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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 鄒頡龍 | 導尿管拔除前，需不需要先夾（綁）住尿管？ | 2009/2/26 下午 11:49:29 | 0 |
| 原 文 | 題 目 | Clamping Short-term Indwelling Catheters A Systematic Review of the Evidence |
| 作 者 | Ritin S. Fernandez | |
| 出 處 | Wound, Ostomy and Continence Nurses Society | |
| 出版日期 | 2005 | |
| 評 論 |
拔除導尿管前，先將尿管夾（綁）起來，經過一段時間，或等患者有想解小便的感覺時，放開尿管；經過這樣程序（訓練），才拔除尿管。這樣的步驟，廣泛於國內的醫療機構中執行，也被許多醫護人員視為理所當然，但是，這樣做的目的是什麼？這樣動作，耗費護理人力，也讓病人與家屬對於尚未拔除的尿管關注再三, 甚至引發焦慮。這樣做，對膀胱的功能有好處嗎？ 在Ritin 等人的文章中提到，原來在1936年 （民國25年），這樣的作法首度被提出，認為在拔除前先夾住尿管，能刺激膀胱張力，提升膀胱感覺。多年下來，這樣的作法廣泛被運用。但是綁住尿管，也有許多缺點：增加尿路感染的機會，若是忘了將導尿管解開反而讓膀胱過漲，造成膀胱不必要的傷害。 問題是：究竟這樣做，是否益處大於壞處？ 作者回顧了從1966年至2004年英文有關比較短期放置導尿管拔除前是否先夾住尿管的英文文獻，其資料以電子資料庫加以分析。短期導尿管的定義為：1-14天。結果發現多個臨床試驗顯示兩者於尿路感染、尿液滯留、住院天數都沒有顯著差異。 作者結論為：目前短期放置導尿管拔除前，需不需要先夾（綁）住尿管在實證醫學的角度仍有爭議，目前不建議常規如此作。 |
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| abstract |
OBJECTIVE: The objective of this review is to determine the effects of clamping short-term indwelling urethral catheters before removal on the incidence of urinary tract infection, time to first void, voiding dysfunction, incidence of recatheterization, and the length of hospital stay. MATERIALS AND METHODS: Published and unpublished randomized and quasi-randomized controlled trials, completed between January 1966 and July 2004, in English and other languages that compared the effects of clamping short-term indwelling urethral catheters, were systematically reviewed using multiple electronic databases. Determination of eligibility of trials for inclusion in the review, assessment of methodological quality, and data extraction were undertaken independently by 2 reviewers. Relative risks for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals. Where synthesis was inappropriate, a narrative overview has been undertaken. RESULTS: Three trials that investigated the effect of clamping the indwelling urethral catheter compared to free drainage before removal were eligible for inclusion. Two trials reported no significant difference in the incidence of urinary tract infection (UTI), number of patients who developed urinary retention or required recatheterization, and the length of hospital stay between the 2 groups. CONCLUSIONS: The evidence for clamping indwelling urethral catheters before removal remains equivocal. Given the current state of evidence, procedures relating to clamping of indwelling urinary catheters should not be initiated. Until stronger evidence becomes available, however, practices relating to clamping indwelling urethral catheters will continue to be dictated by local preferences and cost factors. |
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