| Objective:Enhanced recovery after surgery(ERAS)refers to the use of a series of measures that are based on evidence-based medical evidence to optimize and combine various perioperative treatment measures.It can effectively reduce the physical and psychological trauma of surgical patients.In order to achieve the goal of Enhanced recovery after surgery of the patient,Enhanced recovery after surgery has been successfully applied in many surgical fields such as thoracic surgery,colon surgery,orthopedics,gynecology,urology,etc.The effectiveness and safety have been confirmed.The perioperative management of urinary catheters in general thoracic surgery is also an important part of accelerating recovery.Enhanced recovery after surgery is gaining more and more attention in the perioperative period of general thoracic surgery,and pipeline management is one of the important contents of accelerating rehabilitation surgery.At present,in patients with lung surgery,the occurrence of postoperative urinary retention,bladder accidents,etc.and catheterization during and after surgery have become routine.Accelerated rehabilitation surgery requires perioperative workflow optimization.The thoracic drainage tube has changed during the management of the tube,while the indwelling urinary catheter is still used in the traditional way(before or after anesthesia,and after a 24-72 hours postoperatively).The traditional view is that postoperative catheterization can effectively prevent the dysuria caused by postoperative anesthesia.But at the same time,there are many drawbacks to this view.The bladder trigone and the urethra are rich in innervation and sensitive to touch and pain.Most patients have postoperative irritations of the urethra and even turbulence.Therefore,this study adopts a prospective cohort study method and selects the thoracic surgical wards of the First Affiliated Hospital of Zhejiang University from March to September 2017 according to the prospective inclusion criteria and exclusion criteria.There were 159 patients underwent thoracoscopic surgery(VATS)for pulmonary resection to investigate the clinical advantages of painless indwelling catheterization or no indwelling catheters during perioperative.Method:Based on the prospective inclusion criteria and exclusion criteria,159 patients undergoing thoracoscopic surgery with pulmonary resection from March to September 2017 at the Department of Thoracic Surgery,First Affiliated Hospital,Medical College of Zhejiang University were selected.Catheters were divided into control group,experimental group(including experimental group A(Indwelling catheterization after anesthesia,removal of catheter before anesthesia after surgery)and experimental group B(no catheter during the perioperative period).)The surgical methods mainly included thoracoscopic wedge resection of the lungs,Segmentectomy,lobectomy,Pulmonary sleeve etc.;use of perioperative rehabilitation concepts,including Preoperative and postoperative enhanced education,bed practice urine habits,minimally invasive surgery,short-term inhibition of drinking and fasting,PCA analgesia pump + incision local anesthetic infiltration,vibrating sputum,elastic stockings,early eating time,early ambulation,early removal of drainage tube,simple respiratory training,lung function training,etc.,compared among groups general information of patients,operation time,anesthesia infusion volume,urine volume,blood loss,urethral comfort,urethra Stimulation,postoperative hypersensitivity C-reactive protein,postoperative urine WBC,urinary retention,time of ambulation and discharge time,etc.Result:According to the study’s inclusion criteria and exclusion criteria,a total of 159 patients underwent VATS pulmonary resection at the Department of Thoracic Surgery in the First Affiliated Hospital of Zhejiang University Medical College from March to September 2017,There were including 77 patients with pulmonary lobectomy,70 cases of wedge resection,11 cases of segmental resection,and 1 case of pulmonary sleeve resection.There were 59 males and 100 females.The average age was 50.6±8.9 years.Patients who met the inclusion criteria were randomly included in the control group(conventional catheterization group)78 cases and experimental group 81 cases(including experimental group A(Indwelling catheterization after anesthesia,removal of catheter before anesthesia after surgery)(30 cases)and experimental group B(no catheter during the perioperative period)(51 cases)).The incidence of urethral irritation after general anesthesia in the control group was significantly higher than that in the experimental group B(3/5/78)(52/78),with statistically significant difference(P<0.01),and the control group and experimental group A had urinary tract stimulation rate was((52/78)VS(12/30),the difference was also statistically significant(P<0.01);the postoperative urethral comfort 0 degree(49/51)was significantly better in the experimental group B than in the experimental group A(17/30)and the control group(24/78),the difference was statistically significant(P<0.01);the average length of stay in the experimental group B was significantly shorter than the control group,the difference was statistically significant[(5.5±2.1)d(4.3±1.4)d,P<0.01];and the incidence of postoperative agitation was significantly different between the control group(16/78)and the experimental group B(3/51)(P<0.01).and the incidence of urinary incontinence was not different between the control group(4/78)and the experimental group A(1/30).Statistical significance(p>0.05)The incidence of urinary incontinence was not statistically significant between the control group(4/78)and the experimental group B(4/51);postoperative urine routine WBC was in contrast The difference between the group(117.8±292.0)and the experimental group A(19.8±38.4)was statistically significant(P<0.01);the difference between the postoperative urine routine WBC in the control group(117.8±292.0)and the experimental group B(16.5±28.8),there was a statistically significant difference(P<0.01);The control group and experimental group had statistically significant differences in postoperative 0 degree comfort(24/78 VS 66/81)(P<0.01);The incidence of urethral stimulation was in the control group(52/78)and the experiment,there was a statistically significant difference in the group(15/81)(P<0.01);There was no significant difference in the incidence of postoperative urinary retention(1/78 VS 1/81)between the control group and the experimental group(P>0.01);and the incidence of urinary incontinence was in the control group(4/78)and the experiment.The difference between groups(5/81)was not statistically significant(p>0.01).there was no significant difference in the incidence of urinary retention between the control group,the experimental group A,and the experimental group B.Conclusion:Perioperative patients with pulmonary resection had no catheterization or only intraoperative catheterization did not increase urinary retention and urinary incontinence,shortened hospital stays,reduced postoperative restlessness,reduced pain,and improved postoperative comfort and increasing the ERAS. |
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