[1]李雪梅,李雨威,李珍燕,等.随机对照研究早期综合护理干预在预防正位回肠膀胱术后患者尿潴留中的价值[J].第三军医大学学报,2018,40(04):362-366.
 LI Xuemei,LI Yuwei,LI Zhenyan,et al.Efficacy of early comprehensive nursing care for preventing urinary retention in patients with orthotopic ileal neobladder: a randomized controlled trial[J].J Third Mil Med Univ,2018,40(04):362-366.
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随机对照研究早期综合护理干预在预防正位回肠膀胱术后患者尿潴留中的价值(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
40卷
期数:
2018年第04期
页码:
362-366
栏目:
临床医学
出版日期:
2018-02-28

文章信息/Info

Title:
Efficacy of early comprehensive nursing care for preventing urinary retention in patients with orthotopic ileal neobladder: a randomized controlled trial
作者:
李雪梅李雨威李珍燕陈志文
陆军军医大学(第三军医大学)第一附属医院泌尿外科
Author(s):
LI Xuemei LI Yuwei LI Zhenyan CHEN Zhiwen

Department of Urology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China

关键词:
膀胱肿瘤膀胱切除术尿潴留护理干预
Keywords:
urinary bladder neoplasms cystectomy urinary retention nursing intervention
分类号:
R473.6;R619;R694.55
文献标志码:
A
摘要:

目的    采用随机对照研究,探讨早期综合护理干预在预防正位回肠膀胱术后患者尿潴留中的应用价值。方法   连续纳入2014年10月至2016年10月因膀胱癌于我科行根治性膀胱全切正位回肠膀胱术的患者60例,按随机数字表法分为实验组和对照组,各30例。对照组接受常规护理,实验组在常规护理的基础上实施早期综合护理干预(包括心理干预、行为干预和认知干预等),分别在术后3、6、12个月随访时统计患者排尿日记记录情况及尿潴留相关预防措施(包括定时排尿、蹲式排尿、Valsalva呼吸式排尿、提肛运动)的完成情况,记录患者B超下残余尿量和尿潴留的发生率,对结果进行统计分析。结果   实验组患者术后3、6、12个月总体随访项目完成率均高于对照组(87.3%、83.0%、72.8% vs 55.5%、51.2%、44.2%;P<0.01);实验组患者术后12个月排尿日记完成率,术后3个月和6个月定时排尿、Valsalva呼吸式排尿完成率,以及整个随访期间蹲式排尿和提肛运动的完成率均明显高于对照组(P<0.05);实验组患者术后3次随访时B超下测得残余尿量及尿潴留的发生率较对照组明显降低(P<0.05)。结论    早期综合护理干预可提高正位回肠膀胱术后患者院外依从性,降低残余尿量及尿潴留的发生率。

Abstract:

Objective    To assess the value of early comprehensive nursing care in preventing urinary retention in patients with orthotopic ileal neobladder. Methods    This randomized controlled trial was conducted among 60 patients with bladder cancer undergoing radical cystectomy and orthotopic ileal neobladder reconstruction in our department between October, 2014 and October, 2016. The patients were randomized into control group (n=30) and experimental group (n=30) to receive routine nursing and early comprehensive nursing interventions (including psychological, behavioral and cognitive interventions) on the basis of routine nursing, respectively. At 3, 6 and 12 months after the operation, all the patients were assessed for completion of urinary diary and fulfilment of the preventive measures against urinary retention (including regular urination, squatting urination, Valsalva respiratory urination, and contraction of the levator ani muscles), and the residual urine volume and incidence of retention were compared between the two groups. Results    At 3, 6 and 12 months after the operation, the overall completion rates of the preventive measures were 87.3%, 83.0%, and 72.8% in the experimental group, respectively, significantly higher than the rates in the control group (55.5%, 51.2%, and 44.2%, respectively; P<0.01). The completion rates of urinary diary at 12 months, regular urination and Valsalva respiratory urination at 3 and 6 months, and squatting urination and levator ani movement during the entire followup period were significantly higher in the experimental group than in the control group (P<0.05). The residual urine volume and incidence of urinary retention were significantly lower in the experimental group than in the control group in all the 3 followup examinations (P<0.05). Conclusion    Early comprehensive nursing care can improve the patient compliance and reduce the residual urine and incidence of urinary retention in patients with orthotopic ileal neobladder

参考文献/References:

[1]CHEN W, ZHENG R, BAADE P D, et al. Cancer statistics in China, 2015[J].CA Cancer J Clin, 2016, 66(2): 115-132. DOI: 10.3322/caac.21338.
[2]ONG K, HERDIMAN O, JOHNSON, L, et al.Orthotopic bladder substitution (neobladder): part I: indications, patient selection, preoperative education, and counseling[J]. J Wound Ostomy Continence Nurs, 2013, 40(1): 73-82. DOI: 10.1097/WON.0b013e31827759ea.
[3]HERDIMAN O, ONG K, JOHNSON L, et al.Orthotopic bladder substitution (Neobladder): part II: postoperative complications, management, and longterm followup[J]. J Wound Ostomy Continence Nurs, 2013, 40(2): 171-180. DOI: 10.1097/WON.0b013e31827e8499.
[4]HAUTMANN R E, DE PETRICONI R C, VOLKMER B G. Lessons learned from 1,000 neobladders: the 90day complication rate[J]. J Urol, 2010, 184(3): 990-994. DOI: 10.1016/j.juro.2010.05.037.
[5]杨海芹, 刘春文. 恶性肿瘤患者心理反应的相关因素及心理干预研究进展[J]. 护理学杂志, 2006,21(22): 79-81. DOI: 10.3969/j.issn.10014152.2006.22.041.
YANG H Q, LIU C W. Correlation factors of psychological reaction in patients with malignant tumor and psychological intervention[J]. J Nurs Sci, 2006, 21(22): 7981. DOI: 10.3969/j.issn.10014152.2006.22.041.
[6]邬小荣, 董景文. 恶性肿瘤伴焦虑、抑郁病人的心理护理研究[J]. 护理研究, 2011, 25(1): 54-55. DOI: 10.3969/j.issn.10096493.2011.01.023.
WU X R, DONG J W. Study on psychological nursing care of malignant tumor patients complicated with anxiety or depression[J]. Chin Nurs Res, 2011, 25(1): 54-55. DOI: 10.3969/j.issn.10096493.2011.01.023.
[7]王英, 邱玉贞. 心理干预对恶性肿瘤围手术期患者的影响[J]. 中华护理杂志, 2011, 46(12): 1184-1186. DOI: 10.3761/j.issn.02541769.2011.12.012.
WANG Y, QIU Y Z. Effects of psychological interventions in cancer patients during perioperative period[J]. Chin J Nurs, 2011, 46(12): 1184-1186. DOI: 10.3761/j.issn.02541769.2011.12.012.
[8]文建国, 娄安锋, 王庆伟, 等. 尿流率联和超声残余尿评估良性前列腺增生症逼尿肌收缩功能[J]. 第三军医大学学报, 2009, 31(3): 202-204. DOI: 10.3321/j.issn:10005404.2009.03.005.
WEN J G, LOU A F, WANG Q W, et al. Uroflowmetry combined with ultrasonic residual urine: good approach to evaluate detrusor function for benign prostate hyperplasia patients[J]. J Third Mil Med Univ, 2009, 31(3): 202-204. DOI: 10.3321/j.issn:10005404.2009.03.005.
[9]PAVLIN D J, PAVLIN E G, FITZGIBBON D R, et al. Management of bladder function after outpatient surgery[J]. Anesthesiology, 1999, 91(1): 42-50. DOI: 10.1097/0000054219990700000010.
[10]李晓琼, 甄艳丽, 冉梅林. 护理干预对老年膀胱癌患者手术后生活质量及依从性的影响分析[J]. 基层医学论坛, 2017, 21(9): 1058-1059. DOI: 10.19435/j.16721721.2017.09.022.
LI X Q, ZHEN Y L, RAN M L. Effect of nursing intervention on life quality and compliance of the senile patients with bladder cancer after surgery[J]. Pub Med Forum Mag, 2017, 21(9): 1058-1059. DOI: 10.19435/j.16721721.2017.09.022.
[11]REN H, TANG P, ZHAO Q, et al.Symptom clusters and related factors in bladder cancer patients three months after radical cystectomy[J]. BMC Urol, 2017, 17(1): 65. DOI: 10.1186/s128940170255x.
[12]李烨. 人性化护理干预对改善膀胱癌围术期患者治疗依从性与生活质量的价值[J]. 哈尔滨医药, 2016, 36(1): 97-98.
LI Y. Value of humanistic nursing intervention in improving treatment compliance and quality of life of patients with bladder cancer during perioperative period [J]. Harbin Med J, 2016, 36(1): 97-98.
[13]NAGELE U,ANASTASIADIS A G,STENZL A,et al.Radical cystectomy with orthotopic neobladder for invasive bladder cancer: a critical analysis of longterm oncological, functional, and quality of life results[J]. World J Urol, 2012, 30(6): 725-732. DOI: 10.1007/s0034501106494.
[14]WEI S T,LAMB B W,KELLY J D. Complications of radical cystectomy and orthotopic reconstruction[J]. Adv Urol, 2015, 2015(3): 1-7. DOI: 10.1155/2015/323157.
[15]丁萍. 重建膀胱术后患者排尿功能的训练[J]. 中华护理杂志, 2004, 39(10): 37-39.
DING P. Urination training for patients after bladder reconstruction[J]. Chin J Nurs, 2004, 39(10): 754-756.
[16]沈丽, 孙慧婷. 早期护理干预对预防宫颈癌术后尿潴留的临床效果分析[J]. 实用临床医药杂志, 2014, 18(22): 176-177. DOI: 10.7619/jcmp.201422066.
SHEN L, SUN H T. Clinical effect of early nursing intervention on prevention of urinary retention after cervical cancer[J]. J Clin Med Pract, 2014, 18(22): 176-177. DOI: 10.7619/jcmp.201422066.
[17]IZQUIERDO L, BOLTON D M, LAWRENTSCHUK N. Radical cystectomy and orthotopic bladder substitution: surgical tricks and management of complications[J]. Minerva Urol Nefrol, 2013, 65(4): 225-234.

更新日期/Last Update: 2018-03-03