection rate were recorded.Results The vital signs were stable during the operation,the operation time was 55-90 minutes,the intraoperative blood loss was 15-200 ml,and the intraoperative transfusion volume was 300-600 ml.The changes of heart rhythm,blood pressure and restlessness in the experimental group were less than those in the control group,with significant difference(P<0.01).Postoperative follow-up after general anesthesia and recovery when they woke up in the control group,the urine tube after the subjective feeling of comfort levels significantly lower than the experimental group,self feels bladder filling degree of the postoperative experimental group was obviously less than the control group(P<0.01).Conclusion Anterior cervical single segmental surgery without conventional catheterization would relieve the anxiety in the patients with preoperative urine tube for resettlement,greatly improve the patients regained consciousness after general anesthesia and postoperative experience of comfort,reduce postoperative urinary irritation and urinary tract infection.
引文
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[7] 余小青,刘红娟.改进尿管拔除方法对骨科术后病人舒适度影响[J].全科护理,2018,16(32):4038-4039.
[8] Sandberg EM,Twijnstra AR,Meir CA,et al.Immediate versus delayed removal of urinary catheter after laparoscopic hysterectomy:a randomized-controlled trial[J].BJOG,2018,126(6):804-813.
[9] 陆杰荣,梁静,彭伟萍,等.留置尿管的临床护理[J].临床医药文献电子杂志,2014,1(1):38,70.
[10] Hendren S.Urinary catheter management[J].Clinics in Colon and Rectal Surgery,2013,26(3):178-181.
[11] Marschall J,Carpenter CR,Fowler S,et al.Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter:meta-analysis[J].BMJ(Clinical Research ed.),2013,346:f3147.
[2] 杨翠芹.住院患者尿路感染相关因素分析及预防对策[J].现代预防医学,2010,37(8):1592-1593.
[3] 余群飞,沈志坤(综述),王惠琴(审校).缩短导尿管留置时间的相关研究与展望[J].护理学报,2014(17):23-26.
[4] 刘淑娇,王宏涛.全麻手术留置导尿患者拔管时间的探讨[J].齐鲁护理杂志,2002,8(8):619-620.
[5] 蔡秋荣.留置尿管并发的尿路感染:原因及预防[J].现代预防医学,2011,38(13):2677-2678.
[6] 岳素琴,张延霞,袁康.医院内尿路感染危险因素分析及预防措施[J].中华医院感染学杂志,2000,10(5):41-42.
[7] 余小青,刘红娟.改进尿管拔除方法对骨科术后病人舒适度影响[J].全科护理,2018,16(32):4038-4039.
[8] Sandberg EM,Twijnstra AR,Meir CA,et al.Immediate versus delayed removal of urinary catheter after laparoscopic hysterectomy:a randomized-controlled trial[J].BJOG,2018,126(6):804-813.
[9] 陆杰荣,梁静,彭伟萍,等.留置尿管的临床护理[J].临床医药文献电子杂志,2014,1(1):38,70.
[10] Hendren S.Urinary catheter management[J].Clinics in Colon and Rectal Surgery,2013,26(3):178-181.
[11] Marschall J,Carpenter CR,Fowler S,et al.Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter:meta-analysis[J].BMJ(Clinical Research ed.),2013,346:f3147.