基于10S持续质量改进模式下集束化护理对良性前列腺增生患者术后谵妄发生率的影响研究

Cluster nursing care based on 10S continuous quality improvement reduces incidence of postoperative delirium in BPH patients

目的:研究基于10S持续质量改进模式下集束化护理对良性前列腺增生(BPH)患者术后谵妄发生率的影响。方法:纳入我院2021年8月至2023年2月收治的96例BPH患者进行研究。所有患者均行经尿道前列腺切除术(TURP)治疗,随机分为两组各48例。其中48例患者术后进行常规护理作为对照组;另48例患者术后进行基于10S持续质量改进模式下的集束化护理作为观察组。比较两组患者术后2、6、12 h和24 h的谵妄评分,记录两组患者康复情况、心理情绪、生活质量及并发症发生率。结果:在术后2、6、12 h以及24 h时,观察组谵妄评分[(10.65±2.87)分、(14.19±4.64)分、(10.69±3.18)分、(9.13±2.12)分]均明显低于对照组[(12.72±3.54)分、(20.17±4.92)分、(16.82±4.24)分、(13.61±2.86)分,P<0.001]。下床时间、尿管拔除时间、膀胱冲洗持续时间以及住院时间比较,观察组更短[(2.84±0.83)d vs(3.65±1.41)d,(4.28±1.14)d vs(6.28±1.65)d,(2.25±0.71)d vs(3.41±1.08)d,(7.82±2.06)d vs(10.33±2.41)d,P<0.001]。术前两组患者焦虑自评量表(SAS)和抑郁自评量表(SDS)评分比较无差异(P>0.05);术后SAS和SDS评分观察组更低(P<0.001)。术前两组患者生活质量各评分比较均无差异(P>0.05);术后生活质量各评分观察组均更高(P<0.001)。两组并发症包括谵妄、膀胱痉挛、尿道疼痛以及继发性出血,观察组发生率低于对照组(12.50%vs 52.08%,P<0.001)。结论:基于10S持续质量改进模式下的集束化护理对BPH术后患者的康复起到促进作用,能有效改善患者的心理状态,提高生活质量,降低谵妄等并发症发生率,值得临床应用及推广。

Objective:To study the effect of cluster nursing care based on 10S continuous quality improvement(CQI)on the incidence of postoperative delirium in patients with BPH.Methods:This study included 96 BPH patients undergoing transurethral resection of the prostate(TURP)in our department from August 2021 to February 2023.We randomly divided the patients into two groups of equal number to receive routine postoperative nursing care(the control group)and postoperative cluster nursing care based on the 10S DQI mode(the observation group),respectively.We recorded and compared the delirium scores of the patients at 2,6,12 and 24 hours after operation,their status of recovery,scores on Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS)and quality of life(QOL),and incidence of complications between the two groups.Results:Compared with the controls,the patients in the observation group showed significantly lower delirium scores at 2 h(12.72±3.54 vs 10.65±2.87,P<0.05),6 h(20.17±4.92 vs 14.19±4.64,P<0.01),12 h(16.82±4.24 vs 10.69±3.18,P<0.01)and 24 h(13.61±2.86 vs 9.13±2.12,P<0.01)after operation,and shorter time to ambulation([3.65±1.41]vs[2.84±0.83]d,P<0.01)and time of postoperative catheterization([6.28±1.65]vs[4.28±1.14]d,P<0.01),bladder irrigation([3.41±1.08]vs[2.25±0.71]d,P<0.01)and hospitalization([10.33±2.41]vs[7.82±2.06]d,P<0.01).No statistically significant differences were observed between the two groups in either the SAS and SDS scores(P>0.05)or the QOL scores before operation(P>0.05),but the former two were dramatically decreased(P<0.01)while the latter one increased in the observation group postoperatively(P<0.01).Postoperative complications included delirium,bladder spasm,urethral pain,and secondary bleeding,with a significantly lower total incidence rate in the observation than in the control group(12.50%vs 52.08%,P<0.01).Conclusion:Cluster nursing care based on 10S CQI can promote the postoperative recovery of BPH patients,improve their psychological status and quality of life,and reduce the incidence of delirium and complications.