日间手术患者置入带尾线双J管出院后自行拔管的可行性研究
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摘要
目的探讨日间手术患者置入带尾线双J管出院后自行拔管的可行性。方法 2018年1-5月,便利抽样选取我院日间病房行输尿管软镜碎石手术患者108例,采用随机分组法分为带尾线组和无尾线组。出院前对带尾线组患者宣教自行拔管要点,出院后第14天由患者自行拔管;无尾线组患者14 d后来院行膀胱镜拔管。随访并记录两组患者置管相关指标进行比较分析。结果两组患者均无一例发生双J管移位;带尾线组和无尾线组患者置管期间舒适率分别为87.76%和89.83%、拔管成功率分别为95.92%和100%,差异均无统计学意义(均P>0.05);无尾线组拔管疼痛评分高于带尾线组[(7.00±1.40)分vs.(3.69±1.65)分],相关医疗费用高于带尾线组[(427.80±61.38)元vs.(82.39±15.78)元],差异均有统计学意义(均P<0.05)。结论带尾线双J管患者出院后可安全自行拔管,置管期间舒适率以及拔管成功率与无尾线膀胱镜拔管相当,同时具有拔管相关疼痛轻和医疗花费少的优点,故建议在临床推广使用。
Objective To study the feasibility of self-extraction of double-J stent with a string for patients discharged from the day ward.Methods From January to May 2018,108 patients who were going to receive flexible ureteroscopic lithotripsy in the day ward were selected. Double-J stent with a string or without a string was randomly placed in each patient.Before the discharge, the patients with a string were taught to extubate by themselves, and the string was extubated by themselves on the 14 th day after discharge; the patients without string were extubated by cystoscope after 14 days.The related indicators of catheterization were recorded and compared between the two groups.Results No double-J stent displacement occurred in either group. The comfort rate during catheterization was 87.76% in the string group and 89.83% in the non-string group, and the success rate of extubation was 95.92% and 100%,respectively,there was no significant difference between the two groups(all P>0.05).The pain score of extubation in the non-string group was higher than that in the string group [(7.00±1.40) vs.(3.69±1.65)], and the related medical expenses were higher than those in the string group [(427.80±61.38) vs.(82.39±15.78)],with statistical significance(all P<0.05).Conclusions Double-J stent with string can be removed safely by self-extraction after discharge,the comfort rate and success rate of extubation during catheterization are similar to those of non-string extubation method.At the same time,it has the advantages of light extubation-related pain and low medical cost. Therefore, it is recommended to be popularized in clinical practice.
Objective To study the feasibility of self-extraction of double-J stent with a string for patients discharged from the day ward.Methods From January to May 2018,108 patients who were going to receive flexible ureteroscopic lithotripsy in the day ward were selected. Double-J stent with a string or without a string was randomly placed in each patient.Before the discharge, the patients with a string were taught to extubate by themselves, and the string was extubated by themselves on the 14 th day after discharge; the patients without string were extubated by cystoscope after 14 days.The related indicators of catheterization were recorded and compared between the two groups.Results No double-J stent displacement occurred in either group. The comfort rate during catheterization was 87.76% in the string group and 89.83% in the non-string group, and the success rate of extubation was 95.92% and 100%,respectively,there was no significant difference between the two groups(all P>0.05).The pain score of extubation in the non-string group was higher than that in the string group [(7.00±1.40) vs.(3.69±1.65)], and the related medical expenses were higher than those in the string group [(427.80±61.38) vs.(82.39±15.78)],with statistical significance(all P<0.05).Conclusions Double-J stent with string can be removed safely by self-extraction after discharge,the comfort rate and success rate of extubation during catheterization are similar to those of non-string extubation method.At the same time,it has the advantages of light extubation-related pain and low medical cost. Therefore, it is recommended to be popularized in clinical practice.
引文
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[9] 韩艳艳.护理干预对腹部手术患者麻醉前后留置导尿管舒适度的影响[J].中国医学工程,2015,23(2):126-127.
[10]ALEXANDER G,ITHAMAR G,SOLOMON S,et al.Is diagnostic cystoscopy painful?Analysis of 1,320 consecutive procedures[J].Int Braz J Urol,2014,40(4):533-538.
[11]STEPHAN S,MESUT R,HARUN F,et al.Prospective multi-institutional study analyzing pain perception of flexible and rigid cystoscopy in men[J].Urology,2015,85(4):737-41.
[12]蔡万松,蒋祥新,闻立平.术前免留置双J管一期输尿管软镜治疗肾结石的临床研究[J].中国内镜杂志,2016,22(4):58-62.
[13] 张义,杨嗣星,宋超,等.软性输尿管镜钬激光碎石术后双J管放置时间的单中心随机对照研究[J].微创泌尿外科杂志,2016,5(4):199-202.
[14]Rassweiler M C,Michel M S,Ritter M,et al.Magnetic ureteral stent removal without cystoscopy:a randomized controlled trial[J].J Endourol,2017,31(8):762-766.
[2] 李玉涛,沈鹏飞,徐鹏,等.输尿管镜下钬激光碎石术作为日间手术的可行性及安全性研究[J].中华泌尿外科杂志,2013,34(7):526-529.
[3] MUSLUMANOGLU A Y,FUGLSIG S,FRATTINI A,et al.Risks and benefits of postoperative double-j stent placement after ureteroscopy:results from the clinical research office of endourological society ureteroscopy global study[J].J Endourol,2017,31(5):446-451.
[4] KARTHIKEYAN V S,KESHAVAMURTHY R,MALLYA A,et al.Efficacy of preprocedural diclofenac in men undergoing double J stent removal under local anesthesia:a double-blind,randomized control trial[J].Indian J Urol,2017,33(1):53-57.
[5] 韦巍,钟羽翔,黄剑华,等.经皮肾镜碎石术后双J管相关严重并发症危险因素的Logistics回归分析[J].南方医科大学学报,2016,36(10):1440-1443.
[6] KERI T B,MEGAN T B,CHAD R T.Do ureteral stent extraction strings affect stent-related quality of life or complications after ureteroscopy for urolithiasis:a prospective randomized control trial[J].BJU Int,2014,113(4):605-609.
[7] 郭振家,赵彦执,林桂亭,等.带尾线双J管的临床应用[J].中华泌尿外科杂志,2000,2(10):629-629.
[8] 王珅,陈志强.双J管留置时间与相关并发症发生率关系的分析[J].微创泌尿外科杂志,2015,4(6):359-363.
[9] 韩艳艳.护理干预对腹部手术患者麻醉前后留置导尿管舒适度的影响[J].中国医学工程,2015,23(2):126-127.
[10]ALEXANDER G,ITHAMAR G,SOLOMON S,et al.Is diagnostic cystoscopy painful?Analysis of 1,320 consecutive procedures[J].Int Braz J Urol,2014,40(4):533-538.
[11]STEPHAN S,MESUT R,HARUN F,et al.Prospective multi-institutional study analyzing pain perception of flexible and rigid cystoscopy in men[J].Urology,2015,85(4):737-41.
[12]蔡万松,蒋祥新,闻立平.术前免留置双J管一期输尿管软镜治疗肾结石的临床研究[J].中国内镜杂志,2016,22(4):58-62.
[13] 张义,杨嗣星,宋超,等.软性输尿管镜钬激光碎石术后双J管放置时间的单中心随机对照研究[J].微创泌尿外科杂志,2016,5(4):199-202.
[14]Rassweiler M C,Michel M S,Ritter M,et al.Magnetic ureteral stent removal without cystoscopy:a randomized controlled trial[J].J Endourol,2017,31(8):762-766.