华西医学

华西医学

加速康复外科模式下术前排尿训练联合限制性输液对人工全膝关节置换术患者术后排尿的影响

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目的 探讨加速康复外科(enhanced recovery after surgery,ERAS)模式下,术前排尿训练联合限制性输液对人工全膝关节置换术患者术后排尿的影响。 方法 选取 2018 年 3 月—5 月,行单侧人工全膝关节置换术患者 150 例,随机分为试验组与对照组,每组各 75 例。对照组患者术前不进行排尿训练且手术当日采用自由输液方式,试验组患者术前进行排尿训练且手术当日采用限制性输液方式。记录两组患者手术当日术前、术中、术后输液量及手术当日总输液量,比较两组患者术后首次排尿方式、首次排尿时间及住院天数。 结果 试验组和对照组患者手术当日总输液量分别为(1 581.40±277.54)、(2 395.00±257.40)mL;试验组术后首次排尿顺利 73 例,诱导后顺利 2 例,导尿 0 例,对照组术后首次排尿顺利 66 例,诱导后顺利 3 例,导尿 6 例;试验组和对照组术后首次排尿时间分别为术后回病房(1.85±0.91)、(2.93±1.48)h;以上差异均具有统计学意义(P<0.05)。试验组和对照组住院天数分别为(5.86±2.48)、(6.28±1.60)d,差异无统计学意义(P>0.05)。 结论 ERAS 模式下,人工全膝关节置换术患者术前进行排尿训练并联合限制性输液(手术当日总输液量控制在 1 500 mL 左右),有助于患者术后顺利排尿,降低术后尿潴留的发生率,加快患者康复。

Objective To study the effect of preoperative urination training combined with restrictive fluid therapy with enhanced recovery after surgery (ERAS) on postoperative urination in total knee arthroplasty (TKA) patients. Methods A total of 150 patients who were conducted the unilateral TKA from March to May 2018 were divided into two groups, the trial group and the control group, with 75 patients in each group. The patients in the control group did not undergo urination training before surgery and were given liberal intravenous fluid therapy on the day of surgery; while the patients in the trial group received urination training before surgery and were given restrictive fluid therapy on the day of surgery. The pre-, intra-, and post-operative infusion volume and the total infusion volume on the day of surgery of the two groups were recorded; and the urination situation, urination time for the first time and the hospital days in the two groups were compared. Results The total infusion volume on the day of surgery in the trial group and the control group was (1 581.40±277.54) and (2 395.00±257.40) mL, respectively. After operation, in the trial group, there were 73 patients with smooth urinating, 2 with smooth urinating after inducing method, and none with urethral catheterization; in the control group, there were 66 patients with smooth urinating, 3 with smooth urinating after inducing method, and 6 with urethral catheterization. The urination time for the first time after operation in the trial group and the control group was (1.85±0.91) and (2.93±1.48) hours after back to the ward, respectively. These differences between the two groups were statistically significant (P<0.05). The hospital stay in the trial group and the control group was (5.86±2.48) and (6.28±1.60) days, respectively, and the difference between the two groups was not statistically significant (P>0.05). Conclusions Preoperative urination training combined with restrictive fluid therapy (the total infusion volume controls in about 1 500 mL on the day of surgery) in the TKA patients after ERAS is good for postoperation urination. It also can reduce the rate of postoperative urinary retention, and enhance rehabilitation.

关键词: 加速康复外科; 人工全膝关节置换术; 限制性输液; 排尿训练

Key words: Enhanced recovery after surgery; Total knee arthroplasty; Restrictive fluid therapy; Urination training

引用本文: 段闪闪, 宁宁, 周婷, 李佩芳, 王科, 李玲利, 侯晓玲. 加速康复外科模式下术前排尿训练联合限制性输液对人工全膝关节置换术患者术后排尿的影响. 华西医学, 2018, 33(12): 1491-1494. doi: 10.7507/1002-0179.201809135 复制

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