Shu-Chuan Chen, RN Head Nurse, Department of Nursing, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan. Pei-Ya Chen, MD Researcher, Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan. Guei-Chiuan Chen, MD Researcher, Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan. Su-Yun Chuang, RN Researcher, Infection Control Center, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan. I-Shiang Tzeng, PhD Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan. Shinn-Kuang Lin, MD Associate Professor, Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien, Taiwan.
J Cardiovasc Nurs. 2018 Nov/Dec;33(6):551-558. doi: 10.1097/JCN.0000000000000507.
Urinary tract infection (UTI) during acute ischemic stroke is associated with a longer hospital length of stay and unfavorable functional outcomes.
We investigated the benefits of portable bladder ultrasound (PBU) scanning during acute ischemic stroke.
We retrospectively reviewed patients with acute ischemic stroke from January 2011 to February 2017. Patients were divided into group 1 (PBU not available) and group 2 (PBU available), before or after the split date, April 9, 2014. Portable bladder ultrasound scanning was conducted by nurses to measure postvoid residual urine volume in patients with impaired consciousness and/or dependent ambulation.
In total, 1928 patients were enrolled, of whom 109 (5.7%) had UTI and 901 (46.7%) experienced unfavorable outcomes (modified Rankin scale score ≥ 3). Multivariate analysis revealed that factors that influenced UTI were age of 75 years or older, female gender, initial total National Institutes of Health Stroke Scale (NIHSS) score of 5 or higher, initial NIHSS conscious score of 1 or higher, initial NIHSS leg score of 2 or higher, and urinary catheterization. Factors influencing unfavorable outcomes were similar to those influencing UTI but further comprised UTI. C-statistic for UTI detection was 0.864 for model fitting, including significant factors in logistic regression. Compared with group 1, group 2 had a higher incidence of urinary catheterization (13.1% vs 8.2%), a lower incidence of UTI (4.0% vs 6.9%), and a shorter length of stay (11.9 vs 13.6 days).
Portable bladder ultrasound scanning reduced the incidence of UTI and shortened length of stay. We suggest routine PBU procedures for patients with acute ischemic stroke who fulfill the AGN3 criteria for a high risk of UTI.
急性缺血性脑卒中患者发生尿路感染（UTI）与住院时间延长和不良功能结局相关。
我们研究了便携式膀胱超声（PBU）扫描在急性缺血性脑卒中患者中的作用。
我们回顾性分析了 2011 年 1 月至 2017 年 2 月期间的急性缺血性脑卒中患者。患者分为 1 组（无 PBU）和 2 组（有 PBU），根据 2014 年 4 月 9 日是否分组进行划分。由护士对意识障碍和/或依赖行走的患者进行便携式膀胱超声检查，以测量残余尿量。
共纳入 1928 例患者，其中 109 例（5.7%）发生 UTI，901 例（46.7%）出现不良结局（改良 Rankin 量表评分≥3 分）。多变量分析显示，影响 UTI 的因素包括年龄≥75 岁、女性、初始总国立卫生研究院卒中量表（NIHSS）评分≥5 分、初始 NIHSS 意识评分≥1 分、初始 NIHSS 下肢评分≥2 分和导尿。影响不良结局的因素与影响 UTI 的因素相似，但进一步包括 UTI。纳入 logistic 回归中的显著因素后，用于 UTI 检测的模型拟合的 C 统计量为 0.864。与 1 组相比，2 组导尿率较高（13.1%比 8.2%），UTI 发生率较低（4.0%比 6.9%），住院时间较短（11.9 天比 13.6 天）。
便携式膀胱超声扫描可降低 UTI 的发生率和缩短住院时间。我们建议对符合急性缺血性脑卒中患者尿路感染高危 AGN3 标准的患者常规进行 PBU 检查。
