Abstract: Background　Beside ultrasound has been widely used in clinical diagnosis and treatment of emergency patients.However，available studies are limited to comparing complications induced by catheterization in the emergency department using different methods，and lack of follow-ups of the complications as well as objective laboratory support.Objective　To explore the value of emergency bedside ultrasound in successful insertion of indwelling urinary catheter.Methods　A total of 172 critically ill patients requiring indwelling catheterization were enrolled from Department of Emergency，Xuanwu Hospital，Capital Medical University in 2018.They were randomly divided into the experimental group（n=89） and control group（n=83） by random envelope method，receiving nurse-delivered bedside ultrasound-guided catheterization using the appropriate catheter，and nurse-delivered subjective experience-based catheterization，respectively.Intergroup differences in sex，age，catheterization-related complications，blood pressure，one-time success rate of catheterization and urine volume after catheterization，and results of routine urinalysis，NT-pro BNP，GOT，GPT and creatinine measured at 24 hours and 7 days after catheterization were compared.Spearman correlation analysis was used to explore the correlation of catheterization with urinary tract infections at 7 days after catheterization，and multivariate Logistic regression analysis was used to determine the influencing factors of catheterization with urinary tract infections at 7 days after catheterization.Results　The experimental group showed higher one-time success rate of catheterization，number of red blood cells and urinary protein level examined by urinalysis，lower related indexes of urine microscopic examination and routine urin at 24 hours after catheterization，as well as lower rate of urinary tract infection on the 7th day after catheterization compared with the control group（P<0.05）.The results of correlation analysis demonstrated that the incidence of urinary tract infection within 7 days after catheterization was negatively related to age（rs=-0.166，P=0.029），NT-Pro BNP（rs=-0.204，P=0.040），GOT（rs=-0.224，P=0.004），creatinine（rs=-0.404，P<0.001），urinary bleeding rate at 24 hours after catheterization（rs=-0.195，P=0.010），and ultrasound-guided insertion of indwelling catheter（rs=-0.318，P<0.001），and positively correlated with hypertension（rs=0.164，P=0.031）.Multivariate logistic regression analysis showed that hypertension 〔OR=6.768，95%CI（1.620，28.277）〕，creatinine 〔OR=0.985，95%CI（0.975，0.995）〕，and ultrasound-guided insertion of indwelling catheter 〔OR=0.160，95%CI（0.041，0.615）〕 were the influencing factors of urinary tract infection at 7 days after catheterization.Conclusion　The one-time success rate of catheterization was improved by ultrasound-guided insertion of indwelling catheter，and the risks of urinary complications such as the rate of bleeding and infections were decreased.

Key words: Urinary catheterization, Bedside ultrasound, Critical illness, Indwelling catheter, Urinary bleeding

摘要： 背景　床旁超声已广泛应用于急诊患者的临床诊疗过程中，但目前的研究仅限于对急性期不同导尿方式并发症的比较，缺乏对于导尿后并发症的追踪及客观的检查结果的支持。目的　探讨应用急诊床旁超声协助留置尿管的临床应用价值。方法　选取2018年就诊于首都医科大学宣武医院急诊科的172例要求留置尿管的急危重症患者作为研究对象，采用随机信封法分为试验组（89例）和对照组（83例），试验组经过床旁超声评估后选择合适导尿管进行导尿，对照组由护士根据经验进行导尿。记录患者的性别、年龄及临床并发症，测量其血压，记录一次性留置尿管成功率及留置尿管后尿量、导尿后24 h和7 d的尿常规及尿镜检情况，检测其N末端B型脑钠肽前体（NT-pro BNP）、天冬氨酸氨基转移酶、丙氨酸氨基转移酶、肌酐水平，并比较两组间有无差异。采用Spearman秩相关分析导尿后7 d泌尿系感染的相关性，采用多因素Logistic回归分析，探讨导尿后7 d泌尿系感染的影响因素。结果　试验组患者一次性留置尿管成功率高于对照组，导尿后24 h尿常规及尿镜检相关指标、导尿后24 h泌尿系出血发生率、导尿后7 d患者泌尿系感染发生率低于对照组（P<0.05）。相关性分析结果显示，导尿后7 d泌尿系感染的发生率与年龄（rs=-0.166，P=0.029）、NT-pro BNP（rs=-0.204，P=0.040）、天冬氨酸氨基转移酶（rs=-0.224，P=0.004）、肌酐（rs=-0.404，P<0.001）、导尿后24 h泌尿道出血（rs=-0.195，P=0.010）、超声引导下留置尿管（rs=-0.318，P<0.001）呈负相关，与合并高血压（rs=0.164，P=0.031）呈正相关。多因素Logistic回归分析发现，合并高血压〔OR=6.768，95%CI（1.620，28.277）〕、肌酐水平〔OR=0.985，95%CI（0.975，0.995）〕、超声引导下留置尿管〔OR=0.160，95%CI（0.041，0.615）〕是患者导尿后7 d泌尿系感染的影响因素（P<0.05）。结论　超声引导下留置尿管有助于提高一次性留置尿管的成功率，降低泌尿系感染及泌尿系出血并发症的发生率。

关键词: 导尿管插入术, 床旁超声, 急危重症, 留置尿管, 尿道出血