Yang Han, Cao Guorui, Pei Fuxing, Song Bin
Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Mar 15;34(3):357-361. doi: 10.7507/1002-1892.201906126.
To evaluate the risk factors for postoperative indwelling catheter following enhanced recovery after primary unilateral total knee arthroplasty (TKA) under general anesthesia.
Patients who underwent primary unilateral TKA under general anesthesia between January 2017 and August 2018 were enrolled in the study. Among them, 205 patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, body mass index, preoperative range of motion, Hospital for Special Surgery (HSS) score, American Society of Anesthesiologists (ASA) score, disease type, comorbidity, hemoglobin, hematocrit, blood volume, length of operation and operation time, whether to keep drainage after surgery, intraoperative blood loss, total blood loss, and preoperative, intraoperative, postoperative fluid infusions, and total fluid infusion on the day of surgery, urine volume on the day of surgery. Univariate analysis and logistic regression analysis were used to screen the risk factors for postoperative indwelling catheter. Length of stay and incidences of complications (intermuscular vein thrombosis, deep vein thrombosis, pulmonary embolism, incision swelling and exudation, electrolyte disorder, nausea and vomiting, and urinary tract infection) were compared between the patients with or without indwelling catheter.
Indwelling catheter occurred in 41 (20%) of 205 patients. Single factor analysis showed that the influence factors were age, gender, keeping drainage after surgery, total fluid infusion and urine volume on the day of surgery ( <0.05). The multiple factors analysis showed that the males and more urine volume on the day of surgery were the significant risk factors for indwelling catheter after primary TKA ( <0.05). In addition, postoperative length of stay was shorter and the incidence of urinary tract infection was lower in non-indwelling catheter group than in indwelling catheter group, showing significant differences ( <0.05).
The male patients with more urine on the day of surgery have higher risk for indwelling catheter after primary unilateral TKA under general anesthesia with an enhanced recovery program.
评估全麻下初次单侧全膝关节置换术（TKA）后采用加速康复方案时术后留置导尿管的危险因素。
选取2017年1月至2018年8月期间在全麻下行初次单侧TKA的患者。其中，205例符合入选标准的患者纳入研究，收集其临床资料，包括性别、年龄、体重指数、术前活动范围、特种外科医院（HSS）评分、美国麻醉医师协会（ASA）评分、疾病类型、合并症、血红蛋白、血细胞比容、血容量、手术时长及操作时间、术后是否留置引流管、术中出血量、总失血量以及术前、术中、术后液体输注量和手术当日总液体输注量、手术当日尿量。采用单因素分析和逻辑回归分析筛选术后留置导尿管的危险因素。比较留置导尿管组和未留置导尿管组患者的住院时长及并发症（肌间静脉血栓、深静脉血栓、肺栓塞、切口肿胀及渗出、电解质紊乱、恶心呕吐、尿路感染）发生率。
205例患者中有41例（20%）发生留置导尿管。单因素分析显示，影响因素为年龄、性别、术后留置引流管、手术当日总液体输注量和尿量（<0.05）。多因素分析显示，男性及手术当日尿量较多是初次TKA后留置导尿管的显著危险因素（<0.05）。此外，未留置导尿管组术后住院时长较短，尿路感染发生率低于留置导尿管组，差异有统计学意义（<0.05）。
在全麻下采用加速康复方案的初次单侧TKA患者中，手术当日尿量较多的男性患者留置导尿管的风险较高。
