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全关节置换术后留置导尿与间歇性导尿：一项系统评价与Meta分析

Indwelling versus Intermittent Urinary Catheterization following Total Joint Arthroplasty: A Systematic Review and Meta-Analysis.

作者信息

Zhang Wei, Liu An, Hu Dongcai, Xue Deting, Li Chao, Zhang Kai, Ma Honghai, Yan Shigui, Pan Zhijun

机构信息

Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China.

Department of Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China.

出版信息

PLoS One. 2015 Jul 6;10(7):e0130636. doi: 10.1371/journal.pone.0130636. eCollection 2015.

DOI:10.1371/journal.pone.0130636
PMID:26146830
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4492963/
Abstract

OBJECTIVE

The purpose of this study is to compare the rates of urinary tract infection (UTI) and postoperative urinary retention (POUR) in patients undergoing lower limb arthroplasty after either indwelling urinary catheterization or intermittent urinary catheterization.

METHODS

We conducted a meta-analysis of relevant randomized controlled trials (RCT) to compare the rates of UTI and POUR in patients undergoing total joint arthroplasty after either indwelling urinary catheterization or intermittent urinary catheterization. A comprehensive search was carried out to identify RCTs. Study-specific risk ratios (RR) with 95% confidence intervals (CI) were pooled. Additionally, a meta-regression analysis, as well as a sensitivity analysis, was performed to evaluate the heterogeneity.

RESULTS

Nine RCTs with 1771 patients were included in this meta-analysis. The results showed that there was no significant difference in the rate of UTIs between indwelling catheterization and intermittent catheterization groups (P>0.05). Moreover, indwelling catheterization reduced the risk of POUR, versus intermittent catheterization, in total joint surgery (P<0.01).

CONCLUSIONS

Based on the results of the meta-analysis, indwelling urinary catheterization, removed 24-48 h postoperatively, was superior to intermittent catheterization in preventing POUR. Furthermore, indwelling urinary catheterization with removal 24 to 48 hours postoperatively did not increase the risk of UTI. In patients with multiple risk factors for POUR undergoing total joint arthroplasty of lower limb, the preferred option should be indwelling urinary catheterization removed 24-48 h postoperatively.

LEVEL OF EVIDENCE

Level I.

摘要

目的

本研究旨在比较接受下肢关节置换术的患者在留置导尿或间歇性导尿后发生尿路感染（UTI）和术后尿潴留（POUR）的发生率。

方法

我们对相关随机对照试验（RCT）进行了荟萃分析，以比较接受全关节置换术的患者在留置导尿或间歇性导尿后UTI和POUR的发生率。进行了全面检索以识别RCT。汇总了具有95%置信区间（CI）的特定研究风险比（RR）。此外，进行了荟萃回归分析以及敏感性分析以评估异质性。

结果

本荟萃分析纳入了9项RCT，共1771例患者。结果显示，留置导尿组和间歇性导尿组之间的UTI发生率无显著差异（P>0.05）。此外，在全关节手术中，与间歇性导尿相比，留置导尿降低了POUR的风险（P<0.01）。

结论

基于荟萃分析结果，术后24 - 48小时拔除的留置导尿在预防POUR方面优于间歇性导尿。此外，术后24至48小时拔除的留置导尿不会增加UTI的风险。在接受下肢全关节置换术且有多种POUR危险因素的患者中，首选方案应为术后24 - 48小时拔除的留置导尿。

证据级别

I级。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1de6/4492963/5457fcddf5bd/pone.0130636.g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1de6/4492963/10a9c3e4c69d/pone.0130636.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1de6/4492963/68367238fb4c/pone.0130636.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1de6/4492963/fe90a26e8bb1/pone.0130636.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1de6/4492963/eec297f31cc5/pone.0130636.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1de6/4492963/5457fcddf5bd/pone.0130636.g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1de6/4492963/10a9c3e4c69d/pone.0130636.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1de6/4492963/68367238fb4c/pone.0130636.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1de6/4492963/fe90a26e8bb1/pone.0130636.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1de6/4492963/eec297f31cc5/pone.0130636.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1de6/4492963/5457fcddf5bd/pone.0130636.g005.jpg

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