Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
J Bone Joint Surg Am. 2013 Aug 21;95(16):1498-503. doi: 10.2106/JBJS.K.01671.
The objective of this randomized prospective study was to determine whether a urinary catheter is necessary for all patients undergoing total hip arthroplasty under spinal anesthesia.
Consecutive patients undergoing total hip arthroplasty under spinal anesthesia were randomized to treatment with or without insertion of an indwelling urinary catheter. All patients received spinal anesthesia with 15 to 30 mg of 0.5% bupivacaine. The catheter group was subjected to a standard postoperative protocol, with removal of the indwelling catheter within forty-eight hours postoperatively. The experimental group was monitored for urinary retention and, if necessary, had straight catheterization up to two times prior to the placement of an indwelling catheter.
Two hundred patients were included in the study. There was no significant difference between the two groups in terms of the prevalence of urinary retention, the prevalence of urinary tract infection, or the length of stay. Nine patients in the no-catheter group and three patients in the catheter group (following removal of the catheter) required straight catheterization because of urinary retention. Three patients in the catheter group and no patient in the no-catheter group had development of urinary tract infection.
Patients undergoing total hip arthroplasty under spinal anesthesia appear to be at low risk for urinary retention. Thus, a routine indwelling catheter is not required for such patients.
本随机前瞻性研究旨在确定在椎管内麻醉下进行全髋关节置换术的所有患者是否都需要留置导尿管。
连续接受椎管内麻醉下全髋关节置换术的患者被随机分为留置导尿管组和不插导尿管组。所有患者均接受 15 至 30mg0.5%布比卡因的椎管内麻醉。导尿管组采用标准术后方案，术后 48 小时内拔除留置导尿管。实验组监测尿潴留情况，如有必要，在留置导尿管前进行直导管插入术，最多不超过两次。
共有 200 例患者纳入研究。两组在尿潴留发生率、尿路感染发生率或住院时间方面无显著差异。在无导尿管组的 9 例患者和导尿管组（在拔除导尿管后）的 3 例患者中，因尿潴留需要进行直导管插入术。在导尿管组的 3 例患者和无导尿管组的患者中，均未发生尿路感染。
在椎管内麻醉下接受全髋关节置换术的患者似乎发生尿潴留的风险较低。因此，此类患者无需常规留置导尿管。
