Pavlin D J, Pavlin E G, Fitzgibbon D R, Koerschgen M E, Plitt T M
Department of Anesthesiology, University of Washington School of Medicine, Seattle 98195, USA.
Anesthesiology. 1999 Jul;91(1):42-50. doi: 10.1097/00000542-199907000-00010.
This study was designed to test a treatment algorithm for management of bladder function after outpatient general or local anesthesia.
Three hundred twenty-four outpatients, stratified into risk categories for urinary retention, were studied. Patients in category 1 were low-risk patients (n = 227) having non-pelvic surgery and randomly assigned to receive 10 ml/kg or 2 ml/kg of intravenous fluid intraoperatively. They were discharged when otherwise ready, without being required to void. Patients in category 2 (n = 40), also presumed to be low risk, had gynecologic surgery. High-risk patients included 31 patients having hernia or anal surgery (category 3), and 31 patients with a history of retention (category 4). Bladder volumes were monitored by ultrasound in those in categories 2-4, and patients were required to void (or be catheterized) before discharge. The incidence of retention and urinary tract symptoms after surgery were determined for all categories.
Urinary retention affected 0.5% of category 1 patients and none of category 2 patients. Median time to void after discharge was 75 min (interquartile range 120) in category 1 patients (n = 27) discharged without voiding. Fluids administered did not alter incidence of retention or time to void. Retention occurred in 5% of high-risk patients before discharge and recurred in 25% after discharge.
In reliable patients at low risk for retention, voiding before discharge appears unnecessary. In high-risk patients, continued observation until the bladder is emptied is indicated to avoid prolonged overdistention of the bladder.
本研究旨在测试一种用于门诊全身或局部麻醉后膀胱功能管理的治疗方案。
对324例门诊患者进行了研究，这些患者被分为尿潴留风险类别。1类患者为低风险患者（n = 227），接受非盆腔手术，术中随机分配接受10 ml/kg或2 ml/kg的静脉输液。在其他条件允许时即可出院，无需排尿。2类患者（n = 40）也被认为是低风险患者，接受妇科手术。高风险患者包括31例接受疝气或肛门手术的患者（3类）和31例有尿潴留病史的患者（4类）。对2至4类患者通过超声监测膀胱容量，患者在出院前需排尿（或导尿）。确定了所有类别患者术后尿潴留和尿路症状的发生率。
尿潴留影响了1类患者中的0.5%，2类患者中无一例发生。未排尿出院的1类患者（n = 27）出院后排尿的中位时间为75分钟（四分位间距120）。所输注的液体并未改变尿潴留的发生率或排尿时间。5%的高风险患者在出院前发生尿潴留，25%在出院后复发。
对于尿潴留低风险的可靠患者，出院前排尿似乎没有必要。对于高风险患者，建议持续观察直至膀胱排空，以避免膀胱长期过度扩张。
