基于KAP理论的全方位护理对老年盆腔脏器脱垂患者盆底手术的影响

Comprehensive nursing based on KAP theory in pelvic floor surgery for elderly patients with pelvic organ prolapse

目的观察基于KAP理论的全方位护理对老年盆腔脏器脱垂(POP)患者盆底手术的影响。方法选取2019年7月至2021年7月于空军军医大学第一附属医院妇科门诊收治的92例行盆底手术的老年POP患者,随机分为对照组(常规护理)和观察组(基于KAP理论的全方位护理)各46例,比较两组的术后排气时间、术后排便时间、住院时间和手术前后的尿动力学指标,以及干预前后两组的汉密顿焦虑量表(HAMA)、自我效能感量表(GSES)、盆底功能障碍问卷(PFDI-20)、生活质量评分,随访3个月,记录两组并发症发生情况和护理满意度。结果观察组的术后排气时间、术后排便时间与住院时间均短于对照组(P<0.01),术后两组的最大尿流率、逼尿肌收缩力均有上升,尿道闭合压有所下降,其中观察组的变化幅度更大(P<0.01),干预后两组的HAMA、PFDI-20评分均有下降,GSES评分有所上升,观察组评分变化幅度更显著于对照组(P<0.01),干预后两组的生活质量评分均有下降,观察组评分低于对照组(P<0.01),观察组并发症发生率为10.87%,低于对照组的28.26%(χ^(2)=4.420,P=0.036),观察组的满意度为93.48%,高于对照组的76.09%(χ^(2)=5.392,P=0.020)。结论对行盆底手术的老年POP患者实行KAP理论的全方位护理,有助于患者尽早恢复,改善患者心理症状、盆底功能和尿动力指标,提高生活质量,并发症少,患者较为满意。

Objective To observe the influence of comprehensive nursing based on KAP(knowledge,attitude,practice)theory on pelvic floor surgery for elderly patients with pelvic organ prolapse(POP).Methods Ninety-two elderly patients with POP undergoing pelvic floor surgery in the First Affiliated Hospital of Air Force Military Medical University between July 2019 and July 2021 were enrolled and randomly divided into control group(with routine nursing,n=46)and observation group(KAP theory-based comprehensive nursing,n=46).The postoperative exhaust time,defecation time,hospitalization time and urodynamic indexes before and after surgery and the scores of Hamilton anxiety scale(HAMA),general self-efficacy scale(GSES),pelvic floor distress inventory-short form 20(PFDI-20)and quality of life before and after intervention were compared between two groups.The occurrence of complications and the nursing satisfaction were observed in two groups during 3-months follow-up.Results The postoperative exhaust time,postoperative defecation time and hospitalization time in observation group were significantly shorter than those in control group(P<0.01).After treatment,maximum urinary flow rate and detrusor muscle contractility increased,while urethral closure pressure decreased in both groups,and there were significant differences in them between two groups(P<0.01).After intervention,the scores of HAMA and PFDI-20 were decreased,while GSES scores were increased in both groups(P<0.01).The score of quality of life in both groups decreased and were lower in observation group than those in control group(P<0.01).Compared with control group,the incidence of complications(10.87%vs 28.26%,χ^(2)=4.420,P=0.036)decreased,and the nursing satisfaction rate(93.48%vs 76.09%,χ^(2)=5.392,P=0.020)increased in observation group.Conclusion In elderly POP patients undergoing pelvic floor surgery,comprehensive nursing based on KAP theory is conducive to fast recovery and improving psychological symptoms,pelvic floor function,quality of life and urodynamic indexes,with fewer complication and higher patient satisfaction.