Joelsson-Alm Eva, Ulfvarson Johanna, Nyman Claes R, Divander Mona-Britt, Svensén Christer
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Scand J Urol Nephrol. 2012 Apr;46(2):84-90. doi: 10.3109/00365599.2011.637959. Epub 2011 Dec 12.
The aim of this study was to explore whether close preoperative ultrasound monitoring starting in the emergency room (ER) could prevent postoperative bladder distension among acute orthopaedic patients.
A randomized controlled trial was conducted at a 650-bed level-2 centre in Sweden. Inclusion criteria were admittance via ER to an orthopaedic ward for acute surgery. Bladder volumes were measured with a portable ultrasound scanner (Bladderscan BVI 3000). In the intervention group, all patients were scanned in the ER and then regularly at the ward at predefined times until surgery. In the control group, no regular scanning was performed before surgery. During surgery, the same procedure was performed for both groups: bladder scanning immediately after arrival to the recovery room and continuous postoperative scanning until voiding. The primary outcome was postoperative bladder distension, defined as a bladder volume ≥500 ml. Secondary outcomes were postoperative urinary tract infection and hospital length of stay.
A total of 281 patients completed the study, 141 in the intervention group and 140 in the control group. Postoperative bladder distension was significantly higher in the control group (27.1% vs 17.0%; p = 0.045, 95% confidence interval 4.9-19.8) in the intention-to-treat, per-protocol and as-treated analyses. No statistical difference was found between the intervention group and the control group regarding the secondary outcomes.
Frequent bladder monitoring starting in the ER can reduce postoperative bladder distension among acute orthopaedic patients. A preoperative bladder monitoring protocol should be implemented early in the ER for all patients admitted for acute orthopaedic procedures.
本研究旨在探讨在急诊室（ER）开始进行密切的术前超声监测是否能预防急性骨科患者术后膀胱扩张。
在瑞典一家拥有650张床位的二级中心进行了一项随机对照试验。纳入标准为经急诊室收治入骨科病房进行急性手术。使用便携式超声扫描仪（Bladderscan BVI 3000）测量膀胱容量。在干预组中，所有患者在急诊室接受扫描，然后在病房按预定时间定期扫描，直至手术。在对照组中，术前不进行常规扫描。手术期间，两组采用相同程序：到达恢复室后立即进行膀胱扫描，并在术后持续扫描直至排尿。主要结局为术后膀胱扩张，定义为膀胱容量≥500 ml。次要结局为术后尿路感染和住院时间。
共有281例患者完成研究，干预组141例，对照组140例。在意向性分析、符合方案分析和实际治疗分析中，对照组术后膀胱扩张发生率显著高于干预组（27.1%对17.0%；p = 0.045，95%置信区间4.9 - 19.8）。干预组和对照组在次要结局方面未发现统计学差异。
在急诊室开始频繁的膀胱监测可减少急性骨科患者术后膀胱扩张。对于所有因急性骨科手术入院的患者，应在急诊室早期实施术前膀胱监测方案。
