腰椎骨折切开复位内固定术后镇痛期间尿管拔除时机的探讨  

Exploration on Indwelling Catheter Extraction Time during Analgesia for Open Reduction and Internal Fixation of Lumbar Fracture under General Anesthesia

作　　者：许鑫[1] 胡三莲[2] 周玲[3] 秦瑜[3] 陆盈颖[3] 

机构地区：[1]上海交通大学附属第六人民医院骨科综合病房,上海200233 [2]上海交通大学附属第六人民医院护理部,上海200233 [3]上海交通大学附属第六人民医院骨科脊柱病房,上海200233

出　　处：《解放军护理杂志》2010年第5期331-333,共3页Nursing Journal of Chinese People's Liberation Army

基　　金：2007年上海市第六人民医院院级课题(编号0832)

摘　　要：目的探讨全身麻醉(以下简称全麻)下腰椎骨折切开复位内固定术后镇痛期间留置尿管的拔除时机。方法将478例全麻腰椎骨折术后镇痛期间的患者按手术时间随机分为4组。甲组(116例):术后镇痛泵应用期间自感有尿意时拔除尿管;乙组(124例):结束镇痛同时拔除尿管;丙组(120例):结束镇痛同时并自感有尿意时拔除尿管;丁组(118例):镇痛泵拔除1 d后拔除尿管。观察四组患者在拔除尿管后排尿顺畅情况、首次排尿时间、尿路感染、护理工时等指标。结果甲组患者在术后顺利排尿率、首次排尿时间、尿痛、尿色、护理工时方面均优于其余各组(P<0.01);在尿液混浊方面四组比较无差异(P>0.05)。结论腰椎骨折患者全麻术后镇痛期间自感有尿意时是拔除尿管的最佳时机,是保证排尿成功率、减少尿潴留发生、降低尿路感染的有效护理方法,同时可减少因排尿失败需再次导尿时对患者尿道的损伤,有利于患者术后康复,提升患者舒适度。Objective To explore indwelling catheter extraction time during analgesia for open reduction and internal fixation of lumbar fracture under general anesthesia. Methods A total of 478 patients during analgesia for open reduction and internal fixation of lumbar fracture under general anesthesia were randomized into 4 groups based on the operation time： group A（n=116） with indwelling catheter extraction when micturition desire occurred following the application of demulcent pump,group B（n=124） with indwelling catheter extraction when the demulcent pump was withdrawn, group C（n=120） with catheter extraction when micturition desire occurred combined with the withdrawal of demulcent pump and group D （n=118） with catheter extraction when micturition desire occurred after the withdrawal of demulcent pump Or a day of extraction. A series of indicators were observed on normal urinary flow after indwelling catheter extraction,first micturition time,urinary tract infection and nursing hours. Results The indicators of postoperative normal urinary flow,first micturition and nursing hours in group A were significantly better than those of the other 3 groups（P〈0.01） ;The indictors of odynuria and urine color were significantly better than those of the other 3 groups（P〈0.01）. No significant differences on nebulous urine among the 4 groups （P〉0.05）. Conclusion The optimal time for indwelling catheter extraction is determined when micturition desire occurs during analgesia for open reduction and internal fixation of lumbar fracture under general anesthesia,whiCh provides an effective method to ensure the success rate of micturition,reduce occurrences of retention of urine, urinary tract infection and urethral injuries due to re-extraction for urination failure with a view to promoting healing and elevating comfort.

关 键 词：腰椎骨折 切开复位内固定术 全麻 镇痛 留置尿管 拔除时机 

分 类 号：R473.6[医药卫生—护理学]