结构化膀胱管理预防老年髋部骨折患者术后尿潴留的效果研究

Effect of Structured Bladder Management on Postoperative Urinary Retention of Elderly Patients with Hip Fracture

目的观察老年专科护士主导多专科协作的结构化膀胱管理,预防高龄老年髋部骨折患者术后尿潴留的效果。方法选取2014年1月1日—2019年12月31日广州某三级甲等医院骨科病房473例老年髋部骨折术后患者(其中年龄>80岁的高龄老年患者299例)为研究对象,对照组(206例)采用传统术后膀胱护理的方法,按医嘱拔除尿管,排尿困难则予重置尿管;干预组(267例)采用多专科协作团队建立结构化膀胱管理(包括风险评估、问题处理流程)预防老年髋骨骨折患者术后尿潴留。结果干预组术后尿潴留发生率显著低于对照组(P=0.002);2组患者中,高龄老年患者(>80岁)的尿潴留发生率(17.4%)显著高于低龄老年患者(65~80岁)的30.3%,差异有统计学意义(P<0.001)。结论由老年专科护士主导护理多专科协作的结构化膀胱管理,对预防高龄老年患者髋部骨折术后尿潴留的发生能发挥较好的作用。

Objective To observe the effect of multidisciplinary bladder management led by specialist nurses on the prevention of postoperative urinary retention in elderly patients with hip fractures.Methods A total of 473(299 cases aged over 80)elderly patients with hip fracture after surgery in the orthopedic ward of a tertiary grade A hospital in Guangzhou were selected as subjects from January 1,2014 to December 31,2019.The control group(206 cases)adopted the traditional postoperative bladder care method,and the catheter was removed according to the doctor,and the catheter was reset after dysuria.In the intervention group(267 cases),bladder management was optimized by a multi-specialty collaborative team,and structured bladder management(including risk assessment,problem treatment process,and clinical observation indicators)was implemented.Results The incidence of urinary retention was significantly lower in the intervention group(P=0.002)when compared with that in the control group,Among the two groups,the incidence of urinary retention in patients aged over 80(17.4%)was noticeably lower than that in those aged from 65 to 80(30.3%)(P<0.001).Conclusion The optimized bladder management led by geriatric nurses can effectively reduce the incidence of urinary retention after hip fracture.