基于循证医学的预见性护理干预在肾移植患者术后尿路感染中的应用

doi:10.3760/cma.j.issn.1007-1245.2023.20.028

摘要/Abstract

摘要：

目的　探究基于循证医学的预见性护理干预对肾移植患者术后尿路感染及情绪状态的影响。方法　本研究为前瞻性对比实验研究，选取于2021年1月至2022年12月就诊郑州市第七人民医院肾移植肾脏病诊疗中心的80例肾移植患者为研究对象，根据入院时间分为对照组与观察组，各40例。对照组男24例、女16例，年龄22～64（43.67±7.25）岁，给予常规护理；观察组男23例、女17例，年龄25～67（44.39±8.15）岁，在对照组基础上给予基于循证医学的预见性护理干预。对比两组心理状态［焦虑自评量表（Self-rating Anxiety Scale SAS）、抑郁自评量表（Self-rating Depression Scale，SDS）］、生活质量［肾移植患者生活质量相关评定量表（Quality of Life Scale for Patients of Renal Transplantation，QOL-RT）］、满意度、导尿管留置时间、排尿功能、并发症发生率。统计学方法采用t检验、χ²检验。结果　观察组导尿管留置时间较对照组短，排尿功能较对照组高［（6.87±1.33）d比（8.94±1.52）d、（2.01±0.31）分比（1.54±0.32）分］，差异均有统计学意义（t=6.482、6.672，均P<0.05）。观察组并发症总发生率低于对照组［10.00%（4/40）比42.50%（17/40）］，差异有统计学意义（χ²=10.912，P<0.05）。干预后，两组SDS、SAS均较干预前降低，且观察组低于对照组［（41.26±4.18）分比（46.14±3.66）分、（37.81±5.69）分比（44.87±4.38）分］，QOL-RT均较干预前升高，且观察组高于对照组［（94.67±8.45）分比（87.64±7.34）分］，差异均有统计学意义（t=5.555、6.218、3.972，均P<0.05）。观察组满意度为100.00%（40/40），高于对照组［80.00%（32/40）］，差异有统计学意义（χ²=6.806，P<0.05）。结论　基于循证医学的预见性护理干预可降低肾移植患者术后尿路感染发生风险，改善排尿功能，调节患者心理状态，提高生活质量，从而提升护理满意度。

关键词:

肾移植, 循证医学, 预见性, 尿路感染, 生活质量

Abstract:

Objective　To explore the effect of predictive nursing intervention based on evidence-based medicine on urinary tract infection and emotional state of patients after kidney transplantation. Methods　This is a prospective comparative experimental study. According to the admission order, 80 patients taking at Center for Kidney Transplantation and Diagnosis and Treatment of Kidney Diseases, Zhengzhou Seventh People's Hospital from January 2021 to December 2022 were divided a control group and an observation group, with 40 cases in each group. There were 24 males and 16 females in the control group; they were 22-64 (43.67±7.25) years old. There were 23 males and 17 females in the observation group; they were 25-67 (44.39±8.15) years old. The control group took routine nursing; in addition, the observation group took predictive nursing intervention based on evidence-based medicine. The psychological status [Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS)], quality of life [Quality of Life Scale for Patients of Renal Transplantation (QOL-RT)], satisfaction, catheter retention times, urination function, and incidences of complications were compared between the two groups. t and χ² tests were used. Results　The catheter retention time and urination function in the observation group were better than those in the control group [(6.87±1.33)d vs. (8.94±1.52)d and (2.01±0.31) vs. (1.54±0.32)], with statistical differences (t=6.482 and 6.672; both P<0.05). The total incidence of complications in the observation group was lower than that in the control group [10.00% (4/40) vs. 42.50% (17/40)], with a statistical difference (χ²=10.912, P<0.05). After the intervention, the scores of SDS, SAS, and QOL-RT in the observation group were better than those in the control group [(41.26±4.18) vs. (46.14±3.66), (37.81±5.69) vs. (44.87±4.38), and (94.67±8.45) vs. (87.64±7.34)], with statistical differences (t=5.555, 6.218, and 3.972; all P<0.05). The satisfaction of the observation group was higher than that of the control group [100.00% (40/40) vs. 80.00% (32/40)], with a statistical difference (χ²=6.806, P<0.05). Conclusion　Predictive nursing intervention based on evidence-based medicine can reduce the risk of urinary tract infection in patients after kidney transplantation, improve their urination function, quality of life, and nursing satisfaction, and regulate their psychological state.

Key words:

Kidney transplantation, Evidence-based medicine, Foreseeability, Urinary tract infection, Quality of life

杨智慧索敬钧周船船.

基于循证医学的预见性护理干预在肾移植患者术后尿路感染中的应用 [J]. 国际医药卫生导报, 2023, 29(20): 2956-2960.

Yang Zhihui, Suo Jingjun, Zhou Chuanchuan.

Application of predictive nursing intervention based on evidence-based medicine in patients with urinary tract infection after kidney transplantation [J]. International Medicine and Health Guidance News, 2023, 29(20): 2956-2960.

参考文献

[1] 何元媛,杨勇,熊伟,等. 免疫功能低下肾移植受者的免疫抑制治疗策略[J]. 医药导报,2022,41(4):462-468. DOI:10.3870/j.issn.1004-0781.2022.04.007.
[2] 贺雪梅,储爱琴,王玉,等. 肾移植受者术后感染的回顾性研究[J]. 中国临床保健杂志,2021,24(1):121-124. DOI:10.3969/J.issn.1672-6790.2021.01.031.
[3] 叶倩倩,伍列林,朱笔嵩,等. 脑死亡器官捐献肾移植术后发生尿路感染的危险因素及其对移植肾功能的影响[J]. 中南大学学报(医学版),2021,46(11):1220-1226. DOI:10.11817/j.issn.1672-7347.2021.200666.
[4] 王景芳,郭晓静,冀金亮. 预见性护理干预在淋巴瘤病人化疗后口腔感染预防中的应用[J]. 护理研究,2022,36(4):727-730. DOI:10.12102/j.issn.1009-6493.2022.04.032.
[5] 刘玉皎,王秋丽,朱冬梅. 基于循证医学的生活方式赋权综合管理在学龄前期1型糖尿病患儿长期携带胰岛素泵治疗中的应用[J]. 国际医药卫生导报,2022,28(22):3202-3207. DOI:10.3760/cma.j.issn.1007-1245. 2022.22.021.
[6] 中国医师协会器官移植医师分会,中华医学会器官移植学分会肝移植学组. 中国肝移植受者肾损伤管理专家共识(2017版)[J]. 中华消化外科杂志,2017,16(4):319-326. DOI:10.3760/cma.j.issn.1673-9752.2017.04.001.
[7] Daoud AMO, Khalaf M, Nassar M. Limitations of the karnofsky performance status scale in kidney transplant recipients[J]. Ann Med, 2022 ,54(1):1328-1329. DOI: 10.1080/07853890.2022.2068806.
[8] 陈娟,朱兰. 尿道中段悬吊带术后排尿功能障碍的处理国际妇科泌尿协会专业委员会意见解读[J]. 中华妇产科杂志,2019,54(3):214-216. DOI:10.3760/cma.j.issn.0529-567x. 2019.03.017.
[9] 尿路感染诊断与治疗中国专家共识编写组.尿路感染诊断与治疗中国专家共识(2015版)——复杂性尿路感染[J].中华泌尿外科杂志,2015,36(4):241-244.DOI:10.3760/cma.j.issn.1000-6702.2015.04.001.
[10] 孙毅,莫玲,费晨,等. 云南省金平地区产后抑郁/焦虑的影响因素[J]. 中华围产医学杂志,2022,25(4):248-255. DOI:10.3760/cma.j.cn113903-20211018-00872.
[11] 金正格,刘景,李书琴,等. 安徽省医学专科生体力活动与抑郁症状的关联[J]. 现代预防医学,2021,48(17):3187-3190,3264.
[12] 雷俊,晏晓颖,何国平. 医学应对方式、社会支持对肾移植患者生活质量影响的路径分析[J]. 中国现代医学杂志,2009,19(24):3780-3783. DOI:10.3969/j.issn.1005- 8982.2009.24.025.
[13] 毛芸,姜武佳. 精细化护理对妇科手术患者护理满意度及质量的影响[J]. 河北医药,2021,43(23):3669-3671. DOI:10.3969/j.issn.1002-7386.2021.23.037.
[14] 操晓红,代贝贝,姚伟,等. 肾移植病房护理质量评价指标体系的构建[J]. 护士进修杂志,2022,37(18):1677-1681. DOI:10.16821/j.cnki.hsjx.2022.18.010.
[15] Goldfarb DA. Renal transplantation[J]. J Urol, 2021 ,206(3):760-761. DOI: 10.1097/JU.0000000000001917.
[16] 黄欢,李庆. 循证护理干预对宫颈癌术后患者下肢深静脉血栓形成及并发症的影响[J]. 血栓与止血学,2022,28(3):532-533. DOI:10.3969/j.issn.1009-6213.2022.03.079.
[17] Jureidini J, McHenry LB. The illusion of evidence based medicine[J]. BMJ, 2022,376:o702. DOI: 10.1136/bmj.o702.
[18] 江萌,吴晓英,李莎莎,等. 重症监护室患者尿路感染危险因素的Meta分析[J]. 中国消毒学杂志,2022,39(4):298-302. DOI:10.11726/j.issn.1001-7658.2022.04.017.
[19] 胡月,郑娅婷,汪俊萍,等. TLR5基因多态性与泌尿外科术后留置导尿管相关尿路感染的关联[J]. 中华医院感染学杂志,2021,31(21):3307-3311. DOI:10.11816/cn.ni.2021- 210054.
[20] 杜雪萍,陈婵玲,陈燕珣,等. 降低老年住院患者留置尿管相关尿路感染发生率的集束化护理实践[J]. 护理学报,2021,28(18):12-16. DOI:10.16460/j.issn1008-9969. 2021.18.012.
[21] 禹小溪,杨瑞洁,乔金金. 渐进性盆底肌训练联合膀胱功能训练对老年前列腺癌根治术后患者控尿功能的影响[J]. 中国药物与临床,2021,21(22):3692-3694. DOI:10.11655/zgywylc2021.22.013.
[22] 李从红,施忠英. 精神疾病病人照顾者心理健康状况及其影响因素[J]. 护理研究,2021,35(15):2757-2760. DOI:10.12102/j.issn.1009-6493.2021.15.027.
[23] 劳玉妹,符秀梅,符晶,等. 重症肝炎、肝衰竭患者疾病认知与心理痛苦状况的相关性[J]. 中华保健医学杂志,2021,23(1):39-42. DOI:10.3969/j.issn.1674-3245.2021.01.011.
[24] 王明奇,张耀辉,王辉,等. 健康教育对肺结核患者疾病认知水平及自我管理能力的影响分析[J]. 贵州医药,2022,46(4):669-670. DOI:10.3969/j.issn.1000-744X.2022.04.093.
[25] 王红,范伟,李艺,等. 心理护理结合循证护理对肝癌患者疼痛、疲乏及负面情绪的影响[J]. 现代中西医结合杂志,2022,31(9):1284-1287. DOI:10.3969/j.issn.1008-8849. 2022.09.024.