Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada.
Reg Anesth Pain Med. 2009 Nov-Dec;34(6):542-8. doi: 10.1097/aap.0b013e3181ae9fac.
It is common practice to catheterize the bladder in the presence of epidural analgesia and to leave the bladder catheter in situ to avoid postoperative urinary retention. However, bladder catheterization carries the risk for urinary tract infection (UTI). The objective of this randomized control trial was to assess whether the incidence of UTI will differ among patients receiving standard care and patients who have the bladder catheterization discontinued on the morning after surgery with the epidural still functioning.
Patients at low risk for postoperative urinary retention, scheduled for thoracic and abdominal surgery and receiving continuous thoracic epidural analgesia, were randomized on the morning after surgery to 2 groups: in the early removal group (n = 105), the bladder catheter was removed on the same morning after surgery, whereas in the standard group (SG) (n = 110), the bladder catheter was removed when epidural analgesia was discontinued (3-5 days). Urinary bladder volume was assessed by ultrasound. Primary and secondary outcomes were the incidence of UTI and rate of recatheterization.
Two hundred fifteen patients were randomized. There were 17 UTI cases in total, with 15 (14%) in the SG and 2 (2%) in the early removal group (P = 0.004). The incidence of recatheterizations was not different between the 2 groups (P = 0.09) and did not correlate with the site of epidural insertion. When matched for the types of surgery, the duration of hospital stay was longer in the patients who contracted UTI (P = 0.004). There were more patients older than 65 years in the SG.
Leaving the bladder catheter as long as the epidural analgesia is maintained results in a higher incidence of UTI and prolonged hospital stay. Removal of the bladder catheter on the morning after surgery does not lead to higher rate of catheterizations.
在硬膜外镇痛存在的情况下，对膀胱进行导尿并留置导尿管以避免术后尿潴留是常见的做法。然而，导尿存在尿路感染（UTI）的风险。本随机对照试验的目的是评估在接受标准护理的患者和在硬膜外镇痛仍在发挥作用的情况下，术后第一天早上停止导尿的患者中，UTI 的发生率是否不同。
患有术后尿潴留低风险的患者，计划进行胸腹部手术并接受连续胸部硬膜外镇痛，在手术后的早晨随机分为 2 组：早期拔除组（n=105），术后当天早上拔除导尿管，而标准组（SG）（n=110），在硬膜外镇痛停止时（3-5 天）拔除导尿管。通过超声评估膀胱容积。主要和次要结局是 UTI 的发生率和再导尿率。
共有 215 名患者随机分组。共有 17 例 UTI 病例，SG 组有 15 例（14%），早期拔除组有 2 例（2%）（P=0.004）。2 组的再导尿率无差异（P=0.09），且与硬膜外插入部位无关。当对手术类型进行匹配时，发生 UTI 的患者的住院时间更长（P=0.004）。SG 组中年龄大于 65 岁的患者更多。
只要硬膜外镇痛持续，留置导尿管会导致更高的 UTI 发生率和更长的住院时间。术后第一天早上拔除导尿管不会导致更高的导尿率。
