前列腺癌根治术患者尿失禁随访清单的编制及应用

Development and application of a follow-up checklist for prevention of incontinence following radical prostatectomy

目的构建前列腺癌根治术患者尿失禁随访清单,并评价临床应用效果。方法将94例前列腺癌根治术后患者按入院时间段分为对照组46例和试验组48例。对照组给予常规随访,试验组按随访清单实施随访。随访清单以证据总结为基础,通过半结构式访谈明确患者随访需求,结合2轮德尔菲法专家函询形成,包括尿失禁症状的监测与评估、尿失禁管理与健康教育、信息支持、自我管理评估4项一级指标、10项二级指标、46项三级指标。比较两组患者拔除尿管1个月、3个月尿失禁发生率、严重程度、生活质量及应对效能。结果拔除尿管后1个月试验组应对效能得分显著高于对照组(P<0.05)。拔除尿管后3个月,试验组尿失禁发生率、严重程度显著低于对照组,生活质量和应对效能评分显著高于对照组(均P<0.05)。结论前列腺癌根治术后尿失禁随访清单可以规范随访内容,降低尿失禁的发生,改善患者尿失禁相关症状,提升尿失禁患者的生活质量及应对效能。

Objective To develop a checklist to standardize follow-up care for prevention of post-radical prostatectomy incontinence and to evaluate the effect of clinical application.Methods A total of 94 patients after radical prostatectomy for prostate cancer were divided into a control group of 46 and an intervention group of 48 chronologically.The control group was given routine follow-up,while their counterparts in the intervention group were followed-up by using a checklist.The checklist was developed based on evidence summary,semi-structured interviews with the patients to identify their follow-up needs,and expert consultation using Delphi methods to reach a consensus.The final checklist included 4 primary indicators of monitoring and assessment of incontinence,management and health education,information support,and self-management,10 secondary indicators and 46 tertiary indicators.The incidence and severity of incontinence,quality of life and coping efficacy at 1 and 3 months after removal of urinary catheter were compared between the two groups.Results The coping efficacy score in the intervention group was significantly higher than that in the control group at 1 month after removal of urinary catheter(P<0.05).The incidence and severity of urinary incontinence were significantly lower,whereas the scores of quality of life and coping efficacy were significantly higher in the intervention group compared with the control group at 3 months after removal of urinary catheter(all P<0.05).Conclusion The follow-up checklist facilitates a standardized approach for health care providers to prevent urinary incontinence after radical prostatectomy,thus to reduce the incidence of urinary incontinence,attenuate symptoms,and improve quality of life and coping efficacy of patients who have developed urinary incontinence.