前列腺增生及恶性肿瘤患者术后留置导尿时间的影响因素分析

Influencing factors of indwelling catheter time in the patients with prostate hyperplasia and malignant tumor after prostatic surgery

目的了解前列腺增生及恶性肿瘤患者术后留置导尿时间的影响因素.方法采用便利抽样的方法,于2015年6月—2016年6月对上海市某两家三级甲等综合性医院447例前列腺增生及恶性肿瘤患者术后进行病历统计分析,提取患者基本资料、诊断、并发症、手术方式、医嘱及护理记录等,分析前列腺增生及恶性肿瘤患者术后院内留置导尿天数、带管出院天数及其影响因素.结果300例（67.11%）患者存在术前排尿异常,258例（57.72%）患者患有并发症,病历中对于排尿功能康复训练的记录很少;前列腺增生患者,不同文化程度、医疗付费方式及并发症的术后院内留置导尿时间的差异有统计学意义（t/F值分别为5.048、-2.433、2.086;P〈0.05）,不同术前排尿情况的带管出院时间的差异有统计学意义（t=0.551,P〈0.05）;对于前列腺恶性肿瘤患者,不同居住地及不良嗜好的带管出院时间的差异有统计学意义（t值分别为2.062、-1.974;P〈0.05）.对于前列腺增生患者,文化程度、医疗付费方式、是否有并发症能够联合解释前列腺增生患者术后院内留置导尿时间变异的60.8%;对于前列腺恶性肿瘤患者,居住地、是否有不良嗜好能够联合解释前列腺恶性肿瘤患者术后带管出院时间变异的68.4%.病历统计得出,只有42.5%的患者在术前进行了尿流率、尿流动力学或残余尿量的检查.在护理记录中,只有17.4%的病历记录了与排尿功能相关的宣教;在出院宣教中,只有26.4%的病历记录了与排尿功能相关的宣教.结论临床工作对前列腺增生及恶性肿瘤患者术后排尿功能康复的关注不够,亟须构建一套以外科快速康复理念为核心,以时间为轴线的闭环式前列腺增生及恶性肿瘤患者术后排尿功能康复训练方案.

Objective To investigate the influencing factors of the indwelling catheter time in patients with prostate hyperplasia and malignant tumor after prostate surgery.Methods A total of 447 prostate surgery patients with prostate hyperplasia and malignant tumor were selected for medical record review using convenience sampling method. The demographic data,diagnose,complications,surgical method,medical advice and nursing care items were collected. The indwelling catheter time in or outward of the hospital and its influence factors were analyzed.ResultsA number of 300（44.74%） patients had urination disorders before operation.A number of 258（57.72%） patients had complications. Little information about rehabilitated exercise of urination function was recorded.There were statistically significant differences in indwelling catheter time in the hospital among benign prostatic hyperplasia patients with different education levels, health payments and complications （t/F=5.048, -2.433, 2.086;P〈0.05）. Significant differences in indwelling catheter time outward of the hospital were also observed in patents with different preoperative urination disorders （t=0.551, P〈0.05）. Prostate malignancy patients with different resident places and bad habits had statistically significant differences in indwelling catheter time outward of the hospital （t=2.062, -1.974;P〈0.05）. For patients with benign prostatic hyperplasia, education levels, health payment and complications could explain 60.8% of changes in indwelling catheter time in the hospital. For patients with prostate malignancy, resident place and bad habits could explain 68.4% of changes in indwelling catheter time outward of the hospital. According to medical records, only 42.5% patients had urinary flow rate, urodynamic and residual urine volume examinations. Only 17.4% of medical records had urinary function related admission, which were found in 26.4% of medical records when patients were discharged.ConclusionsMedical workers are lack of attentions to the rehabilitated exercise of urination function for patients with prostate hyperplasia and malignant tumor after prostate surgery. It is urgent to build a scheme of rehabilitated exercise of urination function for postoperative patients of prostate, which based on the fast-track surgery theory and used the time as axis.