开展品管圈活动降低居家自我间歇导尿患者尿路感染率

目的探讨品管圈活动对降低居家自我间歇导尿患者尿路感染发生率的作用。方法按住院时间将脊髓损伤出院行自我间歇导尿患者分为对照组(54例)和观察组(62例),对照组按常规对间歇导尿患者进行健康教育,观察组采用品管圈活动模式管理居家自我间歇导尿患者,即设立品管圈活动小组,进行现状调查分析尿路感染原因,设立目标,制定相应对策并实施。结果出院后3个月内对照组发生尿路感染14例(25.93%),观察组发生尿路感染5例(8.06%),两组比较,差异有统计学意义(P<0.01)。结论品管圈活动的开展可降低居家自我间歇导尿患者尿路感染的发生率,提高其生活质量。     

基于老年综合评估的延续护理方案在老年痴呆患者中的应用

目的评价老年综合评估在老年痴呆患者延续护理中的应用效果。方法将84例老年痴呆患者按照入院时间分为对照组44例和观察组40例。两组患者在住院期间均接受老年科常规健康教育,对照组出院时实施出院宣教和延续护理随访方式,观察组实施基于老年综合评估的延续护理方案。比较两组患者出院后的认知状况、日常生活自理能力及生活质量评分和护理不良事件的发生情况。结果干预后观察组患者认知状况、日常生活自理能力及生活质量得分显著高于对照组(均P0.01),护理不良事件的发生例次明显少于对照组。结论基于老年综合评估构建的痴呆患者延续护理方案,可提供居家康复训练指导,提高患者或照顾者的自我护理技能和对出院指导的依从性,从而改善患者的生活质量,减少不良事件的发生。     

间歇导尿在宫颈癌根治术后患者膀胱功能康复的应用

目的探讨居家清洁间歇导尿术对宫颈癌根治术后膀胱功能快速康复的作用。方法将132例宫颈癌根治术后患者随机分为对照组和观察组各66例,对照组留置尿管,指导膀胱功能训练,观察组在此基础上采用居家清洁间歇导尿。结果两组干预后比较,观察组尿路感染发生率、总导尿天数、生活质量得分显著优于对照组(P0.05,P0.01),两组肾积水发生率比较,差异无统计学意义(P0.05)。结论居家清洁间歇导尿能促进宫颈癌根治术后膀胱功能的快速康复,预防并发症,提高患者的生活质量。     

护士主导的留置导尿管拔除模式构建与实施

目的探索护士主导留置导尿管拔除的可行性。方法采用历史对照研究,对照组375例留置导尿患者按常规拔除留置导尿管,干预组293例留置导尿患者实施护士主导的导尿管拔除:根据指南制定留置导尿适应证,建立拔除导尿管后留置导尿的替代方案;通过每日评估导管,膀胱扫描仪测定残余尿量,选择替代方案管理尿失禁和尿潴留。结果干预组不合理使用导尿管率、尿管留置时间及导管相关性尿路感染率显著低于对照组(均P0.01)。结论护士主导的留置导尿拔除模式的实施,能识别导管相关性尿路感染预防的关键因素,有效缩短置管时间,降低导管相关性尿路感染的发生。     

腰-硬联合麻醉下不留置导尿行单侧全膝关节置换术

目的研究男性患者在腰-硬联合麻醉下不留置导尿行单侧全膝关节置换术(TKA)的可行性。方法根据纳入及排除标准,将2015年1月至2017年1月在我院行初次单侧TKA术的96例男性患者按入院时间排序,随机分为观察组(术前不留置导尿)和对照组(术前留置导尿),各48例。患者入院后均采用国际前列腺症状评分表(IPSS)评估前列腺增生情况。手术均在腰-硬联合麻醉下进行。对照组患者于术后24 h内拔除导尿管并观察和记录尿潴留及尿路感染症状;观察组患者术后监测尿潴留情况,如果出现尿潴留,保守治疗无效后给予留置导尿。结果观察组有8例发生尿潴留,其中6例放置导尿管,均于24 h内拔除,未再出现尿潴留,此6例患者中1例出现尿路感染。对照组3例在拔除导尿管后发生尿潴留,给予再次留置导尿并均于12 h内拔除导尿管,对照组出现2例尿路感染。两组患者术后尿潴留及尿路感染发生均无统计学差异(P0.05)。结论男性患者采用腰-硬联合麻醉行单侧TKA手术可以不留置导尿,而对术后尿潴留可以采用一次性导尿或留置导尿处理。但对于老年男性患者,术前应认真评估前列腺增生情况。     

改性几丁质喷雾剂预防留置尿管所致尿路感染

目的探讨改性几丁质喷雾剂预防留置尿管所致尿路感染的效果。方法将128例留置气囊导尿管患者随机分为观察组（78例）和对照组（50例）。观察组采用改性几丁质喷雾剂于尿道口及周围皮肤5cm范围、导尿管近端5cm处进行喷洒,每日2次;对照组常规采用1∶2000氯己定溶液擦洗尿道外口及会阴部,每日2次。结果留置导尿期间观察组尿路感染发生率显著低于对照组,尿路感染发生时间较对照组显著推迟（均P〈0.05）。结论留置气囊导尿管患者使用改性几丁质喷雾剂,可降低尿路感染发生率,且操作简单,使用方便。     

全麻气管插管患者术后咽喉痛分层预防管理方案的构建及应用

目的 构建全麻气管插管患者术后咽喉痛预防管理方案,评价应用效果。方法 将266例全麻气管插管手术患者按时间段分为对照组142例、干预组126例。对照组行常规护理,干预组采用基于循证方法构建的术后咽喉痛分层预防管理方案。结果 干预组术后咽喉痛发生率及咽喉痛程度显著低于对照组,舒适度评分显著优于对照组,相关不良事件发生率显著低于对照组,脊柱科、妇科、泌尿外科、胸外科手术患者进食时间显著早于对照组（均P＜0.05）。结论 基于循证方法构建的术后咽喉痛分层预防管理方案用于全麻气管插管患者,可降低术后咽喉痛发生率和减轻疼痛程度,提高患者舒适度,降低相关不良事件发生率。     

不同润滑方法对男性留置导尿患者尿路感染的影响

目的:探讨一种有效预防男性留置导尿患者引起尿路感染的护理方法.方法:选择160例需留置导尿的男性患者,随机分为实验组和对照组各80例,对照组用0.5％碘伏消毒外阴、尿道口后用无菌石蜡油润滑导尿管进行导尿;实验组用0.5％碘伏消毒外阴、尿道口后用金霉素眼膏润滑尿管进行导尿,观察两组患者尿路感染发生率.结果:实验组尿路感染发生率明显低于对照组,经统计学处理,差异具有显著性(P＜0.05).结论:用金霉素眼膏润滑导尿管进行导尿,可有效预防留置导尿引起的尿路感染.     

不同引流袋预防结直肠癌术后患者尿路感染效果比较

目的比较普通引流袋、康维抗反流引流袋和防逆流引流袋预防结直肠癌患者术后尿路感染的效果。方法将147例结直肠癌患者随机分为A组49例、B组50例、C组48例,均使用相同的一次性导尿包进行留置导尿,留置尿管期间进行常规留置导尿护理。A组使用普通引流袋,每周更换2次;B组使用康维抗反流引流袋,每周更换1次;C组使用防逆流引流袋,每周更换1次。结果术后第1、3、5天三组尿路感染发生率比较,差异无统计学意义(均P>0.05),术后第7天A组尿路感染发生率显著高于B组和C组(均P<0.0125)。结论康维抗反流引流袋和防逆流引流袋有利于减少留置尿管1周及以上的结直肠癌术后患者尿路感染。     

风险预警护理预防留置导尿患者导尿管相关尿路感染

目的探讨风险预警护理对导尿管相关尿路感染(CAUTI)的预防效果。方法将124例留置导尿患者按时间段分为对照组和干预组各62例,对照组行留置导尿常规护理,干预组筛选出6个风险因素并建立风险评估表对患者进行CAUTI,对不同风险等级患者实施针对性护理。结果干预组CAUTI发生率、导尿管留置时间、住院时间显著低于/短于对照组,出院时护理满意度显著优于对照组(均P0.05)。结论风险预警护理可降低留置导尿患者CAUTI发生率,缩短导尿管留置时间和住院时间,提高患者的护理满意度。     

URINARY BACTERIOLOGY OF CONTINENT URINARY RESERVOIRS AND CALCULUS FORMATION

In order to investigate urinary bacteriology in relation to calculus formation in continent urinary reservoirs, a retrospective study was conducted of 19 patients with the Kock pouch and 23 patients with the Indiana pouch. Analysis of a total of 151 urine-cultures showed that asymptomatic bacteria (any bacterial count) were present in 92% of urines from the Kock pouch and 74% from the Indiana pouch. The incidence of organisms and total bacterial counts were similar for both pouches. The most prevalent organisms were Escherichia coli, Pseudomonas sp., Klebsiella sp., Proteus sp., Enterobacter sp., and Enterococcus sp. Urinary calculi developed in 42% of the Kock pouch patients and 13% of the Indiana pouch patients. More than half of the patients had multiple stone recurrence. Infectious stones developed in 32% of the Kock pouch patients, usually on the foreign materials, and 9% of the Indiana pouch patients. In general, no clear relationship was established between urinary bacteriology and calculus formation although Proteus sp. or Providencia sp. was determined to be the causative organism in some infectious stones. Furthermore, metabolic stones developed in 32% of the Kock pouch patients and 9% of the Indiana pouch patients. Because calcium phosphate was a constituent of 80% of the metabolic stones, the presence of urinary factors promoting calculus formation was suspected.     

Experience with coapted gastric tube outlet and composite gastrointestinal reservoir for continent cutaneous urinary diversion

PURPOSE: Established techniques for urinary diversion are not ideal for certain patients such as those with extensive pelvic irradiation, metabolic acidosis, short bowel syndrome or renal insufficiency. In a multi-institutional study a gastrointestinal reservoir was previously found to provide metabolic balance in such patients. We used a coapted gastric tube as the continent outlet in patients undergoing gastrointestinal urinary diversion. We evaluate the long-term functional results of the gastric tube to provide continence and report our long-term followup results. MATERIALS AND METHODS: A composite reservoir was constructed from gastric and transverse colon or ileal segments. In addition, a gastric strip, in continuity with the gastric segment of the composite reservoir, was tubularized and coapted to provide the continence mechanism. RESULTS: A total of 19 patients with a gastrointestinal reservoir and coapted gastric tube outlet were followed for 24 to 101 months, of whom 18 are continent day and night on intermittent catheterization every 3 to 8 hours. Four of 34 ureters (12.5%) became obstructed. One patient had significant preoperative renal insufficiency, which progressed to end stage renal disease. Another patient had slow progression of renal insufficiency. In the remaining 17 patients mean serum creatinine did not change significantly while serum chloride and bicarbonate improved or remained normal. CONCLUSIONS: A coapted gastric tube functions well as the continence mechanism in patients with a gastrointestinal urinary reservoir. We also confirm the metabolic advantages of a composite gastrointestinal urinary reservoir. Gastrointestinal cutaneous urinary diversion can be an alternative to incontinent diversion in select patients who are not suitable for other forms of diversion.     

Urinary bladder reformation: Regeneration or dilatation?

In an earlier study, urinary bladder regeneration was investigated. For that purpose, 15 dogs were subjected to total or subtotal cystectomy, and a silicone rubber prosthesis was nestled in the trigone and covered with polyglycolic acid mesh. After 3–5 months, a newly formed urinary reservoir was found in six dogs. Since transitional cell epithelium and smooth muscle were identified in the wall of the reservoir, it was concluded that bladder regeneration had probably occurred. However, the possibility of distention of the trigone to form the new cavity could not be ruled out. Therefore, six additional dogs were subjected to subtotal cystectomy, ileal loop, and temporary artificial bladder implantation. The edges of the bladder resection were marked with nonabsorbable sutures. In three fully evaluable dogs a urinary cavity was identified. This was mainly formed by trigonal distention. While the epithelium had regrown over a small area of fibrous tissue found at the dome of the reservoir, no smooth muscle regeneration was found. It is concluded that the new reservoir was formed by trigonal dilatation rather than by regeneration.     

Prosthetic urinary bladder implantation to facilitate bladder regeneration

A temporary artificial bladder was implanted in 15 female dogs undergoing total or subtotal cystectomy. One or two months after implantation, the prosthesis was removed. In three dogs sacrificed 6 months after prosthesis implantation, a new urinary reservoir was identified. Two dogs failed to develop a urinary reservoir, and both ureters anastomosed directly to the top of a dilated urethra. Seven dogs died from complications (infection, urine leakage, etc). Three additional dogs are alive and well 2.5 months after implantation, and in these animals a new urinary reservoir has been demonstrated by cystography. Histologic examination of the new urinary reservoir revealed a thin lining of transitional cell-like epithelium and an underlying attenuated muscle layer. The ability of the canine species to generate a functioning urinary reservoir after total or subtotal cystectomy may hold promise for eventual clinical application in humans.     

输尿管镜在早期泌尿系结核诊治中的应用

目的:探讨输尿管镜在早期泌尿系结核诊断和治疗的应用价值。方法:回顾性分析21例应用输尿管镜诊断和治疗早期泌尿系结核患者的临床资料。21例输尿管镜表现分别为输尿管狭窄14例、输尿管开口炎性水肿4例、输尿管下段息肉3例。18例通过输尿管镜收集肾盂尿作结核杆菌聚合酶链反应(MTb-PCR)、沉渣找抗酸杆菌(AFB)检查和结核杆菌培养诊断为泌尿系结核,其中16例(88.9%)尿MTb-PCR呈阳性,11例(61.1%)尿沉渣找AFB阳性,7例(38.9%)结核杆菌培养阳性。3例输尿管下段息肉,用输尿管镜摘除息肉作病理检查,2例病理诊断为输尿管结核,1例误诊为输尿管炎性息肉。11例输尿管下段狭窄予行输尿管镜狭窄内切开术,其余10例予行输尿管镜扩张置管术。除误诊为输尿管炎性息肉的1例患者外,20例术后均予抗结核治疗至少6个月。结果:21例平均随访18个月,12例(57.1%)一次手术治愈;8例出现狭窄复发,5例需再次行输尿管镜狭窄内切开术治愈,3例因狭窄多次复发致无功能肾行患肾切除术;误诊为输尿管炎性息肉1例,术后12个月复查发现患侧结核性脓肾及膀胱挛缩,予行患肾切除+乙状结肠膀胱扩大术。结论:早期泌尿系结核可表现为输尿管狭窄、输尿管开口炎性水肿或输尿管下段息肉。输尿管镜技术有助于早期诊断和治疗泌尿系结核。