目的:通过腹部B超测量手术时长3小时以内的全麻手术患者的膀胱尿量,分析膀胱功能性容量恢复的影响因素,评估采取非侵入性导尿的可行性,促进患者快速康复。方法:选取我院2021年1至2021年6月期间接受全麻手术患者80例,年龄45.3 ± 5.3岁,手术时长2~3小时,通过经腹部B超测定该患者的术前残余尿量、术中1小时膀胱尿量、手术结束后以及苏醒后离PACU膀胱容量,并记录术后首次排尿时间、尿量、年龄及术中输液总量。以患者首次排尿量为膀胱功能性容量恢复的指标,通过多元线性回归分析,评定手术患者不留置导尿管的可行性。结果:膀胱功能的恢复与年龄、输液总量、憋尿时长显著相关,与手术时长、术前残余尿量、术中1小时膀胱尿量、手术结束后以及苏醒后离开PACU的膀胱尿量未显示相关性。所有患者膀胱功能恢复状态良好。结论:手术时长3小时以内的全麻手术患者,经过客观评估膀胱功能,可以选择不侵入性导尿操作,促进术后快速康复。 Objective: The bladder and urine volume of patients undergoing general anesthesia surgery within 3 hours of operation was measured by abdominal B-ultrasound, and the factors affecting the recov-ery of functional bladder capacity were analyzed, and the feasibility of non-invasive catheterization was evaluated to promote rapid recovery of patients. Methods: A total of 80 patients who under-went general anesthesia surgery in our hospital from January 2021 to June 2021 were selected, aged 45.3 ± 5.3 years old, and the operation time was 2~3 hours. The urine volume of the bladder in 1 hour, the bladder volume after the operation and after the recovery from the PACU were recorded, and the first urination time, urine volume, age and the total amount of intraoperative infusion were recorded. Using the patient’s first voiding volume as an index of functional bladder capacity recov-ery, multiple linear regression analysis was used to evaluate the feasibility of surgical patients without indwelling catheters. Results: The recovery of bladder function was significantly related to age, total infusion volume, and duration of holding urine, but not to operation time, preoperative residual urine volume, intraoperative bladder urine volume within 1 hour, and bladder urine vol-ume after surgery and after recovery from the PACU. The bladder function of all patients recovered well. Conclusions: Patients undergoing general anesthesia surgery with operation duration of less than 3 hours can choose non-invasive catheterization after objective assessment of bladder function to promote rapid postoperative recovery.
目的:通过腹部B超测量手术时长3小时以内的全麻手术患者的膀胱尿量,分析膀胱功能性容量恢复的影响因素,评估采取非侵入性导尿的可行性,促进患者快速康复。方法:选取我院2021年1至2021年6月期间接受全麻手术患者80例,年龄45.3 ± 5.3岁,手术时长2~3小时,通过经腹部B超测定该患者的术前残余尿量、术中1小时膀胱尿量、手术结束后以及苏醒后离PACU膀胱容量,并记录术后首次排尿时间、尿量、年龄及术中输液总量。以患者首次排尿量为膀胱功能性容量恢复的指标,通过多元线性回归分析,评定手术患者不留置导尿管的可行性。结果:膀胱功能的恢复与年龄、输液总量、憋尿时长显著相关,与手术时长、术前残余尿量、术中1小时膀胱尿量、手术结束后以及苏醒后离开PACU的膀胱尿量未显示相关性。所有患者膀胱功能恢复状态良好。结论:手术时长3小时以内的全麻手术患者,经过客观评估膀胱功能,可以选择不侵入性导尿操作,促进术后快速康复。
B超,残余尿量,术后快速康复,功能性膀胱容量
Qingxia Zhao, Gaixia Shi, Yan Zhang, Jie Liu, Qiang Wen, Lu Chen, Zhixin Wu
Shaanxi Provincial People’s Hospital, Xi’an Shaanxi
Received: Jul. 8th, 2022; accepted: Aug. 3rd, 2022; published: Aug. 10th, 2022
Objective: The bladder and urine volume of patients undergoing general anesthesia surgery within 3 hours of operation was measured by abdominal B-ultrasound, and the factors affecting the recovery of functional bladder capacity were analyzed, and the feasibility of non-invasive catheterization was evaluated to promote rapid recovery of patients. Methods: A total of 80 patients who underwent general anesthesia surgery in our hospital from January 2021 to June 2021 were selected, aged 45.3 ± 5.3 years old, and the operation time was 2~3 hours. The urine volume of the bladder in 1 hour, the bladder volume after the operation and after the recovery from the PACU were recorded, and the first urination time, urine volume, age and the total amount of intraoperative infusion were recorded. Using the patient’s first voiding volume as an index of functional bladder capacity recovery, multiple linear regression analysis was used to evaluate the feasibility of surgical patients without indwelling catheters. Results: The recovery of bladder function was significantly related to age, total infusion volume, and duration of holding urine, but not to operation time, preoperative residual urine volume, intraoperative bladder urine volume within 1 hour, and bladder urine volume after surgery and after recovery from the PACU. The bladder function of all patients recovered well. Conclusions: Patients undergoing general anesthesia surgery with operation duration of less than 3 hours can choose non-invasive catheterization after objective assessment of bladder function to promote rapid postoperative recovery.
Keywords:B-Ultrasound, Residual Urine Volume, Rapid Postoperative Recovery (ERAS), Functional Bladder Volume
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术后加速康复(enhanced recovery after surgery, ERAS),是指以降低并发症的发生、促进患者快速康复为目的,控制炎症,减少应激反应,并应用一系列具有循证医学依据且多学科参与的围术期优化处理措施 [
选取2021年1月至6月期间在我院手术部全麻手术患者80例。纳入标准:① 年龄18~60岁(45.3 ± 5.3),男41例、女39例;② 血、尿常规正常③ 血压正常,肝肾功能正常;④ 术前无泌尿系感染;⑤ ASA分级I~II级,全麻手术;⑥ 患者本人同意,签订知情同意书。排除标准:① 有糖尿病、高血压、精神病及其他内科疾病或合并症;② 术前B超测定残余尿量 > 50 ml;③ 手术体位为俯卧位或侧卧位;④ 手术时间 > 3小时;⑤ 其他原因不愿参与本研究的。经医院伦理委员会批准,术前与患者充分沟通。
患者进入手术室等待区嘱患者排尿,并进行自主排尿训练,锻炼膀胱逼尿肌的功能。患者入室后,腹部B超测定膀胱残余尿量并记录。给患者放置假性导尿装置 [
经腹部B超检测患者术前膀胱残余尿量;手术不同时段的膀胱尿量,清醒后膀胱尿量。首次排尿时间及尿量。记录患者年龄,手术时长,手术期间输液总量,憋尿时长。术后排尿量评估膀胱功能性容量的恢复。
采用SPSS 18.0进行统计分析,作图分析采用Graph Pad Prism 5完成。定量资料以均数±标准差(
患者的一般资料情况。见表1。
N = 80 | 男 | 女 | |
---|---|---|---|
例数 | 39 (48.75%) | 41 (51.25%) | |
年龄 | 18~30 | 18 (22.5%) | 12 (15%) |
31~40 | 11 (13.75%) | 15 (18.75%) | |
41~50 | 4 (5%) | 12 (15%) | |
51~60 | 6 (7.5%) | 2 (2.5%) | |
身高(cm) | 173.4 ± 8.1 | 159.9 ± 6.8 | |
体重(Kg) | 70.7 ± 4.5 | 58.6 ± 3.4 | |
BMI | 30.3 ± 4.4 | 29.9 ± 3.9 | |
ASA分级 | I级 | 4 (5%) | 5 (6.25%) |
II级 | 35 (43.75%) | 36 (45%) | |
术前膀胱残余尿量(ml) | 39.2 ± 4.1 | 38.6 ± 7.2 |
表1. 患者一般资料
影响膀胱功能恢复的因素比较多,本项目影响因素变量为年龄,手术时长,B超测定的术前残余尿量、术中1小时膀胱尿量、手术结束后以及苏醒后离开PACU的膀胱尿量,输液总量,憋尿时长,将各变量进行单因素方差分析,具体数据如表2。
序号 | 影响因素 | 变量值 | F值 | P值 |
---|---|---|---|---|
1 | 年龄 | 45.3 ± 5.3 | 0.455 | 0.621 |
2 | 入室至手术时长(min) | 158.5 ± 25.4 | 2.34 | 0.105 |
3 | 输液总量(ml) | 534.6 ± 74.1 | 6.23 | 0.003 |
4 | 术前残余尿量(ml) | 6.5 ± 5.6 | 1.546 | 0.211 |
5 | 术中1小时尿量(ml) | 95.6 ± 14.7 | 1.316 | 0.273 |
6 | 手术结束后尿量(ml) | 168.3 ± 17.1 | 0.897 | 0.472 |
7 | 苏醒后离开PACU的尿量(ml) | 228.9 ± 27.9 | 0.986 | 0.32 |
8 | 憋尿时长(min) | 306.6 ± 75.10 | 4.388 | 0.015 |
9 | 排尿量(ml) | 356.3 ± 44.7 | 5.215 | 0.012 |
表2. 膀胱功能恢复影响单因素方差分析(
纳入全部变量进行分析,以术后首次排尿量为因变量,以年龄,手术时长,B超测定的术前残余尿量、术中1小时膀胱尿量、手术结束后以及苏醒后离开PACU的膀胱尿量,输液总量,憋尿时长为预测变量。纳入多元线性回归模型。由标准回归系数统计结果显示:首次排尿量与年龄、输液总量、憋尿时长对首次排尿量影响程度最大,P值均为0.000 (P< 0.05),憋尿时长影响程度较大,P值为0.020 (P < 0.05)。手术时长,术前残余尿量、术中1小时膀胱尿量、手术结束后以及苏醒后离开PACU的膀胱尿量对首次排尿量影响程度较低(P > 0.05)。见表3。
模型 | B | 标准误差 | 标准回归系数 | t | P |
---|---|---|---|---|---|
常量项 | 578.428 | 65.569 | 8.822 | 0.000 | |
年龄 | −5.43 | 0.649 | −0.605 | −8.364 | 0.000 |
入室至手术时长 | 20.095 | 13.791 | 0.116 | 1.457 | 0.152 |
输液总量 | −0.226 | 0.053 | −0.279 | −4.3 | 0.000 |
术前残余尿量 | 1.632 | 0.997 | 0.17 | 1.637 | 0.109 |
术中1小时膀胱尿量 | −0.903 | 0.647 | −0.364 | −1.395 | 0.170 |
手术结束后膀胱尿量 | −0.078 | 0.269 | −0.044 | −0.291 | 0.773 |
苏醒后离开PACU膀胱尿量 | 0.337 | 0.447 | 0.218 | 0.754 | 0.455 |
憋尿时长 | 20.266 | 8.419 | 0.304 | 2.407 | 0.020 |
表3. 膀胱功能恢复影响多因素的回归分析
有报道显示:大量医疗机构留置尿管护理临床实践操作未达标,因留置导尿导致的院内感染依然居高不下 [
本项目显示在2~3时长的全麻手术中,膀胱自主功能的恢复与年龄、输液总量、憋尿时长密切相关,与手术时长、术前残余尿量,术中、手术结束后以及苏醒后离开PACU的膀胱尿量都无相关性,提示导尿方式的选择更多的是关注患者的年龄、术中输液总量和术后憋尿时长。通过术前筛选和测定膀胱残余尿量初步评估,膀胱功能良好的患者,在 < 3小时的全麻手术可以不导尿或者选择假性导尿。解决了术前选择导尿方式的困惑。没有侵入导尿操作的患者有一定的自我心理安抚效应,术后临床护士关注憋尿时间,帮助患者麻醉苏醒后的早期锻炼,膀胱自主功能恢复,大大提高患者的舒适度,促进快速康复;提高患者和手术医师对护理工作的满意度。同时,降低导管所致泌尿系感染的发生率,对于治疗效果及住院天数、治疗费用都大有裨益,促进ERAS [
陕西省人民医院孵化项目。
赵清侠,师改霞,张 妍,刘 捷,文 强,陈 璐,吴志新. 经腹部B超评估全麻手术患者膀胱功能性容量恢复的多因素分析Multivariate Analysis of Bladder Functional Capacity Recovery in Patients Undergoing General Anesthesia by Transabdominal B-Ultrasound[J]. 临床医学进展, 2022, 12(08): 7300-7306. https://doi.org/10.12677/ACM.2022.1281054