CAJ | 학술논문

目的前瞻性研究静脉联合吸入麻醉下不导尿全膝关节置换术（TKA）的有效性和安全性。方法将112例拟行初次单侧 TKA 手术患者按导尿与否随机分为术前不留置导尿管（NIC）组和术前留置导尿管（IC）组。所有患者术前检查均未见明显排尿异常，手术采用静脉联合吸入复合麻醉。IC 组患者（n＝56）于术后12 h 内拔除导尿管并监测尿潴留、尿路刺激等症状；NIC 组患者（n＝56）术后4 h 开始监测尿潴留、尿路刺激等症状。如果出现尿潴留，保守治疗无效后需重新留置导尿管。尿路刺激症主要通过主诉及症状确诊。尿培养尿菌落计数＞10万／ml 可确诊尿路感染，有症状者尿培养尿菌落计数＞100／ml 也有意义。结果NIC组与 IC 组术后出现尿潴留、尿路刺激症状、尿路感染病例数及平均住院时间之差异无统计学意义（P＞0．05）。NIC 组有4例发生尿潴留，IC 组2例在拔除导尿管后发生尿潴留，导尿管重新留置2～3 d 后均顺利拔除。IC 组10例患者在拔除导尿管后小便时出现尿路刺激症状，其中2例诊断为尿路感染；NIC 组1例患者术后出现尿路刺激症状，但没有发现尿路感染。结论全身麻醉下单侧初次 TKA 手术患者留置导尿管与不留置导尿管发生尿潴留风险相当，故术前可不必常规留置导尿管，不留置导尿管可在一定程度上减少术后尿路感染及尿路刺激症发生率。
목적전첨성연구정맥연합흡입마취하불도뇨전슬관절치환술（TKA）적유효성화안전성。방법장112례의행초차단측 TKA 수술환자안도뇨여부수궤분위술전불류치도뇨관（NIC）조화술전류치도뇨관（IC）조。소유환자술전검사균미견명현배뇨이상，수술채용정맥연합흡입복합마취。IC 조환자（n＝56）우술후12 h 내발제도뇨관병감측뇨저류、뇨로자격등증상；NIC 조환자（n＝56）술후4 h 개시감측뇨저류、뇨로자격등증상。여과출현뇨저류，보수치료무효후수중신류치도뇨관。뇨로자격증주요통과주소급증상학진。뇨배양뇨균락계수＞10만／ml 가학진뇨로감염，유증상자뇨배양뇨균락계수＞100／ml 야유의의。결과NIC조여 IC 조술후출현뇨저류、뇨로자격증상、뇨로감염병례수급평균주원시간지차이무통계학의의（P＞0．05）。NIC 조유4례발생뇨저류，IC 조2례재발제도뇨관후발생뇨저류，도뇨관중신류치2～3 d 후균순리발제。IC 조10례환자재발제도뇨관후소편시출현뇨로자격증상，기중2례진단위뇨로감염；NIC 조1례환자술후출현뇨로자격증상，단몰유발현뇨로감염。결론전신마취하단측초차 TKA 수술환자류치도뇨관여불류치도뇨관발생뇨저류풍험상당，고술전가불필상규류치도뇨관，불류치도뇨관가재일정정도상감소술후뇨로감염급뇨로자격증발생솔。
Objective To prospective study the safety and efficacy of non-indwel ing urinary catheter in patients undergoing total knee arthroplasty (TKA)under intravenous combined inhaled anesthesia.Methods One hundred and twelve patients scheduled to unilateral primary TKA were randomized into two groups:non-indwel ing urinary catheter (NIC)group and indwel ing urinary catheter (IC)group.The preoperative urination of patients in both groups was normal.Al patients received inhalation and intravenous anesthesia.In IC group (n=56),catheter was removed within postoperative 12 hours,then urinary retention and urinary irritation were under the monitoring.In NIC group (n=56),patients were under the monitoring for urinary retention and urinary irritation after 4 hours of surgery.If urinary retention was diagnosed,and the conservative treatment was non-effective,urinary catheter should be placed.Urinary irritation was diagnosed by symptoms and complaints of patients,if clump count >100 thousand/ml,urinary tract infection would be diagnosed,clump count >100/ml also had diagnostic value in patients with symptoms.Results Urinary retention,urinary irritation,urinary tract infection and length of hospital stay had not significant difference between IC group and NIC group (P>0.05).Four cases were diagnosed as urinary retention in NIC group and two in IC group,they were placed catheters again,al the catheters were removed successful y after 2-3 days.Ten cases in IC group and one in NIC group were diagnosed as urinary irritation,two cases in IC group and no one in NIC group were diagnosed as urinary tract infection.Conclusions The risk of urinary retention is similar for patients of both groups when received intravenous combined inhaled anesthesia in primary TKA.Indwel ing urinary catheter is not routinely needed in TKA,non-indwel ing urinary catheter can contribute to decreasing the risk of postoperative urinary irritation and urinary tract infection.