集束护理联合康复训练在预防宫颈癌患者术后尿潴留中的应用

Effect of cluster care combined rehabilitation training in preventing postoperative urinary retention in cervical cancer patients

目的观察集束护理联合康复训练预防宫颈癌患者术后尿潴留的应用效果。方法选取2019年8月至2021年8月期间厦门大学附属第一医院妇科收治的宫颈癌患者159例,按照随机数字表法分为观察组79例和对照组80例。两组患者均由同一医师团队于全麻下行腹腔镜下广泛性子宫切除术+盆腔淋巴结清扫术。对照组给予常规护理联合康复训练。观察组给予集束护理联合康复训练。比较两组患者围术期指标(下床活动时间、首次自行排尿时间以及留置尿管时间、住院时间、首次进食时间)、一次性拔除导尿管成功率、尿潴留发生率、尿动力学指标(膀胱顺应性、膀胱逼尿肌收缩压及尿道闭合压)、盆底肌功能及生活质量评分。结果观察组患者下床活动时间、首次自行排尿时间以及留置尿管时间、住院时间、首次进食时间均明显短于对照组,差异有统计学意义(P<0.05)。观察组一次性拔除尿管成功率高于对照组,术后尿潴留发生率低于对照组(P<0.05)。治疗前,两组患者尿道闭合压、膀胱逼尿肌收缩压、膀胱顺应性、盆底障碍影响简易问卷-7(PFIQ-7)评分、盆底肌功能障碍调查表-20(PFDI-20)评分及生活质量评分比较差异无统计学意义(P>0.05)。治疗后2 w,观察组患者尿道闭合压、膀胱逼尿肌收缩压及膀胱顺应性均高于对照组,术后1个月、术后6个月、术后1年观察组PFIQ-7评分及PFDI-20评分均低于对照组(均P<0.05)。经过治疗,观察组患者生活质量评分中生理、环境、心理评分均高于对照组,差异有统计学意义(均P<0.05)。结论集束护理联合康复训练可以有效预防宫颈癌患者术后尿潴留,改善患者生活质量。

Objective To observe the effect of cluster nursing combined with rehabilitation training on preventing postoperative urinary retention in patients with cervical cancer.Methods A total of 159 patients with cervical cancer admitted to the hospital from August 2019 to August 2021 were selected.There were 79 patients in the observation group and 80 patients in the control group according to random number table method.Both groups underwent extensive laparoscopic hysterectomy and pelvic lymph node dissection under general anesthesia by the same physician team.The control group was given routine nursing combined with rehabilitation training.The observation group was given cluster nursing combined with rehabilitation training.Perioperative indexes(time of getting out of bed,time of first spontaneous urination,time of catheter indwelling,time of hospital stay,time of first feeding),success rate of one-time catheter removal,incidence of urinary retention,urodynamic indexes(bladder compliance,bladder detrusor systolic pressure and urethral closure pressure),pelvic floor muscle function and quality of life scores of the two groups were compared.Results The time of getting out of bed,the time of first spontaneous urination,the time of catheter indentation,the time of hospitalization and the time of first feeding in observation group were significantly shorter than those in control group,and the differences were statistically significant(P<0.05).The success rate of one-time catheter removal in observation group was higher than that in control group,and the incidence of postoperative urinary retention in observation group was lower than that in control group(P<0.05).Before treatment,there were no statistically significant differences in urethral closure pressure,detrusor systolic pressure,bladder compliance,Pelvic Floor Inventory Questonnaire-7(PFIQ-7)score,Pelvic Floor Distress Inventory-20(PFDI-20)score and quality of life score between 2 groups(P>0.05).Two weeks after treatment,urethral closure pressure,detrusor systolic pressure and bladder compliance of observation group were higher than those of control group,and PFIQ-7 score and PFDI-20 score of observation group were lower than those of control group at 1 month,6 months and 1 year after surgery(P<0.05).After treatment,the scores of physiological,environmental and psychological quality of life in observation group were higher than those in control group,and the differences were statistically significant(P<0.05).Conclusions Cluster nursing combined with rehabilitation training can effectively prevent postoperative urinary retention in patients with cervical cancer and improve their quality of life.