骨盆或髋臼骨折患者术前灌肠的横断面调查研究  

Preoperative enema in patients with pelvic or acetabular fracture: a cross sectional survey

作　　者：李俊宏 陈戈 欧艺 陈仲 Li Junhong;Chen Ge;Ou Yi;Chen Zhong(Department of Orthopaedics and Trauma,Affiliated Hospital to Yunnan University,Kunming 650021,China)

机构地区：[1]云南大学附属医院骨与创伤外科,昆明650021

出　　处：《中华创伤骨科杂志》2021年第12期1032-1036,共5页Chinese Journal of Orthopaedic Trauma

基　　金：云南省科技厅-昆明医科大学联合专项基金(重点项目:2019FE001(-170),面上项目:2019FE001(-264))。

摘　　要：目的了解骨盆或髋臼骨折患者术前灌肠的现状,以及骨科医师对灌肠这一术前准备措施的看法,以期指导临床治疗。方法2019年9月以微信问卷星形式进行横断面调查,调查问卷发给1000名全国各地的骨科医师,涉及的内容为参与调查者职称、所在单位级别,调查的问题包括:①在进行骨盆或髋臼骨折手术前是否会给患者灌肠?②如果术前给患者灌肠,会选择何种方式?③给患者进行术前灌肠的目的是什么?④如果术前不给患者灌肠,理由是什么?等等。按参与调查医师所在医院等级不同(二级医院和三级医院)做分层分析。结果共有704名来自全国各地的骨科医师完成了本次调查,其中三级医院506名(71.88%,506/704),二级医院198名(28.13%,198/704)。调查结果显示:41.90%(295/704)的医师在术前会给患者灌肠,但选择"不灌肠"(26.99%,190/704)和"不一定"(31.11%,219/704)的医师也很多。对于主张灌肠的医师,灌肠的目的主要是为了"排除肠气,使术中透视更为清晰"(77.04%,396/514)。对于不支持灌肠的医师,反对这一措施的主要原因是"会增加患者的痛苦"(76.84%,146/190)。与三级医院比较,二级医院的医师进行术前灌肠、选择机械性灌肠的比例更高,同时,更高比例的二级医院医师认为灌肠可以减少患者并发症的发生,也可以使术中透视更为清晰。结论目前国内一些医师、特别是三级医院医师在骨盆或髋臼骨折手术前不对患者进行灌肠。Objective To investigate the current situation of preoperative enema in patients with pelvic or acetabular fracture and how orthopedists think about enema as a preoperative preparation so as to provide clinical guidance.Methods In a cross-sectional survey conducted in September 2019 in the form of Wechat Questionnaire Star,a questionnaire was sent to 1,000 orthopedists all over the country.The items surveyed included the professional title and the hospital level of the participants.The questions asked included:1.Will enema be performed for a patient with pelvic or acetabular fracture before surgery?2.If enema is given to a patient before surgery,what method will you choose?3.What is your purpose of preoperative enema for patients?4.What are your reasons for not giving a patient enema before surgery?Stratified analysis was conducted by the hospital levels of the participants.Results A total of 704 orthopedists from all over the country completed the present survey.The questionnaires finished came from 506(71.88%,506/704)tertiary hospitals and 198(28.13%,198/704)secondary hospitals.The survey showed that 41.90%of the orthopedists(295/704)would give their patients enema before surgery,26.99%(190/704)would not and 31.11%(219/704)would not necessarily.The main purpose of enema in the orthopedists who advocated enema was to eliminate intestinal gas so as to make intraoperative fluoroscopy more clearly(77.04%,396/514);the main reason against this measure in those who did not support enema was that it would increase the pain of patients(76.84%,146/190).Compared with the tertiary hospitals,a higher proportion of orthopedists in the secondary hospitals would perform preoperative enema and choose mechanical enema.Moreover,a higher proportion of orthopedists in the secondary hospitals believed that enema could reduce complications and make intraoperative fluoroscopy clearer.Conclusion At present,a number of orthopedists in China,especially those in a tertiary hospital,do not give their patients enema before surgery of pelvic

关 键 词：骨盆 髋臼 骨折 灌肠 术前准备 

分 类 号：R687.3[医药卫生—骨科学]