Xu S H, Wang B B, Pang Q Y, Zhong L J, Ding Y M, Huang Y B, Che X Y
Department of Urology, Peking University First Hospital, Beijing 100034, China.
Nursing Department, Peking University First Hospital, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Aug 18;55(4):676-683. doi: 10.19723/j.issn.1671-167X.2023.04.018.
To evaluate the effect of equal temperature bladder irrigation on bladder spasm, postoperative bleeding, vital signs and discomfort of chills in patients of transurethral resection of prostate using meta-analysis.
Several electronic databases included Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, China Biology Medicine (CBM) were searched systematically for published randomized controlled trial about equal temperature bladder irrigation in patients with transurethral resection of prostate before November 20, 2019. Two reviewers selected independently the literature in the light of the inclusion and exclusion criteria, assessed the risk of bias by quality assessment and extracted data which were consisted of clinical efficacy indexes, such as incidence of bladder spasm, severity of bladder spasm, incidence of tube plugging, amount of bladder flushing fluid, time of bladder flushing, heart rate, systolic pressure, diastolic pressure, and incidence of chills. Data were pooled using fixed-effects model or random-effects model, and the summary effect measure was calculated by risk ratio () or mean difference () and 95% confidence interval (95%). Meta-analysis was performed by Review Manager 5.3 Software.
In the study, 13 randomized controlled trails met the requirement with a total of 2 033 patients of transurethral resection of prostate were included, of whom 1 015 were carried out with equal temperature bladder irrigation and 1 018 with room temperature bladder irrigation. The results of meta-analysis showed that incidence of bladder spasm [=0.51, 95% (0.45, 0.57), < 0.001], severity of bladder spasm [=-1.61, 95% (-2.00, -1.23), < 0.001], incidence of urinary blockage [=0.29, 95% (0.19, 0.44), < 0.001], dosage of bladder irrigation [=-6.75, 95% (-7.33, -6.17), < 0.001], time of bladder rinse [=-7.60, 95% (-11.91, -3.29), < 0.001], heart rate [=-13.68, 95% (-15.19, -12.17), < 0.001], systolic pressure [=-29.26, 95% (-31.92, -26.59), < 0.001], diastolic pressure [=-29.36, 95% (-31.75, -26.98), < 0.001], incidence of chills and discomfort [=0.37, 95% (0.31, 0.44), < 0.001] in equal temperature group of the patients with transurethral resection of prostate had significantly statistical difference compared with room temperature group.
Based on current available evidence, equal temperature bladder irrigation reduced the incidence of bladder spasm and urinary blockage, relieved bladder spasm, reduced dosage and time of bladder irrigation, and hardly affected normal vital signs and increased the patient' s comfort.
采用Meta分析评价恒温膀胱冲洗对经尿道前列腺电切术患者膀胱痉挛、术后出血、生命体征及寒战不适的影响。
系统检索Cochrane图书馆、PubMed、Embase、中国知网(CNKI)、万方、维普、中国生物医学文献数据库(CBM)等多个电子数据库,收集2019年11月20日前发表的关于经尿道前列腺电切术患者恒温膀胱冲洗的随机对照试验。两名研究者根据纳入和排除标准独立筛选文献,采用质量评估法评估偏倚风险,并提取包括膀胱痉挛发生率、膀胱痉挛严重程度、堵管发生率、膀胱冲洗液量、膀胱冲洗时间、心率、收缩压、舒张压及寒战发生率等临床疗效指标的数据。采用固定效应模型或随机效应模型合并数据,计算风险比(RR)或均值差(MD)及95%置信区间(95%CI)作为汇总效应量。运用Review Manager 5.3软件进行Meta分析。
本研究共纳入13项符合要求的随机对照试验,共计2033例经尿道前列腺电切术患者,其中1015例行恒温膀胱冲洗,1018例行室温膀胱冲洗。Meta分析结果显示,恒温组患者膀胱痉挛发生率[RR = 0.51,95%CI(0.45,0.57),P < 0.001]、膀胱痉挛严重程度[MD = -1.61,95%CI(-2.00,-1.23),P < 0.001]、尿路梗阻发生率[RR = 0.29,95%CI(0.19,0.44),P < 0.001]、膀胱冲洗用量[MD = -6.75,95%CI(-7.33,-6.17),P < 0.001]、膀胱冲洗时间[MD = -7.60,95%CI(-11.91,-3.29),P < 0.001]、心率[MD = -13.68,95%CI(-15.19,-12.17),P < 0.001]、收缩压[MD = -29.26,95%CI(-31.92,-26.59),P < 0.001]、舒张压[MD = -29.36,95%CI(-31.75,-26.98),P < 0.001]、寒战及不适发生率[RR = 0.37,95%CI(0.31,0.44),P < 0.001]与室温组相比差异均有统计学意义。
基于现有证据,恒温膀胱冲洗可降低膀胱痉挛和尿路梗阻的发生率,缓解膀胱痉挛,减少膀胱冲洗用量和时间,对正常生命体征影响较小,提高了患者舒适度。