Effect of preoperative urination training combined with restrictive fluid therapy with enhanced recovery after surgery on postoperative urination in total knee arthroplasty patients_West China Medical Journal

Authors：

DUAN Shanshan ,  NING Ning , ZHOU Ting , LI Peifang , WANG Ke , LI Lingli , HOU Xiaoling

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

NING Ning, Email: gkningning@126.com

Keywords：

Enhanced recovery after surgery; Total knee arthroplasty; Restrictive fluid therapy; Urination training

DOI：

10.7507/1002-0179.201809135

Video：

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Objective To study the effect of preoperative urination training combined with restrictive fluid therapy with enhanced recovery after surgery (ERAS) on postoperative urination in total knee arthroplasty (TKA) patients. Methods A total of 150 patients who were conducted the unilateral TKA from March to May 2018 were divided into two groups, the trial group and the control group, with 75 patients in each group. The patients in the control group did not undergo urination training before surgery and were given liberal intravenous fluid therapy on the day of surgery; while the patients in the trial group received urination training before surgery and were given restrictive fluid therapy on the day of surgery. The pre-, intra-, and post-operative infusion volume and the total infusion volume on the day of surgery of the two groups were recorded; and the urination situation, urination time for the first time and the hospital days in the two groups were compared. Results The total infusion volume on the day of surgery in the trial group and the control group was (1 581.40±277.54) and (2 395.00±257.40) mL, respectively. After operation, in the trial group, there were 73 patients with smooth urinating, 2 with smooth urinating after inducing method, and none with urethral catheterization; in the control group, there were 66 patients with smooth urinating, 3 with smooth urinating after inducing method, and 6 with urethral catheterization. The urination time for the first time after operation in the trial group and the control group was (1.85±0.91) and (2.93±1.48) hours after back to the ward, respectively. These differences between the two groups were statistically significant (P<0.05). The hospital stay in the trial group and the control group was (5.86±2.48) and (6.28±1.60) days, respectively, and the difference between the two groups was not statistically significant (P>0.05). Conclusions Preoperative urination training combined with restrictive fluid therapy (the total infusion volume controls in about 1 500 mL on the day of surgery) in the TKA patients after ERAS is good for postoperation urination. It also can reduce the rate of postoperative urinary retention, and enhance rehabilitation.

Citation： DUAN Shanshan, NING Ning, ZHOU Ting, LI Peifang, WANG Ke, LI Lingli, HOU Xiaoling. Effect of preoperative urination training combined with restrictive fluid therapy with enhanced recovery after surgery on postoperative urination in total knee arthroplasty patients. West China Medical Journal, 2018, 33(12): 1491-1494. doi: 10.7507/1002-0179.201809135 Copy

1.	Stowers MD, Manuopangai L, Hill AG, et al. Enhanced recovery after surgery in elective hip and knee arthroplasty reduces length of hospital stay. ANZ J Surg, 2016, 86(6): 475-479.
2.	耿晴晴. 預防骨科術后尿潴留的國內研究近況. 實用醫藥雜志, 2013, 30(11): 1040-1043.
3.	Hollman F, Wolterbeek N, Veen R. Risk factors for postoperative urinary retention in men undergoing total hip arthroplasty. Orthopedics, 2015, 38(6): e507-e511.
4.	Huang Z, Ma J, Shen B, et al. General anesthesia: to catheterize or not? A prospective randomized controlled study of patients undergoing total knee arthroplasty. J Arthroplasty, 2015, 30(3): 502-506.
5.	Mcdonald DA, Siegmeth R, Deakin AH, et al. An enhanced recovery programme for primary total knee arthroplasty in the United Kingdom - follow up at one year. Knee, 2012, 19(5): 525-529.
6.	Miller AG, Mckenzie J, Greenky M, et al. Spinal anesthesia: should everyone receive a urinary catheter? A randomized, prospective study of patients undergoing total hip arthroplasty. J Bone Joint Surg Am, 2013, 95(16): 1498-1503.
7.	陳有榮, 文鵬飛, 郭萬首, 等. 初次髖膝關節置換術中不留置尿管的可行性和安全性研究. 中華關節外科雜志: 電子版, 2018, 12(3): 350-355.
8.	Boulis NM, Mian FS, Rodriguez D, et al. Urinary retention following routine neurosurgical spine procedures. Surg Neurol, 2001, 55(1): 23-27; discussion 27-28.
9.	郭文玉. 排尿訓練對預防骨科術后患者尿潴留的效果觀察. 當代護士: 專科版, 2012(1): 50-51.
10.	張少云, 曹國瑞, 裴福興. 髖、膝關節置換術加速康復圍術期液體治療方案. 中國矯形外科雜志, 2018, 26(3): 234-237.
11.	雷一霆, 黃強, 張少云, 等. 人工全髖關節置換術圍術期限制性輸液聯合術前排尿訓練的臨床研究. 中國修復重建外科雜志, 2017, 31(11): 1295-1299.
12.	梁蘭. 骨科患者術后尿潴留的相關因素與護理進展. 世界最新醫學信息文摘, 2015, 15(9): 34-36.
13.	王幫瓊. 骨科手術病人術前排尿訓練對手術后患者排尿影響的分析. 中外醫療, 2010, 29(4): 86.
14.	張少云, 黃強, 曹國瑞, 等. 加速康復外科模式下全膝關節置換術圍術期限制性輸液的臨床研究. 中國矯形外科雜志, 2017, 25(17): 1567-1571.
15.	周宗科, 翁習生, 曲鐵兵, 等. 中國髖、膝關節置換術加速康復--圍術期管理策略專家共識. 中華骨與關節外科雜志, 2016, 9(1): 1-9.
16.	裴福興, 翁習生. 現代關節置換術加速康復與圍手術期管理. 北京: 人民衛生出版社, 2017.
17.	楊曉娟, 繆云仙, 楊樹琴. 術前排尿訓練對甲狀腺腫瘤患者術后排尿的影響分析. 當代護士: 上旬刊, 2017(1): 74-75.
18.	孫美芝, 唐霖. 骨科術后尿潴留的相關因素研究現狀. 中國誤診學雜志, 2011, 11(20): 4807-4808.
19.	汪濤, 陳莉. 術前排尿訓練對心血管介入患者術后排尿的影響探究. 中國醫藥指南, 2017, 15(35): 171-172.

1. Stowers MD, Manuopangai L, Hill AG, et al. Enhanced recovery after surgery in elective hip and knee arthroplasty reduces length of hospital stay. ANZ J Surg, 2016, 86(6): 475-479.
2. 耿晴晴. 預防骨科術后尿潴留的國內研究近況. 實用醫藥雜志, 2013, 30(11): 1040-1043.
3. Hollman F, Wolterbeek N, Veen R. Risk factors for postoperative urinary retention in men undergoing total hip arthroplasty. Orthopedics, 2015, 38(6): e507-e511.
4. Huang Z, Ma J, Shen B, et al. General anesthesia: to catheterize or not? A prospective randomized controlled study of patients undergoing total knee arthroplasty. J Arthroplasty, 2015, 30(3): 502-506.
5. Mcdonald DA, Siegmeth R, Deakin AH, et al. An enhanced recovery programme for primary total knee arthroplasty in the United Kingdom - follow up at one year. Knee, 2012, 19(5): 525-529.
6. Miller AG, Mckenzie J, Greenky M, et al. Spinal anesthesia: should everyone receive a urinary catheter? A randomized, prospective study of patients undergoing total hip arthroplasty. J Bone Joint Surg Am, 2013, 95(16): 1498-1503.
7. 陳有榮, 文鵬飛, 郭萬首, 等. 初次髖膝關節置換術中不留置尿管的可行性和安全性研究. 中華關節外科雜志: 電子版, 2018, 12(3): 350-355.
8. Boulis NM, Mian FS, Rodriguez D, et al. Urinary retention following routine neurosurgical spine procedures. Surg Neurol, 2001, 55(1): 23-27; discussion 27-28.
9. 郭文玉. 排尿訓練對預防骨科術后患者尿潴留的效果觀察. 當代護士: 專科版, 2012(1): 50-51.
10. 張少云, 曹國瑞, 裴福興. 髖、膝關節置換術加速康復圍術期液體治療方案. 中國矯形外科雜志, 2018, 26(3): 234-237.
11. 雷一霆, 黃強, 張少云, 等. 人工全髖關節置換術圍術期限制性輸液聯合術前排尿訓練的臨床研究. 中國修復重建外科雜志, 2017, 31(11): 1295-1299.
12. 梁蘭. 骨科患者術后尿潴留的相關因素與護理進展. 世界最新醫學信息文摘, 2015, 15(9): 34-36.
13. 王幫瓊. 骨科手術病人術前排尿訓練對手術后患者排尿影響的分析. 中外醫療, 2010, 29(4): 86.
14. 張少云, 黃強, 曹國瑞, 等. 加速康復外科模式下全膝關節置換術圍術期限制性輸液的臨床研究. 中國矯形外科雜志, 2017, 25(17): 1567-1571.
15. 周宗科, 翁習生, 曲鐵兵, 等. 中國髖、膝關節置換術加速康復--圍術期管理策略專家共識. 中華骨與關節外科雜志, 2016, 9(1): 1-9.
16. 裴福興, 翁習生. 現代關節置換術加速康復與圍手術期管理. 北京: 人民衛生出版社, 2017.
17. 楊曉娟, 繆云仙, 楊樹琴. 術前排尿訓練對甲狀腺腫瘤患者術后排尿的影響分析. 當代護士: 上旬刊, 2017(1): 74-75.
18. 孫美芝, 唐霖. 骨科術后尿潴留的相關因素研究現狀. 中國誤診學雜志, 2011, 11(20): 4807-4808.
19. 汪濤, 陳莉. 術前排尿訓練對心血管介入患者術后排尿的影響探究. 中國醫藥指南, 2017, 15(35): 171-172.

West China Medical Journal

Effect of preoperative urination training combined with restrictive fluid therapy with enhanced recovery after surgery on postoperative urination in total knee arthroplasty patients

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