颅内未破裂动脉瘤患者介入栓塞术后不同时机拔除导尿管的研究

doi:10.3761/j.issn.0254-1769.2022.23.007

摘要/Abstract

摘要：

目的探讨加速康复外科理念下，不同时机拔除导尿管对颅内未破裂动脉瘤介入栓塞术后患者的影响。方法采取便利抽样法，选取2021年10月—2022年1月四川省某三级甲等医院介入手术室收治的140例接受介入栓塞术治疗的颅内未破裂动脉瘤患者作为研究对象，采用随机数字表法将其分为试验组和对照组，每组70例。试验组在Aldrete评分≥12分后，术后2 h内拔除导尿管，对照组在术后24 h内拔除导尿管。结果共135例完成研究，试验组68例，对照组67例，两组一般资料比较，除导尿管留置时间外，其余一般资料比较，差异无统计学意义（P>0.05）。试验组出麻醉恢复室前苏醒期躁动评分及躁动率均低于对照组，差异均具有统计学意义（P=0.013，0.008）。试验组首次排尿时间晚于对照组，首次排尿量低于对照组，差异均具有统计学意义（均P<0.001）；两组首次排尿情况比较，差异无统计学意义（均P>0.05）。试验组在拔管前、拔管时、拔管后2 h的疼痛视觉模拟评分均低于对照组，差异具有统计学意义（P<0.05）。结论术后2 h内拔除导尿管，有助于降低颅内未破裂动脉瘤患者介入栓塞术后苏醒期躁动率，不增加尿潴留及导尿管重置的风险，减轻患者尿道疼痛程度。在保证颅内未破裂动脉瘤患者介入栓塞术后安全的情况下，可尽早拔除导尿管。

关键词: 颅内动脉瘤, 介入栓塞术, 导尿管, 基础护理, 快速康复

Abstract:

Objective To investigate the effect of catheter removal at different times on patients with unruptured intracranial aneurysm（UIA） after interventional embolization under the concept of enhanced recovery after surgery. Methods Convenience sampling method was used to select 140 patients with UIA who underwent interventional embolization in an interventional operating room of a tertiary A hospital in Sichuan Province from October 2021 to January 2022 as the research subjects. They were divided into an experimental group and a control group by table method，with 70 patients in each group. After the Aldrete score ≥12 points in the experimental group，the urinary catheter was removed within 2 h after the operation，and the urinary catheter in the control group was removed within 24 h after the operation. Results A total of 135 patients were included in the study，with 68 in the experimental group and 67 in the control group. There was no significant difference in the general data between the 2 groups（P>0.05）. The agitation score and agitation rate in the wake-up period before leaving the anesthesia recovery room in the experimental group were lower than those in the control group，and the difference was statistically significant（P=0.013 and P=0.008）. The urine output was lower than that of the control group，and the difference was statistically significant（P<0.05）.Compared with the control group，there was no significant difference in the first urination in the experimental group（P>0.05）. The visual analog scores of pain in the experimental group before，during and 2 hours after the extubation were lower than those in the control group，and the difference was statistically significant（P<0.05）. Conclusion Removing the urinary catheter within 2 hours after surgery can help to reduce rate of restlessness during recovery after interventional embolization in patients with UIA，not increase the risk of urinary retention and catheter replacement，and reduce the the pain of the urethra.It is recommended to remove the urinary catheter as soon as possible while ensuring the safety of patients with UIA after interventional embolization.

Key words: Intracranial Aneurysm, Interventional Embolization, Urinary Catheter, Basic Care, Quick Recovery

罗月, 宿伟, 丁婉玉, 刘仑鑫, 李伟. 颅内未破裂动脉瘤患者介入栓塞术后不同时机拔除导尿管的研究[J]. 中华护理杂志, 2022, 57(23): 2864-2869.

LUO Yue, SU Wei, DING Wanyu, LIU Lunxin, LI Wei. Study on the removal of urinary catheter at different times after interventional embolization in patients with unruptured intracranial aneurysm[J]. Chinese Journal of Nursing, 2022, 57(23): 2864-2869.

图/表 4

表1 两组一般资料比较

Table 1 Comparison of general information between 2 groups of patients

表2 两组苏醒期躁动评分及躁动率比较

Table 2 Comparison of Riker Sedation-Agitation Scale score and agitation rate during recovery between 2 groups of patients

表3 两组首次排尿时间、量及排尿情况比较

Table 3 Comparison of the first urination time， volume and urination between the 2 groups of patients

表4 两组尿道疼痛评分比较[分，M（P25，P75）]

Table 4 Comparison of urethral pain scores between 2 groups of patients[score，M（P25，P75）]

参考文献 18

[1]	中国医师协会神经介入专业委员会, 中国颅内动脉瘤计划研究组. 中国颅内未破裂动脉瘤诊疗指南2021[J]. 中国脑血管病杂志, 2021, 18(9):634-664.
	Neurointerventional Professional Committee of Chinese Medical Doctor Association,China Intracranial Aneurysm Project Research Group. Chinese guideline for diagnosis and treatment of unruptured intracranial aneurysm 2021[J]. Chin J Cerebrovasc Dis, 2021, 18(9):634-664.
[2]	楚瑨. 乳液静电纺缓释型纳米纤维腹膜支架的制备及在颅内动脉瘤的应用[D]. 上海: 东华大学, 2020.
	Chu J. Preparation of emulsion electrospun sustained-release nanofiber peritoneal stent and its application in intracranial aneurysms[D]. Shanghai: Donghua University, 2020.
[3]	罗小平, 牟江涛, 李斌飞, 等. 麻醉恢复室全麻复苏患者清醒前导尿管拔除方案的制订及应用效果评价[J]. 中华护理杂志, 2018, 53(12):1468-1472.
	Luo XP, Mou JT, Li BF, et al. Development and evaluation of catheter removing in general anesthesia patients during anesthesia recovery in post-anesthesia care unit[J]. Chin J Nurs, 2018, 53(12):1468-1472.
[4]	Gould CV, Umscheid CA, Agarwal RK, et al. Guideline for prevention of catheter-associated urinary tract infections 2009, updated 2017[EB/OL]. (2017-02-01)[2022-06-07]. https://www.cdc.gov/infectioncontrol/guidelines/cauti/updates.html.
[5]	Hayami S, Ueno M, Kawai M, et al. Optimal timing of removal of epidural and urethral catheters to avoid postoperative urinary retention undergoing abdominal surgery[J]. Dig Surg, 2019, 36(3):261-265. DOI URL
[6]	Zhang L, Yang XY, Tian Y, et al. The feasibility and advantages of immediate removal of urinary catheter after lobectomy:a prospective randomized trial[J]. Nurs Open, 2021, 8(6):2942-2948. DOI URL
[7]	李小寒, 尚少梅. 基础护理学[M]. 6版. 北京: 人民卫生出版社, 2017.
	Li XH, Shang SM. Basic nursing[M]. 6th ed. Beijing: People’s Medical Publishing House, 2017.
[8]	陈罡, 代恒茂, 赵以林, 等. 改良Aldrete量表用于妇科全麻术后患者复苏效果评价[J]. 护理学杂志, 2018, 33(6):4-7.
	Chen G, Dai HM, Zhao YL, et al. Effect evaluation of modified Aldrete Scale application on recovery of postoperative gynecological patients after general anesthesia[J]. J Nurs Sci, 2018, 33(6):4-7.
[9]	Feng ZY, Shi X, Yan X, et al. Comparing the effects of dexmedetomidine versus propofol on the treatment of emergence agitation in adult patients after general anesthesia:study protocol for a randomized,superiority,controlled trial(DP-TEA Trial)[J]. Trials, 2021, 22(1):811. DOI URL
[10]	卢芳燕, 李茜, 金静芬, 等. 肝胆胰外科短期留置和早期拔除导尿管的最佳证据应用[J]. 中华护理杂志, 2018, 53(6):650-655.
	Lu FY, Li Q, Jin JF, et al. Best practice implementation of short-term indwelling urinary catheter and its early removal in hepatopancreatobiliary surgery[J]. Chin J Nurs, 2018, 53(6):650-655.
[11]	卫转, 郭锦丽, 李冰, 等. 骨科全麻下肢手术患者术后超早期拔除尿管临床研究[J]. 护理学杂志, 2020, 35(9):36-39.
	Wei Z, Guo JL, Li B, et al. Super-early removal of urinary catheter in patients undergoing lower extremity orthopedic surgery under general anesthesia[J]. J Nurs Sci, 2020, 35(9):36-39.
[12]	Shatkin-Margolis A, Yook E, Hill AM, et al. Self-removal of a urinary catheter after urogynecologic surgery:a randomized controlled trial[J]. Obstet Gynecol, 2019, 134(5):1027-1036. DOI PMID
[13]	杨华文, 易凤琼, 曾彦超, 等. 全麻术后患者超早期拔除尿管的临床研究[J]. 护理学报, 2021, 28(5):66-69.
	Yang HW, Yi FQ, Zeng YC, et al. Super early removal of urinary catheter in patients after general anesthesia[J]. J Nurs Chin, 2021, 28(5):66-69.
[14]	王海燕, 鲁彦斌, 梁国庆, 等. 右美托咪啶对颅内动脉瘤手术患者全麻苏醒期躁动的影响研究[J]. 中华神经外科疾病研究杂志, 2018, 17(6):512-515.
	Wang HY, Lu YB, Liang GQ, et al. Effect of dexmedetomidine on agitation during recovery from general anesthesia in patients with intracranial aneurysm surgery[J]. Chin J Neurosurg Dis Res, 2018, 17(6):512-515.
[15]	Bray R, Cartwright R, Digesu A, et al. A randomised controlled trial comparing immediate versus delayed catheter removal following vaginal prolapse surgery[J]. Eur J Obstet Gynecol Reprod Biol, 2017, 210:314-318. DOI PMID
[16]	邹焱, 刘婷, 张艳云, 等. 妇产科手术患者留置导尿管拔管时机的Meta分析[J]. 中华护理杂志, 2016, 51(9):1076-1081.
	Zou Y, Liu T, Zhang YY, et al. The timing of removing indwelling urinary catheter for patients undergoing gynecologic surgery:a Meta-analysis[J]. Chin J Nurs, 2016, 51(9):1076-1081.
[17]	Sandberg EM, Twijnstra A, van Meir CA, et al. Immediate versus delayed removal of urinary catheter after laparoscopic hysterectomy:a randomised controlled trial[J]. BJOG, 2019, 126(6):804-813. DOI URL
[18]	Bach H, Kaasby K, Sørensen A, et al. Incidence and severity of catheter-related bladder discomfort among nonurological adult patients in a postanesthesia care unit[J]. J Perianesth Nurs, 2020, 35(1):29-33. DOI PMID