尤田++++++王霜++++++温琴琴++++++胡会英++++++肖银贵++++++李九群

[摘要] 目的 基于快速康复理论，探讨优化术后尿管应用在全膝关节置换术（TKA）中的临床效果。 方法 选择2015年1～6月北京大学深圳医院行TKA的100例患者，按照随机数字表法分为对照组（全部常规留置尿管）50例和试验组（以膀胱>500 mL作为留置尿管的标准）50例。观察并比较术后首次自解小便的时间和尿量、尿路感染情况、排尿舒适度。 结果 试验组首次自解小便的时间短于对照组，差异有统计学意义（P < 0.05）。试验组首次自解小便的量多于对照组，差异有统计学意义（P < 0.05）。试验组排尿舒适度评分优于对照组，差异有统计学意义（P < 0.05）。两组之间尿路感染率比较，差异无统计学意义（P > 0.05）。 结论 在TKA患者的快速康复中，将膀胱残余尿>500 mL作为是否留置尿管的指征是合理和安全的，能有效地减轻患者的不适，有利于术后尽快恢复。

[关键词] 快速康复；留置尿管；全膝关节置换术；膀胱残余尿

[中图分类号] R687.4 [文献标识码] A [文章编号] 1673-7210（2017）06（a）-0047-04

Effect of optimized postoperative urinary catheterization after total knee arthroplasty based on fast track theory

YOU Tian1 WANG Shuang1 WEN Qinqin1 HU Huiying2 XIAO Yingui1 LI Jiuqun1

1.Department of Sport Medicine， Peking University Shenzhen Hospital， Guangdong Province， Shenzhen 518000， China； 2.Department of Ultrasonic Imaging Division， Peking University Shenzhen Hospital， Guangdong Province， Shenzhen 518000， China

[Abstrct] Objective To discuss the effect of optimized postoperative urinary catheterization after total knee arthroplasty （TKA） based on fast track theory. Methods From January to June 2015， in Peking University Shenzhen Hospital， 100 patients underwent TKA were selected， according to random number table， they were divided into control group （all indwelling catheter） and trial group （catheterization threshold of 500 mL）， with 50 cases in each group. The time and volume of first voluntary micturition， urinary tract infection， urination comfort index were observed and compared. Results The first urination time of trial group were shorter than control group， the difference was statistically significant （P < 0.05）. the difference was statistically significant （P < 0.05）. The first urination volume of trial group were more than control group， the difference was statistically significant （P < 0.05）. The comfort index of trial group were better than control group， the difference was statistically significant （P < 0.05）. The urinary tract infection rate of two groups were compared， the difference was not statistically significant （P > 0.05）. Conclusion In fast-track TKA， a bladder volume of 500 mL is reasonable and safe catheterization threshold， which can relieve the discomfort effectively， and speed the recovery postoperatively.

[Key words] Fast track； Indwelling catheter； Total knee arthroplasty； Bladder residual urine

幾乎有所外科医生都有可能碰到术后尿储留（POUR），因为感染是关节置换术后一个严重的并发症，所以关节外科医生对于全膝关节置换术（TKA）术后尿潴留导致的尿路感染（UTI），以及继发的假体周围感染特别警惕[1]。有报道[2]显示：TKA术后留置尿管组尿潴留率与不留置尿管组比较，差异无统计学意义（P > 0.05）；但TKA术后留置尿管组感染率与不留置尿管组比较，差异有统计学意义（P < 0.05）。这说明TKA术后常规放置尿管更容易导致尿路感染。在2016年《中国髋、膝关节置换术加速康复——围术期管理策略专家共识》[3]中指出：如手术时间>1.5 h，手术失血超过5%或>300 mL；或者同期双侧TKA者应安置尿管预防尿潴留，但不应超过24 h；而手术时间短或术中出血少的不推荐常规安置尿管。但是……