麻醉恢復室之留置導尿管導致膀胱不適感

麻醉恢復室是為照護全身或脊髓麻醉手術後病人，病人常因需要於術中放置導尿管，在麻醉恢復之際，會因導尿管留置導致膀胱不適感而焦躁不安，甚至可能引發病人術後自行拔除導尿管之虞，故導尿管留置導致膀胱之不適感，亦是病人安全需被重視之一環。由於國內較少有此相關資訊，藉由搜尋文獻並指出，對此高風險因子的病人，如泌尿科手術、男性或放置大於18Fr.導尿管等病人，可預防性投予藥物以減緩不適；雖然藥物可能會帶來不同程度之副作用，卻也著實可減少此症狀或發生率。此外，放置導尿管時可選用麻醉性凝膠以潤滑導尿管、泌尿科手術男性病人則可考慮採用陰部神經阻斷術以預防不適感。非藥物方面雖有討論導尿管水球打入量之多寡，然而非藥物性的成效目前尚未有大量數據之證明，護理人員應提早發現病人的不適感，主動說明原因，提供足夠訊息。盡早評估拔除導尿管，減輕不適感也能促使病人術後早期下床。本文藉由文獻整理以期提供臨床護理人員能對於此議題有更深一層的認識。

關鍵字

手術麻醉恢復室；留置導尿管；導尿管導致膀胱不適感

並列摘要

The post anesthesia care unit is for caring patients underwent general or spinal anesthesia surgery, and these patients may have the indwelling urinary catheter insertion during the operation. Catheter-related bladder discomfort frequent and occurred immediately after anesthesia is restored. During this period, the catheter indwelling causes bladder discomfort and patient can be restless; it may even initiate the patients to remove the catheter themselves after the operation. It is also an important part of the patient safety. There are few relevant information about this subject in our country, after searching through the literature for demonstration, for high risk patients such as: urology surgery, men or patients with catheters greater than 18Fr., can be given drugs to alleviate discomfort; although the drug will cause some side effects, but symptoms or incidence rate can be reduced. In addition, anesthetic gel can be applied to lubricate the catheter before inserting. Male patients undergoing urologic surgery can consider pudendal nerve block to prevent discomfort. In the non-pharmaceutical aspect, there is a discussion in regards to the amount of catheter water polo injection. However, the effectiveness of non-pharmaceuticals has not yet been proved by a large amount of data. The nursing staff should discover the patients' discomfort early, proactively explain the reason and provide sufficient information for the patient to understand. Early assessment of catheter removal will prevent discomfort can also prompt the patient to get out of bed early after surgery. This article aims to provide clinical nurses with an intensive understanding of this issue through the compilation of literature.

並列關鍵字

post anesthesia care unit ； indwelling urinary catheter ； catheter-related bladder discomfort

參考文獻

曾淑如、張淑芳、陳鳳玲、劉金屏、劉靜怡（2011）．改善鼻部手術病患麻醉恢復期躁動方案．榮總護理，28(1)，64-72。doi:10.6142/ VGHN.28.1.64

Bai, Y., Wang, X., Li, X., Pu, C., Yuan, H., Tang, Y., … Han, P. (2015) Management of catheter-related bladder discomfort in patients who underwent elective surgery. Journal of endourology, 29(6), 640-649. doi:10.1089/end.2014.0670. Epub 2014 Dec 9.

de Castro, S. M., Ü nlü, Ç ., Tuynman, J. B., Honig, A., van Wagensveld, B.A., Steller, E. P., & Vrouenraets, B. C. (2014). Incidence and risk factors of delirium in the elderly general surgical patient. American Journal of Surgery, 208(1), 26-32. doi:10.1016/j.amjsurg.2013.12.029

Fields, A., Huang, J., Schroeder, D., Sprung, J., & Weingarten, T. (2018). Agitation in adults in the post-anaesthesia care unit after general anaesthesia. The British Journal of Anaesthesia , 121(5), 1052-1058. doi:org/10.1016/j.bja.2018.07.017

Kim, J. Y., Yoo, J. H., Kim, E., Kwon, K. B., Han, B. R., Cho, Y., & Park, J. H. (2017). Risk factors and clinical outcomes of delirium in osteoporotic hip fractures. Journal of Orthopaedic Surgery, 25(3), 1-7. doi: 10.1177/2309499017739485

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麻醉恢復室之留置導尿管導致膀胱不適感

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