腰硬联合麻醉术后拔除尿管时机的对比研究

[目的]探讨腰硬联合麻醉术后尿管拔除最佳时机,最大限度地缩短术后留置尿管时间,减轻病人痛苦,预防或减少泌尿系感染的发生。[方法]将240例腰硬联合麻醉术后留置尿管病人随机分成3组,实验A组病人术后感觉尿管不适即＂随意＂排空膀胱拔出尿管,实验B组术后24h后待膀胱充盈时拔出尿管,对照组在术后于镇痛泵使用完毕且等待膀胱充盈时一起拔管。[结果]实验A组、实验B组和对照组拔管后自然排尿率分别为82.50%、56.25%和41.25%,3组间差异具有统计学意义（P〈0.01）,实验A组排尿痛消失时间最短,拔管后第1次．排尿量最多。[结论]腰硬联合麻醉术后如感觉尿管不适即“随意”排空膀胱拔出尿管,无须等24h或到停止镇痛泵后拔管。     

拔除留置尿管时机对排尿的影响

[目的]探讨拔除留置尿管时机对排尿的影响.[方法]将120例剖宫产术后留置尿管的产妇随机分为两组,实验组在膀胱充盈有尿意时拔管,对照组在膀胱空虚时拔管,观察拔管后的第1次排尿情况.[结果]两组病人自然排尿率比较,差异有统计学意义(P<0.01).[结论]拔除尿管的最佳时机是膀胱充盈有尿意时.     

骨科硬膜外镇痛病人拔除尿管时机选择的临床研究

[目的]探索骨科硬膜外麻醉手术后使用硬膜外持续镇痛病人拔除导尿管的最佳时机,缩短留置尿管时间,降低再次导尿率,减少院内感染,增加病人舒适度。[方法]采用随机分组法将符合要求的142例骨科下肢择期手术病人分为4组。术前留置导尿管,术后均行间歇性引流夹管,甲组术后12h膀胱充盈时拔除导尿管;乙组术后24h膀胱充盈时拔除导尿管;丙组术后48h结束镇痛同时拔除导尿管;丁组术后48h结束镇痛后当病人膀胱充盈时拔除导尿管。[结果]乙组、丙组、丁组排尿评分分值均高于甲组,经比较均有统计学意义(P<0.01);乙组、丙组、丁组之间排尿评分分值相差不大,且无统计学意义(P>0.05)。[结论]骨科硬膜外麻醉手术后使用硬膜外持续镇痛病人术后应夹住尿管,2h开放1次,并于术后24h膀胱充盈时拔除尿管,而无需在停止镇痛后才拔除尿管。     

拔除留置尿管时机对排尿的影响

[目的]探讨拔除留置尿管时机对排尿的影响。[方法]将120例剖宫产术后留置尿管的产妇随机分为两组,实验组在膀胱充盈有尿意时拔管,对照纽在膀胱空虚时拔管,观察拔管后的第1次排尿情况。[结果]两组病人自然排尿率比较,差异有统计学意义（P〈O．01）。[结论]拔除尿管的最佳时机是膀胱充盈有尿意时。     

骨科硬膜外镇痛病人拔除尿管时机选择的临床研究

[目的] 探索骨科硬膜外麻醉手术后使用硬膜外持续镇痛病人拔除导尿管的最佳时机，缩短留置尿管时间，降低再次导尿率，减少院内感染，增加病人舒适度。[方法] 采用随机分组法将符合要求的142例骨科下肢择期手术病人分为4组。术前留置导尿管，术后均行间歇性引流夹管，甲组术后12h膀胱充盈时拔除导尿管；乙组术后24h膀胱充盈时拔除导尿管；丙组术后48h结束镇痛同时拔除导尿管；丁组术后48h结束镇痛后当病人膀胱充盈时拔除导尿管。[结果] 乙组、丙组、丁组排尿评分分值均高于甲组，经比较均有统计学意义（P〈0．01）；乙组、丙组、丁组之间排尿评分分值相差不大，且无统计学意义（P〉0．05）。[结论] 骨科硬膜外麻醉手术后使用硬膜外持续镇痛病人术后应夹住尿管，2h开放1次，并于术后24h膀胱充盈时拔除尿管，而无需在停止镇痛后才拔除原警     

留置尿管拔除时机对子宫切除术后病人排尿的影响

目的减少子宫切除术后留置尿管拔除后尿潴留的发生.方法将子宫切除患者280例,随机分为观察组和对照组,观察组采用膀胱充盈时先拔管、后排尿,对照组采用膀胱空虚时拔管,待膀胱再充盈时排尿.结果第一次排尿量无明显差异P＞0.05,观察组第一次自然排尿成功率明显高于对照组P＜0.01.结论留置尿管拔出时机选择在膀胱充盈时为最佳时机.     

剖宫产术病人留置尿管的护理

[目的]探讨剖宫产术病人留置尿管的心理护理、健康指导以及操作中的注意事项.[方法]对316例剖宫产留置尿管产妇的护理进行总结与分析.[结果]所有产妇均能轻松接受此项操作,没有恐惧心理;2例产妇拔管后膀胱充盈,不能自行排尿,经护理人员诱导排尿,1例产妇自行排尿成功,另1例产妇最终再次行留置尿管,2 d后拔除尿管能自行排尿.[结论]留置尿管前后做到耐心细致的心理护理、正确的健康指导以及注意操作中的有关事项、产妇如何配合,可有效的降低尿路感染和尿潴留的发生率.     

剖宫产术病人留置尿管的护理

[目的]探讨剖宫产术病人留置尿管的心理护理、健康指导以及操作中的注意事项.[方法]对316例剖宫产留置尿管产妇的护理进行总结与分析.[结果]所有产妇均能轻松接受此项操作,没有恐惧心理;2例产妇拔管后膀胱充盈,不能自行排尿,经护理人员诱导排尿,1例产妇自行排尿成功,另1例产妇最终再次行留置尿管,2 d后拔除尿管能自行排尿.[结论]留置尿管前后做到耐心细致的心理护理、正确的健康指导以及注意操作中的有关事项、产妇如何配合,可有效的降低尿路感染和尿潴留的发生率.     

留置尿管拔除时机对子宫切除术后病人排尿的影响

目的　减少子宫切除术后留置尿管拔除后尿潴留的发生。方法　将子宫切除患者 2 80例 ,随机分为观察组和对照组 ,观察组采用膀胱充盈时先拔管、后排尿 ,对照组采用膀胱空虚时拔管 ,待膀胱再充盈时排尿。结果　第一次排尿量无明显差异P >0 .0 5 ,观察组第一次自然排尿成功率明显高于对照组P <0 .0 1。结论　留置尿管拔出时机选择在膀胱充盈时为最佳时机     

泌尿灵对长期留置尿管病人拔管后排尿的影响

为探讨长期留置尿管病人拔管后排尿一次成功的有效措施,随机将165例留置尿管10d以上病人分为观察1组、观察2组及对照组。3组病人在膀胱充盈时拔出尿管,观察1组拔管前30min口服泌尿灵0．4g,拔管时肛门内注入开塞露20ml;对照组采用常规拔尿管法。结果显示：观察1组病人拔管后均一次排尿成功,观察2组一次排尿成功率72．7％,对照组 一次排尿成功率56．0％。拔管后3d内3组排尿异常率分别为5．0％、38．2％、52．0％。经x^2检验,有统计学意义（P＜0．01）。提示：泌尿灵与开塞露联合用药可提高长期留置尿管病人拔管后排尿成功率,并可明显减轻病人拔管后排尿疼痛的痛苦。     

循证麻醉访视在局部麻醉患者术前的应用研究

目的研究循证术前麻醉访视在局部麻醉患者中的应用效果。方法将240例局部麻醉患者采用随机数字表分为观察组和对照组,各120例,对照组采用常规术前访视,观察组采用循证麻醉访视,比较2组的手术应激情况以及功能恢复情况。结果观察组术中的恐惧评分低于对照组,收缩压、舒张压以及心率低于对照组,差异有统计学意义(P0.05)。观察组术后的躯体功能、认知功能、情感功能评分均高于对照组,差异有统计学意义(P0.05)。结论循证麻醉访视能够减轻局部麻醉患者的恐惧情绪,提高麻醉效果,有利于患者术后躯体功能的恢复。     

New advances in anesthesia

Pharmacologic advances in anesthesia over the last decade have focused on drug safety, shorter durations of action, reversibility, and ease of administration. This is reflective of major changes in the focus of patient care from inpatient to outpatient settings as well as from available risk management data that support the investigation of these new drugs. The pharmacologic advances discussed included those drugs in current practice as well as experimental drugs yet to be released for general clinical use. Inhaled agents, such as isoflurane and perhaps the experimental agent, desflurane, will maintain or achieve their popularity because of the relative ease of administration and wide margins of safety. Propofol, the most recent intravenous anesthetic available for clinical use, has already gained wide acceptance because of its dual function as an induction and maintenance agent and its appropriateness for use in the ambulatory surgical population. The role of midazolam in anesthesia practice has increased to such an extent that it has largely supplanted the use of diazepam (Valium). The introduction of the antagonist, flumazenil, will undoubtedly enhance the safety and efficacy of midazolam as well as broaden its applicability of use across various patient populations. Several of the newer synthetic narcotics, such as alfentanil and sufentanil, have replaced other narcotics formerly used in anesthesia practice, such as meperidine and morphine, primarily because of their short action and lack of significant side effects. The use of muscle relaxants as a critical component of anesthetic management has led to the development of a number of new drugs in this classification. Pharmacologic management of patients under anesthesia will at some future date likely include the administration of alpha 2 agonists. Administration of these drugs can reduce anesthetic requirements of traditional agents by as much as 50%. As research continues, new drugs will be incorporated into the practice of anesthesia, ones that will promote rapid uptake, low toxicity, intense analgesia, easy reversibility, shorter durations, and fewer side effects. One measure of success relative to pharmacologic development in anesthesia is the recent and dramatic decreases in patient morbidity and mortality figures over the last decade. This attests to the rapid growth and development of not only improved patient monitoring systems but also newly improved "agents of sleep."