脊柱术后短期留置尿管患者无痛拔除尿管方法的探讨

目的探讨脊柱术后短期留置尿管患者无痛拔除尿管的方法。方法便利抽样选择2014年6月至2015年12月在解放军兰州总医院脊柱外科行脊柱手术且术后短期(1~7d)留置尿管的334例患者为研究对象,随机分为观察组和对照组,每组167例。观察组在术毕麻醉清醒后,夹管训练2~3次,待膀胱再次充盈有尿意时,将气囊中的生理盐水抽尽,再往回注0.3ml生理盐水,在气囊壁保持光滑的状态下,嘱患者自行排尿,将尿管随尿液排出体外;对照组在膀胱充盈有尿意时,抽空气囊,在气囊壁塌陷状态下,嘱患者自行排尿,将尿管排出体外。分析比较两组患者拔管后排尿情况及尿道疼痛发生情况。结果观察组与对照组尿潴留发生率分别为1.80%、19.16%,对照组拔管后的尿道刺激性疼痛症状发生率明显高于观察组,两组比较差异均有统计学意义(均P0.01)。结论采用在膀胱充盈有尿意且气囊壁保持光滑的状态下,嘱患者自行排尿,让尿管随尿液一起排出尿道的方法拔除尿管,患者自行排尿成功率高,拔管后尿道疼痛的发生率低,值得临床推广应用。

Discussion of Painless Urinary Catheter Removal Methods in Patients with Short-term Indwelling Catheter after Spinal Surgery

Objective To investigate the painless urinary catheter removal methods in patients with shortterm indwelling catheter after spinal surgery.Methods By convenience sampling,334 cases were selected and randomly divided into observation group and control group,with 167 cases in each group.In observation group,indwelling urinary canal were clamped for 2-3 times,waiting for the bladder filling again,then pumping the saline of the gas bag and injecting back 0.3ml to keep the wall of the gas bag smooth,eventually the catheter was excreted when urinating.In control group,the saline of the gas bag was pumped,then the catheter was excreted when urinating.Urinary retention and urethral pain of two groups were analyzed.Results The urinary retention rates in observation group and control group were 1.80％ and 19.16 ％,respectively.The incidence of urinary tract irritant pain after extubation in control group was significantly higher than those of observation group(all P＜0.01).Conclusions Keeping the gas bag smooth,and then excreting the catheter when urinating after spinal surgery has a lower incidence of urethral pain and a higher success rate of self-micturition,which is worth of clinical promotion.