全关节置换术中导尿管拔除前的膀胱训练：一项随机对照试验
Bladder training prior to urinary catheter removal in total joint arthroplasty.A randomized controlled tria
全关节置换术中导尿管拔除前的膀胱训练
一项随机对照试验
Abstract
Background
Urinary catheters are commonly ud in patients undergoing total hip and knee arthroplasty. Bladder training before catheter removal is reported to shorten the time to return to normal bladder function and reduce the incidence of urinary retention.
Objective
To evaluate the results of bladder training in patients with total hip and knee arthroplasty.
Design
Randomized controlled trial.
Setting
Orthopaedic Department of a tertiary Military Hospital.
Participants
We enrolled concutive patients undergoing total hip or knee arthroplasty during a period of 14 months.
Methods
while是什么意思
40的英文人人网 上市We randomly allocated the participants into either a bladder training group, in which clamping was considered prior to catheter removal, or a free drainage removal group, using a computer-generated list and subquently assd their need for re-catheterization due to urinary retention. The primary outcome of this study was to evaluat
e if bladder training in patients with total hip and knee arthroplasty reduces the need for re-catheterization due to urinary retention. Multivariable logistic regression was ud to model the association between postoperative urinary retention and independent variables (total hip or total knee arthroplasty, age, gender, and history of diabetes mellitus or prostatism). Secondary outcomes were the incidence of urinary tract infection, and subjective patients’ symptoms.考研专业课考试时间
Results
We included 218 patients in the study; 114 in the bladder training group and 104 in the free drainage removal group. All patients were over 50 years old with a mean age of 69.3 (SD=8) years. We obrved three cas of urinary retention in the bladder training and six in free drainage removal group, and the difference was not statistically significant (2.6% and 5.8% respectively, p=0.316). We also obrved incread odds of re-catheterization in patients with prostatism under medication (odds ratio was 26.42, p<0.001). No infections or major subjective symptoms were noted.
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Conclusion爱情大魔咒歌词
This trial shows that bladder training by catheter clamping offers no advantage over free draining removal of short-term urinary catheters in patients with total hip and knee arthroplasty. Therefore, we conclude that the bladder training procedure is not indicated. However, healthcare providers should monitor patients’ urination after removal of the catheter.
搞笑的英文名Keywords: bladder training; Foley catheter removal; urinary retention; total joint arthroplasty
stepmother摘要
背景：
导尿管通常用于进行全髋关节和膝关节置换术的患者。据报道，导管拔除前的膀胱训练可缩短恢复正常膀胱功能的时间并减少尿潴留的发生率。
目的：
评估全髋关节和膝关节置换术患者的膀胱训练结果。
设计：随机对照试验。
研究地点：骨科高等军事医院。
研究对象：在14个月内接受全髋关节或膝关节置换术的患者。
方法
yank我们使用计算机生成的列表将患者随机分配到自由引流组和膀胱训练组中，膀胱训练组中患者在导管移除之前使用钳夹进行训练，随后评估他们由于尿潴留而再次导尿的需要。这项研究的主要结果是评估全髋关节和膝关节置换术患者的膀胱训练是否减少了因尿潴留导致再次导尿的需要。多变量logistic回归用于模拟术后尿潴留与自变量（全髋关节或全膝关节置换术，年龄，性别和糖尿病或前列腺病史）之间的关联。次要结果是尿路感染的发生率和患者的其他不良症状。
结果
我们纳入了研究中的218名患者;膀胱训练组114例，自由排水组104例。所有患者年龄均超过50岁，平均年龄为69.3（SD = 8）岁。我们在膀胱训练中观察到3例尿潴留，在自由引流清除组中观察到6例，差异无有统计学意义（分别为2.6％和5.8％，p = 0.316）。我们还观察到在服药期间前列腺炎患者再次插管的几率增加（优势比为26.42，p <0.001）。未发现任何感染或主观症状。
结论
该试验表明，通过导管夹持进行膀胱训练与完全髋关节和膝关节置换术患者的自由引流去除短期导尿管相比没有任何优势。因此，我们得出结论，该研究没有形成膀胱训练程序。然而，医疗保健提供者应在移除导管后监测患者的排尿情况。
关键词：膀胱训练;Foley导管切除;尿潴留;全关节置换术
Introduction
Patients undergoing total hip and knee arthroplasty may have difficulty or inability to urinate becau of confinement in bed and postoperative pain. Male gender, intrathecal
morphine and supplementary epidural anesthesia are additional risk factors, increasing the incidence of urinary retention up to 67% (Griesdale et al., 2011, Williams et al., 1995). Becau of the difficulties, short-term urinary catheters are inrted before surgery and removed as soon as possible postoperatively.
前言：
周一到周日的英文由于床上空间的限制和术后疼痛的折磨，接受全髋关节和膝关节置换术的患者可能很难或无法排尿。男性在鞘内注射吗啡和补充硬膜外麻醉后也会排尿困难，这使尿潴留发生率增加至67％。由于这些困难，应在术前插入短期导尿管并在术后尽快切除。
Bladder training by intermittent clamping before catheter removal is reported to shorten the time to return to normal bladder function and reduce the incidence of urinary retention (Roe, 1990). However, there is no connsus on its u; a Cochrane review reported inconclusive evidence, and a more recent meta-analysis concluded that higher quality trials are needed to draw conclusions (Griffiths and Fernandez, 2007, Wang et al., 2016). Moreover, the effectiveness and safety of bladder training in total joint arthroplasty is not
yet assd.
据报道，在导管拔除前通过间歇钳夹进行膀胱训练可缩短恢复正常膀胱功能的时间并减少尿潴留的发生率。但是，研究人员对其使用的方式没有达成共识;最近的一项荟萃分析中，Cochrane系统评价报告了不确定的研究结果，需要更高质量的试验来提供证据支撑。此外，尚未评估膀胱训练在全关节置换术中的有效性和安全性。
The purpo of this randomized controlled trial was to evaluate the results of bladder training in patients with total hip and knee arthroplasty, evaluating the incidence of urinary retention after the removal of the catheter, and the occurrence of other adver effects.
这项随机对照试验的目的是评估全髋关节和膝关节置换术患者的膀胱训练结果，评估拔除导尿管后尿潴留的发生率以及其他不良反应的发生率。
Material and methods
We conducted a prospective randomized controlled trial comparing bladder training by clamping before catheter removal, or free drainage removal. The study was approved by
the institutional review board (IRB No 4337/424MGH).
材料与方法
我们进行了一项前瞻性随机对照试验，比较导管拔除前夹紧膀胱训练或自由排水的效果。该研究得到了机构审查委员会（IRB No 4337 / 424MGH）的批准。
Participants and randomization
We included concutive adult patients undergoing total hip or knee arthroplasty from January 2015 to February 2016 in the Orthopaedic Department of a tertiary Military Hospital. Exclusion criteria were age under 50 years old, and known history of recurrent urinary tract infections, neurogenic bladder, previous urinary retention or voiding dysfunction, and diabetic cystopathy.
