肾结石微创术后复发风险模型构建及护理干预研究

目的通过构建肾结石微创术后复发风险模型，分析阜阳市第二人民医院收治肾结石病人与健康行为有关的复发影响因素，为临床护理干预提供循证策略。方法回顾性收集行肾结石微创手术的148例病人首次发病时与疾病相关的资料，微创术后复发时与疾病相关的资料，首次结石微创术后饮食运动情况以及健康行为能力自评量表进行健康行为能力评估。通过单因素分析和多因素logistic回归分析构建结石复发模型。结果复发组高血压和糖尿病病人人数高于非复发组，复发组体质量指数（BMI） > 30.0 kg/m2人数比例高于非复发组，差异均有统计学意义（P < 0.05~P < 0.01）；2组病人在每日饮水量、经常饮用水性质、经常服用鱼油、经常吃腌制食物、摄入蛋白质来源方面比较，差异均有统计学意义（P < 0.05~P < 0.01）；非复发组在健康行为能力总分、营养维度、心理安适维度、健康责任维度得分均显著高于复发组（P < 0.05）；构建模型复发方程LogitP=6.122-0.633X_1（1）-2.512X_1（2）+1.351X₂-4.124X₃-1.888X₄-2.111X₅-0.996X₆，结果显示饮水量1.5~3 L/d、健康行为能力、经常服用鱼油、摄入蛋白以植物蛋白为主是结石复发的保护因素，饮水量 < 0.5 L/d、BMI > 30.0 kg/m2、经常吃腌制食物是结石复发的危险因素。由方程系数得知其比重由大到小分别为健康行为能力、每天饮水量、吃腌制食物、BMI、蛋白质来源。结论预防肾结石术后复发，护理干预应着重提高病人健康行为能力，形成健康的生活方式。

Study on the construction of recurrence risk model and nursing intervention of kidney stone after minimally invasive surgery

ObjectiveTo establish the recurrence risk model after minimally invasive surgery for kidney stones to analyze the influencing factors of recurrence related to health behavior in patients with kidney stones from Fuyang Second People's Hospital for providing the evidence-based strategies in clinical nursing intervention.MethodsThe data of disease at first onset and recurrence after minimally invasive surgery related to disease in 148 kidney stones patients treated with minimally invasive surgery were retrospectively analyzed.The health behavior ability of pateints after the first minimally invasive surgery for calculi were assessed using the health behavior ability self-rating scale.The calculus recurrence model was established by univariate analysis and multivariate logistic regression analysis.ResultsThe number of hypertensive and diabetic patients in recurrent group were higher than that in non-recurrent group, and the proportion of patients with body mass index(BMI) > 30.0 kg/m2 in recurrence group was higher than that in non-recurrence group(P < 0.05 to P < 0.01).The differences of the daily intake of water, nature of regular drinking water, frequent use of fish oil, frequent consumption of preserved foods and intake of protein sources between two groups were statistically significant(P < 0.05 to P < 0.01).The total score of healthy behavior ability, and scores of nutritional dimension, psychological comfort dimension and health responsibility dimension in non-recurrent group were higher than those in recurrent group(P < 0.05).The model recurrence equation was LogitP=6.122-0.633X₁₍₁₎-2.512X₁₍₂₎+1.351X₂-4.124X₃-1.888X₄-2.111X₅-0.996X₆.The results showed that the 1.5-3 L/d water intake, healthy behavior ability, frequent use of fish oil, intake mainly plant protein were the protective factors of stone recurrence, and the water intake less than 0.5 L/d, BMI > 30.0 kg/m2 and frequent consumption of preserved food were the risk factors of stone recurrence.According to the coefficient of the equation, the proportion from large to small were healthy behavior ability, daily water intake, pickled food, BMI and protein source in turn.ConclusionsTo prevent recurrence of kidney stones after operation, the nursing intervention should focus on improving patients' healthy behavior ability and forming healthy lifestyle.