尿管留置对胸科手术患者全身麻醉苏醒期躁动影响的前瞻性队列研究  

Influence of Postoperative Indwelling Urethral Catheter on Emergence Agitation of Patients with Thoracic Surgery:A Prospective Cohort Study

作　　者：赵金兰[1] 邱姝婷[1] 许宁惠[1] 龚仁蓉[1] 杨梅[2] 李为民[3] 车国卫[2] 

机构地区：[1]四川大学华西医院麻醉手术中心,成都610041 [2]四川大学华西医院胸外科,成都610041 [3]四川大学华西医院呼吸内科,成都610041

出　　处：《中国胸心血管外科临床杂志》2016年第4期319-322,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：四川省科技厅基金资助(2014 SZ 0148;2015 SZ 0158)~~

摘　　要：目的探讨麻醉清醒前拔除导尿管对胸科手术患者苏醒期躁动影响的因素。方法 2014年1月至4月,连续纳入140例胸科手术患者,将患者分为无尿管留置组(试验组,70例,手术结束后麻醉清醒前拔除尿管)和尿管留置组(对照组,70例,留置尿管带回病房或ICU),两组均在麻醉诱导后导尿。记录术中尿量、尿道刺激、麻醉苏醒期躁动和术后尿潴留发生率。结果试验组和对照组术后尿潴留发生率差异无统计学意义(1.43%vs.2.86%,P=0.230);对照组尿道刺激发生率高于试验组(12.86%vs.0.00%,P=0.012),且男性患者诉尿管刺激发生率(20.51%,8/39)高于女性患者(3.23%,1/31,P=0.033);对照组不良事件发生率高于试验组(2.86%vs.0.00%,P=0.039)。对照组全身麻醉苏醒期躁动发生率高于试验组(28.57%vs.12.86%,P=0.010),对照组中由尿管刺激引起的苏醒期躁动发生率高于试验组(45.00%vs.12.86%,P=0.043)。结论胸科手术患者全身麻醉苏醒期躁动发生的主要原因是尿道刺激,麻醉清醒前拔除尿管可以降低其发生率。Objective To explore the emergence agitation resulting from postoperative indwelling urethral catheters in patients of thoracic surgery.Methods In this prospective cohort study,we recruited 140 patients who were scheduled for thoracic surgery under general anesthesia in West China Hospital from January through April 2014.These patients were divided into two groups including a control group and a trial group with 70 patients in each group.The patients in the control group had indwelled urethral catheter routinely.The catheter removed after the surgery at operation room in the trial group.Intraoperative urinary volume,emergence agitation（EA）occurrence,postoperative urinary retention,and urethral irritation were recorded.Results There was no statistical difference in postoperative urinary retention rate between the control group and the trial group（1.43 % vs.2.86 %,P= 0.230）.However,the urethral irritation rate in the control group was significantly higher than that in the trial group（12.86 % vs.0.00 %,P= 0.012）.And there was a statistical difference in adverse event rate（2.86 % vs.0.00 %,P= 0.039）between the two groups.There was a significantly higher incidence of urethral irritation in male patients（20.51 %,8/39）than female patients（3.23 %,1/31,P= 0.033）.The rate of EA in the control group was significantly higher than that in the trial group（28.57 % vs.12.86 %,P= 0.010）.There was a significantly higher EA rate in the patients who had urethral irritation by postoperative indwelling catheters compared with those without indwelling catheters（45.00 % vs.12.86 %,P= 0.043）.Conclusion This study suggests that postoperative EA is a result from urethral irritation than local pain,and the EA rate can be decreased by removal of catheter before anaesthetic recovery.

关 键 词：胸科手术 尿管留置 全身麻醉苏醒期躁动 不良事件 

分 类 号：R614[医药卫生—麻醉学]