夹管训练降低短期留置导尿相关并发症效果的Meta分析
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湖北省自然科学基金项目(2015CFB712)


Bladder training by clamping prior to removal urinary catheters reduces short-term urinary retention:a Meta-analysis
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    目的 评价夹管训练降低短期留置尿管患者相关并发症发生率的效果。方法 检索 PubMed、CochraneLibrary、Medline、Embase、CINAHL、Scopus、中国知网、万方数据库,检索短期留置尿管患者尿管拔除前进行夹管训练和自然引流的随机对照试验文 献,以 RevMan5.3.5软件进行统计分析。结果 共纳入文献20篇,共计3899例患者。夹管训练在尿管拔除后发生尿潴留[RR= 0.33,95%CI(0.16,0.70),P 0.05)。结论 夹管训练可降低尿潴留、尿管重置、排尿困难的风险,但对导管相关尿路感染发生率影响的证据不足。对于有拔管 指征的患者,建议尽早拔除导尿管。现有证据尚不能认为夹管训练对于短期留置导尿患者是无意义的,仍须大样本、多中心的联 合研究、统一标准的客观指标来评价夹管训练的作用。

    Abstract:

    Objective To evaluate the effect of bladder training by clamping prior to removal urinary catheters on the incidences of complications associated with short-term indwelling urinary catheters. Methods A computerized search in PubMed, Cochrane Library, Medline, Embase, CINAHL, Scopus, China National Knowledge Infrastructure (CNKI) and Wan Fang Data were performed to retrieve randomized controlled trials (RCTs) on bladder training by clamping versus free drainage prior to removal of urinary catheters for patients with short-term indwelling urinary catheters. Meta-analysis of the trials was conducted using RevMan 5.3.5 software. Results A total of 20 studies were included, adding up to 3 899 patients.Compared to the free drainage group, the risks of urinary retention after catheter removal [RR=0.33,95%CI(0.16,0.70),P<0.01]], urinary catheter reinsertion[RR=0.50,95%CI(0.38,0.67),P<0.01], voiding dysfunction [RR=0.31,95%CI(0.14,0.71),P<0.01], and patient perceived voiding-related discomfort [RR=0.56,95%CI(0.36,0.86),P<0.01] were significantly lower in the clamping group. The risk of catheter-associated urinary tract infections (CAUTI) in the clamping group was 1.11 times that of the free drainage group [RR=1.11,95%CI(0.71,1.74)], without statistical significance (P>0.05). Conclusion Bladder training by clamping could lower the post-catheter-removal risks of urinary retention, urinary catheter reinsertion, and voiding dysfunction, though evidence on the increased risk of urinary tract infection by clamping is limited.It is recommended that catheters be removed as soon as possible if the patient is indicated for removal. The current evidence cannot rule out that bladder training by clamping is meaningless. Large sample, multi-centered trials, and objective outcome measures are still needed to evaluate the role of bladder training by clamping.

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王颖,杨建国,刘洪娟,尹世玉,郭月,汪晖,曾铁英.夹管训练降低短期留置导尿相关并发症效果的Meta分析[J].护理学杂志,2019,34(19):29-33

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  • 收稿日期:2019-05-07
  • 最后修改日期:2019-07-25
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  • 在线发布日期: 2022-08-09