腹部手术后患者尿管早期拔除效果的系统评价  

Effect of Early Removal of Urethral Catheter in Patients After Abdominal Surgery:A Systematic Review

作　　者：熊照玉 梁珊珊[2] 黄帅[2] Xiong Zhaoyu;Liang Shanshan;Huang Shuai(School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China;Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicineal, Shanghai 200092, China)

机构地区：[1]上海交通大学护理学院,上海200025 [2]上海交通大学医学院附属新华医院普外科,上海200092

出　　处：《解放军护理杂志》2018年第4期1-8,共8页Nursing Journal of Chinese People's Liberation Army

摘　　要：目的系统评价腹部手术后患者尿管早期拔除的效果。方法计算机检索Cochrane图书馆、CINAHL、PubMed、荷兰医学文摘数据库(the excerpta medica database,Embase)、Web of Knowledge、中国生物医学文献数据库(Chinese biomedical literature database,CBM)、中国期刊全文数据库(Chinese national knowledge infrastructure,CNKI)与万方数据库,查找关于腹部手术后患者尿管拔除时间的随机对照试验、类随机对照试验、队列和病例对照研究,采用RevMan 5.3进行Meta分析。结果最终共纳入9项研究,其中有6项为随机对照试验、3项为队列研究,共计889名患者。Meta分析结果显示,早期拔除尿管能降低导尿管相关尿路感染的发生率[RR=0.38,95%CI(0.24,0.60),P<0.0001],缩短住院时间(P<0.05),但会增加术后尿潴留的发生率[RR=2.30,95%CI(1.60,3.31),P<0.00001],对肺部并发症和伤口感染发生率等方面,差异均无统计学意义(均P>0.05)。结论早期拔除尿管能降低导尿管相关尿路感染的发生率,缩短住院时间,但会增加尿潴留的发生率。目前尚无足够证据支持早期拔除尿管能够降低肺部并发症和伤口感染发生率。To systematically evaluate the effect of early removal of urethral catheter in patients after abdominal surgery.Methods We searched the Cochrane Database of Systematic Reviews,CINAHL,PubMed,the Excerpta Medical Databse（Embase）,Web of Knowledge,Chinese biomedical literature database（CBM）,Chinese national knowledge infrastructure（CNKI）and Wanfang database to collect randomized control trials（RCTs）,controlled clinical trials（CCTs）,cohort studies and case control studies.Meta-analysis was conducted for the eligible studies using RevMan 5.3.Results Six RCTs and three cohort studies involving a total of 889 patients were included.Meta-analysis results indicated that early removal of urethral catheter decreased the incidence of catheter-associated urinary tract infection（CAUTI）（RR =0.38,95%CI（0.24,0.60）,P〈0.0001）,shorten the length of stay（P〈0.05）.However,it increased the incidence of postoperative urinary retention（RR=2.30,95%CI（1.60,3.31）,P〈0.00001）.There was no significant difference in the incidence of pulmonary complications and wound infection from among 3 studies（all P〈0.05）.Conclusion Early removal of urethral catheter can reduce the incidence of CAUTI,shorten length of stay,however,with result in higher incidence of POUR.There is not enough evidence to support early removal of urethral catheter to reduce the incidence of pulmonary complications and wound infection.

关 键 词：腹部手术 尿管 尿路感染 尿潴留 META分析 

分 类 号：R656[医药卫生—外科学] R473.6[医药卫生—临床医学]