Griffiths R, Fernandez R
South Western Sydney Area Health Service, Locked bag 7103, Liverpool BC, NSW, Australia, 2170.
Cochrane Database Syst Rev. 2007 Apr 18;2007(2):CD004011. doi: 10.1002/14651858.CD004011.pub3.
Approximately 15% to 25% of all hospitalised patients have indwelling urethral catheters, mainly to assist clinicians to accurately monitor urine output during acute illness or following surgery, to treat urinary retention, and for investigative purposes.
The objective of this review was to determine the best strategies for the removal of catheters from patients with a short-term indwelling urethral catheter. The main outcome of interest was the number of patients who required recatheterisation following removal of indwelling urethral catheter.
We searched the Cochrane Incontinence Group Specialised Register (searched 7 December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2), MEDLINE (January 1966 to 12 July 2006), EMBASE (January 1980 to 12 July 2006), CINAHL (January 1982 to 12 July 2006), Nursing Collection (January 1995 to January 2002) and reference lists of relevant articles and conference proceedings were searched. We also contacted manufacturers and researchers in the field. No language or other restrictions were applied.
All randomised and quasi-randomised controlled trials (RCTs) that compared the effects of alternative strategies for removal of short-term indwelling urethral catheters on patient outcomes were considered for inclusion in the review.
Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials were assessed independently by two reviewers. Relative risks (RR) for dichotomous data and a weighted mean difference (WMD) for continuous data were calculated with 95% confidence intervals (CI). Where synthesis was inappropriate, trials were considered separately.
Twenty six trials involving a total of 2933 participants were included in the review. One trial included three treatment groups. In 11 RCTs amongst 1389 people, there was no significant difference in need for recatheterisation, although recatheterisation after removal at night was more likely to be during working hours. Pooled results demonstrated that, following urological surgery and procedures, patients whose indwelling urethral catheters were removed at midnight passed significantly larger volumes at their first void (Difference (fixed) 96 ml; 95% CI 62 to 130). Similar findings were reported for patients following TURP (Difference (fixed) 27; 95% CI 23 to 31). Removal at midnight was also associated with longer time to first void, and shorter lengths of hospitalisation (relative risk of not going home on day of removal = 0.71, 95% CI 0.64 to 0.79). Results in 13 trials amongst 1422 participants having early rather than delayed catheter removal were consistent with a higher risk of voiding problems and a lower risk of infection, with shorter hospitalisation. In three trials involving 234 participants the data were too few to assess differential effects of catheter clamping compared with free drainage prior to withdrawal. No eligible trials compared flexible with fixed duration of catheterisation, or assessed prophylactic alpha sympathetic blocker drugs prior to catheter removal.
AUTHORS' CONCLUSIONS: There is suggestive but inconclusive evidence of a benefit from midnight removal of the indwelling urethral catheter. There are resource implications but the magnitude of these is not clear from the trials. The evidence also suggests shorter hospital stay after early rather than delayed catheter removal but the effects on other outcomes are unclear. There is little evidence on which to judge other aspects of management, such as catheter clamping.
约15%至25%的住院患者留置尿道导管，主要用于协助临床医生在急性疾病期间或手术后准确监测尿量、治疗尿潴留以及用于检查目的。
本综述的目的是确定从短期留置尿道导管患者中拔除导管的最佳策略。主要关注的结果是拔除留置尿道导管后需要再次插管的患者数量。
我们检索了Cochrane尿失禁组专业注册库（2005年12月7日检索）、Cochrane对照试验中央注册库（《Cochrane图书馆》2006年第2期）、MEDLINE（1966年1月至2006年7月12日）、EMBASE（1980年1月至2006年7月12日）、CINAHL（1982年1月至2006年7月12日）、护理文集（1995年1月至2002年1月），并检索了相关文章和会议论文的参考文献列表。我们还联系了该领域的制造商和研究人员。未施加语言或其他限制。
所有比较拔除短期留置尿道导管的替代策略对患者结局影响的随机和半随机对照试验（RCT）均被考虑纳入本综述。
两名评审员独立评估试验纳入本综述的资格、合格试验的详细信息以及试验的方法学质量。计算二分数据的相对风险（RR）和连续数据的加权平均差（WMD），并给出95%置信区间（CI）。若合并分析不合适，则分别考虑各试验。
本综述纳入了26项试验，共2933名参与者。一项试验包括三个治疗组。在1389人的11项RCT中，再次插管的需求无显著差异，尽管夜间拔除导管后再次插管更可能发生在工作时间。汇总结果表明，泌尿外科手术和操作后，午夜拔除留置尿道导管的患者首次排尿量显著更大（差异（固定效应）96毫升；95%CI 62至130）。经尿道前列腺切除术（TURP）后的患者也有类似发现（差异（固定效应）27；95%CI 23至31）。午夜拔除导管还与首次排尿时间延长和住院时间缩短相关（拔除当天未出院的相对风险=0.71，95%CI 0.64至0.
