Koomen Erik, Bouman Esther, Callewaerdt Piet, Vos Gijs D, Prins Martin H, Anderson Brian J, Marcus Marco A E
Department of Anaesthesia, Sophia Children's Hospital, Rotterdam, The Netherlands.
Scand J Urol Nephrol. 2008;42(5):444-8. doi: 10.1080/00365590802054600.
Postoperative urinary retention (PUR) is associated with overdistension of the bladder. The prevention of PUR by routine catheterization may increase the risk of urinary tract infection. Postoperative monitoring of the bladder volume by ultrasound to prevent PUR is reliable in adults, but has not been evaluated in children.
The BladderScan BVI 6200, an ultrasound device specifically designed for children, was assessed. Forty patients who required urinary catheter placement during surgery or during intensive care unit stay were entered into this blinded calibration study. An assessment of bladder urine volume by ultrasound was performed before and after catheterization in surgical patients. In these patients and intensive care patients 0, 2.5 or 5 ml/kg sterile normal NaCl was injected through the bladder catheter and the catheter was clamped. Volumes estimated with ultrasound were compared with measured catheter drainage or/and injected volume after the scan.
The mean relative difference (bias) between the ultrasound estimate and the injected volume was -20% (95% confidence interval 140 to -180%). Precision, estimated using the Wilcoxon signed ranks test, showed a significant difference (Z = -3.25, p = 0.001) between the ultrasound-estimated volumes and the injected volumes.
This study could not confirm good agreement between the ultrasound-estimated volumes and the injected volumes at volumes below 5 ml/kg. Bladder volumes were underestimated with a very broad 95% confidence interval. The ultrasound device should not replace current clinical assessment.
术后尿潴留（PUR）与膀胱过度扩张有关。常规导尿预防PUR可能会增加尿路感染的风险。通过超声对膀胱容量进行术后监测以预防PUR在成人中是可靠的，但尚未在儿童中进行评估。
对专门为儿童设计的超声设备BladderScan BVI 6200进行了评估。40例在手术期间或重症监护病房住院期间需要放置导尿管的患者进入了这项盲法校准研究。对手术患者在导尿前后进行超声膀胱尿量评估。在这些患者和重症监护患者中，通过膀胱导管注入0、2.5或5 ml/kg无菌生理盐水，然后夹住导管。将超声估计的容量与扫描后测量的导管引流量或/和注入量进行比较。
超声估计值与注入量之间的平均相对差异（偏差）为-20%（95%置信区间为140至-180%）。使用Wilcoxon符号秩检验估计的精密度显示，超声估计容量与注入容量之间存在显著差异（Z = -3.25，p = 0.001）。
本研究未能证实低于5 ml/kg容量时超声估计容量与注入容量之间具有良好的一致性。膀胱容量被低估，95%置信区间非常宽。该超声设备不应取代当前的临床评估。
