摘要
[目的]评价初次单侧全膝关节置换术通过术前排尿训练联合围术期限制性输液,不留置尿管的临床效果。[方法]回顾比较2017年07月~2019年01月190例行术前排尿训练、手术当日限制性输液、不留置尿管的初次单侧全膝关节置换患者(不置管组)与2016年01月~2017年05月190例手术当日自由性输液、留置尿管的患者(置管组)的临床早期结果。[结果]两组患者均顺利手术,无严重术中并发症。两组患者在手术时间、术中失血量、24 h引流量的差异无统计学意义(P>0.05);不置管组患者手术当日术前、术中、术后输液量及总输液量均低于置管组,差异有统计学意义(P<0.05);两组手术当日尿量比较,差异无统计学意义(P>0.05)。术后1个月内,两组尿潴留发生率比较,差异无统计学意义(P>0.05);不置管组在尿路感染、尿路刺激征、膀胱不适发生率方面均显著低于置管组,差异均有统计学意义(P<0.05)。不置管组住院时间显著小于置管组,且患者满意度优于置管组,差异有统计学意义(P<0.05)。[结论]通过术前排尿训练联合围术期限制性输液,初次单侧全膝关节置换术不留置尿管不增加术后尿潴留风险,且降低术后早期尿路感染、尿路刺激征、尿管相关膀胱不适的发生率,缩短住院时间,提高患者满意度。
[Objective]To evaluate the early clinical outcomes of preoperative bladder training combined perioperative restrictive fluid therapy without indwelling catheter in primary total knee arthroplasty(TKA).[Methods]A retrospective study was conducted on 190 patients who received preoperative bladder training and perioperative restrictive fluid therapy without indwelling catheter(the non-catheter group)in primary unilateral TKA from July 2017 to Jan 2019,compared with the other 190 patients who underwent primary unilateral TKA without preoperative bladder training,whereas with routine fluid therapy and indwelling catheter(the catheter group)between Jan 2015 and May 2017.[Results]All the patients had operation performed smoothly without serious complications.There were no statistical differences between the two groups in operation time,intraoperative blood loss and drainage volume in 24 hours(P>0.05).However,the non-catheter group had significantly less preoperative,intraoperative,postoperative and total fluid infusions than the catheter group at the same day of operation(P<0.05),whereas no a statistically significant difference in total urine output in the operation day between the two groups(P>0.05).There was no significant difference in terms of postoperative urinary retention(P>0.05).In addition,the non-catheter group had significantly less complications than the catheter group in 1 months after operation,including postoperative urinary retention,urinary tract infection,urethral irritation and bladder discomfort(P<0.05).At discharging from hospital,the patients in the noncatheter group were significantly more satisficed,with significantly shorter hospital stay than those in the catheter group(P<0.05).[Conclusion]This preoperative bladder training combined with perioperative restrictive fluid therapy without indwelling catheter does not increase the risk of postoperative urinary retention,whereas decrease the risk of postoperative urinary tract infection,urethral irritation and bladder discomfort,as well as shorten h
作者
刘沛
张利克
丁冉
张启栋
刘朝晖
程立明
王卫国
郭万首
LIU Pei;ZHANG Li-ke;DING Ran;ZHANG Qi-dong;LIU Zhao-hui;CHENG Li-ming;WANG Wei-guo;GUO Wan-shou(Beijing University of Chinese Medicine,Beijing 100029,China;Second Department of Orthopaedic,Yichuan County People 5 Hospital,Yichuan 471300,China;Department of Orthopaedic Surgery,China-Japan Friendship Hospital,Beijing 100029,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2020年第7期592-596,共5页
Orthopedic Journal of China
基金
首都卫生发展科研专项(编号:2016-2-4062)
国家重点研发计划课题(编号:2017YFC0108102)
国家自然科学基金项目(编号:81703896、81673776)。
关键词
全膝关节置换术
排尿训练
限制性输液
留置导尿
术后尿潴留
total knee arthroplasty
bladder training
restrictive fluid therapy
indwelling catheter
postoperative urinary retention
