The Analisis Of Indwelling Catheter And Urinary Retention-related Factors In Patients With Thyroid Or Gallbladder Diseases

Urinary Retention:Postoperative patients who can not urinate and the bladder urine volume> 600ml or self-emptying effectively, the bladder and residual urine volume>100ml. Under normal circumstances, the human urinary function under the control of the two nerve centers, the nerve center in 2 to 4 sacral is the formation of micturition reflex; another center in the brain, with the activities of the human will to control urination. The age, gender, urinary system diseases, intraoperative fluid volume, neurological diseases and the duration of anesthesia are the possible factors causing urinary retention. Current treatment and prevention of postoperative urinary retention is mainly indwelling catheter before surgery, but the catheter bring great discomfort to patients, easily lead to urinary tract infections, urinary tract damage and other symptoms.It is not conducive to postoperative recovery.Objective:Collecting the cases of patients from June 2009 to October 2010 at the First Affiliated Hospital of Shanxi Medical University with treatment of thyroid and gallbladder surgery under general anesthesia.1. Analyse the impact of age, gender, the duration of anesthesia, intraoperative fluid volume on urinary retention. Determine wheather they are the related factors.2. Analyse the urine test results of preoperative and postoperative (or after pulling out the catheter).Determine the correlation of urinary tract infections and the indwelling catheter.Methods:1.With a retrospective survey methods, I collected the cases of patients from June 2009 to October 2010 at the First Affiliated Hospital of Shanxi Medical University with treatment of thyroid and gallbladder surgery under general anesthesia. I recorded their age, gender, amount of intraoperative transfusion, duration of anesthesia, urinary retention or not, the urine test results of preoperative and postoperative (or after pulling out the catheter). The following diseases excluded:Urinary system diseases, mental diseases, urinary tract infection, diabetes, prostate disease. Information will be entered one by one in the pre-designed forms, Risk factors calculated by chi-square test P value. Determine wheather the age, gender, duration of anesthesia, intraoperative fluid volume with urinary retention is related.2. Determine the correlation of the indwelling catheter group and the comparison group without indwelling catheter.Results:1.The incidence of postoperative urinary retention is 37.21%, it's related with age, gender, the duration of anesthesia, intraoperative fluid volume(P<0.05),unrelated with gender.2.Indwelling urethral catheter and the urinary tract infections are unrelated(P>0.05).3.For young people, the people with duration of anesthesia less than 1.5 hour and intraoperative fluid volume less than 1500ml are different from the others in Urinary retention.4.The young people with indwelling catheter duration shorter than 24 hours are different from the people with indwelling catheter longer than 24 hours; the young people with no catheter are different from those with indwelling catheter longer than 24 hours in urinary tract infection.5. For middle-aged people, the people with duration of anesthesia less than 1.5 hour and intraoperative fluid volume less than 1500ml are different from the others in urinary retention.6. The middle-aged people with indwelling catheter duration shorter than 24 hours are different from the people with indwelling catheter longer than 24 hours;the middle-aged people with no catheter are different from those with indwelling catheter longer than 24 hours in urinary tract infection.7.The older people are different form the young people and the middle-aged people in Urinary retention.8. The older people are different form the young people and the middle-aged people in urinary tract infection.9. For older people, the people with duration of anesthesia less than 1.5 hour and intraoperative fluid volume less than 1500ml are different from the others in Urinary retention.10. The older people with indwelling catheter duration shorter than 24 hours are not different from the people with indwelling catheter longer than 24 hours but less than 72 hours.There is no differents between the older people whose indwelling cathter duration between 24 hours to 72 hours.The older people with no catheter are different from those with indwelling catheter longer than 72 hours in urinary tract infection.Conclusion:1. The incidence of postoperative urinary retention is 37.21%, it's related with age, gender, the duration of anesthesia, intraoperative fluid volume(P<0.05),unrelated with gender. Indwelling urethral catheter and infection are unrelated(P>0.05).The age, the duration of anesthesia, intraoperative fluid volume is risk factors for postoperative urinary retention.2. Indwelling urethral catheter and infection are significantly correlated(P<0.05), indwelling catheter is an important factor in urinary infections.3. Clinically, patients should be based on the specific circumstances to determine whether is preoperative to indwelling catheter.4. The young people with duration of anesthesia less than 1.5 hour and intraoperative fluid volume less than 1500ml, indwelling catheter should not be done to get less urinary tract irritation.5. For the young people with duration of anesthesia longer than 1.5 hour and intraoperative fluid volume more than 1500ml, we propose to indwelling catheter to them, but shorter than 24 hours, because there is no difference in urinary infections between those who's indwelling catheter time less than 24 hours and those with no catheter.6. The middle-aged people with duration of anesthesia less than 1.5 hour and intraoperative fluid volume less than 1500ml, indwelling catheter should not be to get less urinary tract irritation.7. For the middle-aged people with duration of anesthesia longer than 1.5 hour and intraoperative fluid volume more than 1500ml, we propose to indwelling catheter to them, but shorter than 24 hours, because there is no difference in urinary infections between those who's indwelling catheter time less than 24 hours and those with no catheter.8. For the older people, we propose to indwelling catheter to them.9. For the older people we propose to indwelling catheter to them, but shorter than 72 hours.10. Shorten the duration of anesthesia, intraoperative fluid volume to reduce to reduce the incidence of postoperative urinary retention by shorten the duration of surgery.