Petros J G, Mallen J K, Howe K, Rimm E B, Robillard R J
Department of Surgery, St. Elizabeth's Medical Center, Boston, Massachusetts 02135.
Surg Gynecol Obstet. 1993 Aug;177(2):172-5.
We retrospectively studied 279 patients who had undergone uncomplicated open appendectomy for acute appendicitis to determine risk factors for postoperative urinary retention. The gender of the patients, the operating time and the amount of fluid given perioperatively had no influence on the occurrence of retention. The amount of analgesic agent administered postoperatively and the age of the patient were significantly associated with urinary retention (p = 0.01 and p < 0.0001, respectively, after adjustment for potential confounding factors). The use of meperidine hydrochloride as compared with morphine and of patient-controlled analgesia as compared with intramuscular delivery were initially found to be significantly related to retention (p = 0.014 and p < 0.0001, respectively). After the effects of the age of the patient, the drug type and the amount of fluid and analgesic agent administered were controlled for, patient-controlled analgesia remained significantly associated with retention (p < 0.0001), whereas the type of drug given was no longer significant after controlling for potential confounding factors. Because we found that urinary retention was 13 times more likely to occur in the patients who had patient-controlled analgesia, we recommend that the use of this form of analgesia delivery be avoided after open appendectomy.
我们回顾性研究了279例行单纯性急性阑尾炎开腹阑尾切除术的患者，以确定术后尿潴留的危险因素。患者的性别、手术时间及围手术期补液量对尿潴留的发生无影响。术后镇痛药的用量及患者年龄与尿潴留显著相关（在对潜在混杂因素进行校正后，p值分别为0.01和p<0.0001）。最初发现，与吗啡相比，使用盐酸哌替啶以及与肌肉注射给药相比，使用患者自控镇痛与尿潴留显著相关（p值分别为0.014和p<0.0001）。在对患者年龄、药物类型以及补液量和镇痛药用量的影响进行控制后，患者自控镇痛仍与尿潴留显著相关（p<0.0001），而在控制潜在混杂因素后，所给药物类型不再具有显著性。由于我们发现接受患者自控镇痛的患者发生尿潴留的可能性高13倍，因此我们建议开腹阑尾切除术后应避免使用这种镇痛方式。
