摘要
目的 探讨尿动力监控仪在重症患者留置导尿中的应用，旨在早期发现并预防急性肾损伤，提供膀胱锻炼的新方法，减少导尿管相关性并发症的发生。方法 选取浙江省人民医院重症医学科2021年1月-2021年12月留置尿管预计超过7天的患者，采用随机数字表法进行分组，对照组患者采用常规的定时放尿模式，试验组患者采用尿动力监控仪畅通模式下监测，3天后由畅通模式改为定时定压的模式进行训练，并对结果进行分析。结果 试验组膀胱容量427.31±46.34 ml，对照组膀胱容量400.24±39.01 ml,两组比较有统计学差异（P<0.05）。导尿管相关性感染发生率试验组10/102(10%)，对照组 12/98(12%) ，两者比较无统计学差异（P>0.05）；使用尿动力监控仪患者平均腹内压 7.24±3.18mmHg；5例预测急性肾损伤先兆。结论 重症患者留置导尿过程中进行尿动力监测能预测急性肾损伤，增加患者的膀胱安全容量，并能锻炼膀胱功能。
关键词： 尿动力监控仪；留置导尿；重症监护病房
Abstract
Objective: To explore the application of urodynamic monitoring instrument in indwelling catheterization in severe patients, aiming at early detection and prevention of acute kidney injury, providing a new method of bladder exercise, and reducing the occurrence of catheter-related complications. Methods select intensive medicine of zhejiang province people's hospital in January 2021 - December 2021 patients expected to more than 7 days, placing a urinary catheter to group by random number table method, the timing of the control group were treated by routine urine mode, experimental group were treated by dynamic monitor urine flow monitoring mode, three days later by the open mode to the constant voltage mode to train regularly, The results were analyzed. Results The bladder volume of the experimental group was 427.31±46.34 mL, and that of the control group was 400.24±39.01 ml, the difference between the two groups was statistically significant (P<0.05). There was no significant difference in the incidence of catheter-related infection between experimental group 10/102(10%) and control group 12/98(12%) (P>0.05). The mean intra-abdominal pressure was 7.24±3.18mmHg. Five patients were predicted to have acute kidney injury. Conclusion Urodynamic monitoring during indwelling catheterization in severe patients can predict acute kidney injury, increase bladder safety capacity and exercise bladder function.
Key words： Urodynamic Monitor; Indwelling Catheter; Intensive Care Unit
参考文献 References
[1] Wakefield A.Use of indwelling catheters and preventing catheter-associated urinary tract infections[J].Nurs Stand. 2021, 36(5):77-82.
[2] Gyesi-Appiah E,Brown J,Clifton A.Short-term urinary catheters and their risks: an integrated systematic review[J].Br J Nurs.2020,29(9):S16-S22.
[3] Li F, Song M, Xu L,et al.Risk factors for catheter- associated urinary tract infection among hospitalized patients: A systematic review and meta-analysis of observational studies[J].J Adv Nurs.2019, 75(3): 517-527.
[4] Menegueti MG,Ciol MA,Bellissimo-Rodrigues F,et al.Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: A quasi-experimental study[J]. Medicine (Baltimore). 2019,98(8):e14417.
[5] 于书慧,王为,车新艳,等.泌尿外科患者短期留置导尿管的循证护理研究[J].护理学杂志,2020,35(17):93-97.
[6] 彭金香,张小如,聂苹,等.多学科合作护理模式促进宫颈癌患者术后膀胱功能恢复效果观察[J]. 齐鲁护理杂志,2021,27(4):45-47.
[7] 叶蕾,姚惠萍. 膀胱压力监测下定压放尿在重症病人长期留置导尿中的应用[J]. 护理研究,2022, 36(10): 1846-1849.
[8] 中华医学会肾脏病学分会专家组. 新型冠状病毒感染合并急性肾损伤诊治专家共识[J]. 中华肾脏病杂志,2020,36(3):242-246.
[9] Suzuki I,Kijima T,Wake K, et al.A case of renal trauma successfully treated by close monitoring of intravesical pressure and subsequent intervention[J].Urol Case Rep.2022 ,42:102014.
[10] 顾璐璐,叶向红,邬一凡,等.ICU腹部手术后病人腹内压与谵妄发生风险的相关性分析[J]. 护理研究,2022, 36(4):741-743.
[11] Markopoulos G,Kitridis D,Tsikopoulos K,et al.Bladder training prior to urinary catheter removal in total joint arthroplasty[J].A randomized controlled trial.Int J Nurs Stud.2019,89:14-17.
[12] Büyükyilmaz F,Culha Y,Zümreler H,et al.The effects of bladder training on bladder functions after transurethral resection of prostate[J].J Clin Nurs. 2020 ,29(11-12): 1913-1919.
[13] 黄彦飞,骆媛媛,李金蓉,等.排尿日记对泌尿系结石患者尿量及残石预后的影响[J].临床与病理杂志,2021, 41(9): 2077-2081.
[14] 贺倩,李艳萌,王宏伟,等.预防老年患者导尿管相关尿路感染的研究进展[J].中国老年学杂志,2022, 42(4): 1016-1019.