Risk factors of urinary tract infections after radical prostatectomy for prostate cancer and PDCA nursing strategy analysis
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摘要:
目的 基于logistic回归模型研究前列腺癌根治术(RP)术后并发尿路感染的危险因素及计划-执行-检查-处理(PDCA)循环管理模式的护理策略，为RP患者术后护理提供参考。 方法 选取2019年4月—2023年1月于海南医学院第一附属医院行RP手术治疗的284例前列腺癌患者为研究对象，采用随机数字表法将其分为对照组和观察组，各142例。术后对照组接受常规护理，观察组加用PDCA护理模式，比较2组术后尿路感染的发生情况，分析RP术后发生尿路感染的影响因素。 结果 与对照组比较，观察组干预措施执行率较高(均P＜0.05)，尿路感染发生率较低[2.82%(4/142) vs. 13.38%(19/142), P＜0.05]。单因素分析和多因素logistic回归分析发现，年龄(≥65岁)、合并糖尿病、手术时间(≥90 min)、术后尿导管留置时间(≥5 d)是RP患者术后并发尿路感染的独立危险因素，护理方案(PDCA循环管理)是RP术后并发尿路感染的保护因素。 结论 护理方案(PDCA循环管理)为前列腺癌根治术后并发尿路感染的保护因素，将PDCA循环管理模式应用于RP患者有助于提升护理措施执行力，降低术后尿路感染风险。 Abstract:Objective To investigate the risk factors of urinary tract infections after radical prostatectomy (RP) and the nursing strategy of the plan-do-check-act (PDCA) cycle management model based on the logistic regression model, and provide reference for postoperative care of RP patients. Methods A total of 284 patients with prostate cancer who underwent RP surgery in the First Affiliated Hospital of Hainan Medical University from April 2019 to January 2023 were selected as the study subjects. They were randomly divided into control group and observation group by using radom number table method with 142 cases each. The control group received routine nursing after surgery, while the observation group received PDCA nursing mode on the basis on control group. The incidence of postoperative urinary tract infections between the two groups was compared, and the influencing factors of urinary tract infections after RP surgery were analyzed. Results Compared to the control group, the observation group had a higher implementation rate of intervention measures (all P < 0.05) and a lower incidence of urinary tract infections [2.82% (4/142) vs. 13.38% (19/142), P < 0.05]. Univariate analysis and multivariate logistic regression analysis showed that age (≥65 years old), combined with diabetes, operation time (≥90 min), and postoperative catheter retention time (≥5 days) were independent risk factors for postoperative urinary tract infection in RP patients, and nursing program (PDCA circulation management) was the protective factor for postoperative urinary tract infection in RP patients. Conclusion The nursing plan (PDCA cycle management) is a protective factor for postoperative urinary tract infections in patients with prostate cancer undergoing radical surgery. Applying PDCA cycle management mode to RP patients can help improve the execution of nursing measures and reduce the risk of postoperative urinary tract infections. -
Key words:
- Radical prostatectomy /
- PDCA nursing /
- Urinary tract infection /
- Risk factors /
- Prostatic cancer
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表 1 2组前列腺癌患者术后并发尿路感染的单因素分析[例(%)]
Table 1. Univariate analysis of postoperative urinary tract infection in 2 groups of prostate cancer patients[cases (%)]
项目 感染组
(n=23)未感染组
(n=261)χ2值 P值 年龄(岁) 6.793 0.009 < 65 6(26.09) 142(54.41) ≥65 17(73.91) 119(45.59) 病理分期 0.481 0.488 T1~2 15(65.22) 188(72.03) T3~4 8(34.78) 73(27.97) 合并高血压 0.018 0.893 是 12(52.17) 140(53.64) 否 11(47.83) 121(46.36) 合并糖尿病 23.396 < 0.001 是 16(69.57) 60(22.99) 否 7(30.43) 201(77.01) 手术时间(min) 21.017 <0.001 < 90 8(34.78) 204(78.16) ≥90 15(65.22) 57(21.84) 术后尿导管留置时间(d) 11.765 0.001 < 5 9(39.13) 191(73.18) ≥5 14(60.87) 70(26.82) 住院时间(d) 13.040 <0.001 < 7 11(47.83) 210(80.46) ≥7 12(52.17) 51(19.54) 护理方案 10.645 0.001 常规护理 19(82.61) 123(47.13) PDCA循环管理 4(17.39) 138(52.87) 
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表 2 前列腺癌根治术术后并发尿路感染的多因素logistic回归分析
Table 2. Multivariate logistic regression analysis of urinary tract infection after radical prostatectomy
变量 B SE Wald χ2 P值 OR值 95% CI 年龄(≥65岁) 0.453 0.194 5.479 0.019 1.573 1.101~2.351 合并糖尿病 0.813 0.200 16.484 < 0.001 2.254 1.440~3.156 手术时间(≥90 min) 0.621 0.200 9.649 0.002 1.861 1.259~2.757 术后尿导管留置时间(≥5 d) 1.160 0.359 10.413 0.001 3.190 2.214~9.061 住院时间(≥7 d) 0.125 0.180 0.480 0.498 1.133 0.742~1.504 护理方案(PDCA循环管理) -0.475 0.044 114.052 < 0.001 0.622 0.583~0.694
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表 3 2组行前列腺癌根治术的患者导尿管留置期间各干预措施执行情况[例(%)]
Table 3. Implementation of each intervention during catheter indentation in 2 groups of patients undergoing radical resection of prostate cancer[cases (%)]
组别 例数 导尿管留置必要性评估 会阴彻底清洁 放尿前后集尿袋出口消毒 集尿袋距离地面高度>15 cm 收集容器个人专用性 对照组 142 125(88.03) 133(93.66) 129(90.85) 113(79.58) 108(76.06) 观察组 142 135(95.07) 140(98.59) 138(97.18) 126(88.73) 142(100.00) χ2值 4.551 4.634 5.068 4.463 38.624 P值 0.033 0.031 0.024 0.035 < 0.001
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[1] 黄泽海, 黄晓敏, 陈泽荣, 等. 3D腹腔镜与2D腹腔镜下腹膜外前列腺癌根治术双中心回顾性队列研究[J]. 中华全科医学, 2022, 20(6): 919-922. doi: 10.16766/j.cnki.issn.1674-4152.002487HUANG Z H, HUANG X M, CHEN Z R, et al. Three-dimensional versus two-dimensional imaging systems in extraperitoneal radical prostatectomy for prostate cancer: A bicenter and retrospective cohort study[J]. Chinese Journal of General Practice, 2022, 20(6): 919-922. doi: 10.16766/j.cnki.issn.1674-4152.002487 [2] VELLKY J E, RICKE W A. Development and prevalence of castration-resistant prostate cancer subtypes[J]. Neoplasia, 2020, 22(11): 566-575. doi: 10.1016/j.neo.2020.09.002 [3] HYUN J, HA M S, OH S Y, et al. Urinary tract infection after radiation therapy or radical prostatectomy on the prognosis of patients with prostate cancer: a population-based study[J]. BMC Cancer, 2023, 23(1): 395-399. doi: 10.1186/s12885-023-10869-4 [4] 王华静, 周雪琴, 王义霞, 等. 应用PDCA循环管理模式对降低腹膜透析相关感染效果的研究[J]. 中国消毒学杂志, 2022, 39(11): 874-876. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXD202211023.htmWANG H J, ZHOU X Q, WANG Y X, et al. Study on the effect of PDCA circulation management mode on reducing Peritoneal dialysis related infections[J]. Chinese Journal of Disinfection, 2022, 39(11): 874-876. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXD202211023.htm [5] PAN N, LUO Y Y, DUAN Q X. The influence of PDCA cycle management mode on the enthusiasm, efficiency, and teamwork ability of nurses[J]. Biomed Res Int, 2022, 8(12): 935-937. [6] CARROLL P R, PARSONS J K, ANDRIOLE G, et al. NCCN clinical practice guidelines prostate cancer early detection, version 2.2015[J]. J Natl Compr Canc Netw, 2015, 13(12): 1534-1539. doi: 10.6004/jnccn.2015.0181 [7] 中华人民共和国卫生部. 医院感染诊断标准(试行)[J]. 中华医学杂志, 2001, 81(5): 314-320.Ministry of Health of the Ministry of Health of the People's Republic of China Diagnostic Standards for Hospital Infection (Trial)[J]. Chinese Medical Journal, 2001, 81(5): 314-320. [8] 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. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY202121023.htmHU Y, ZHENG Y T, WANG J P, et al. Association between TLR5 gene polymorphism and postoperative urinary catheter-associated urinary tract infection in urology surgery patients[J]. Chinese Journal of Nosocomiology, 2021, 31(21): 3307-3311. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY202121023.htm [9] 游婷, 陈然, 刘春红, 等. 标准化管理模式在预防宫颈癌术后尿路感染中的作用[J]. 中华医院感染学杂志, 2022, 32(19): 3031-3035. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY202219032.htmYOU T, CHEN R, LIU C H, et al. Effect of standardized management model on prevention of postoperative urinary tract infection in cervical cancer patients[J]. Chinese Journal of Nosocomiology, 2022, 32(19): 3031-3035. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY202219032.htm [10] 张婕, 槐华胜. PDCA循环用于消毒供应室护理管理中对清洗灭菌合格率及手术器械感染率的影响[J]. 重庆医学, 2021, 50(2): 337-339.ZHANG J, HUAI H S. The impact of PDCA cycle on cleaning and sterilization qualification rate and surgical instrument infection rate in nursing management of disinfection supply rooms[J]. Chongqing Medicine, 2021, 50(2): 337-339. [11] 邱月. PDCA循环管理在泌尿科管道护理中的应用[J]. 重庆医学, 2021, 50(1): 431-433. https://www.cnki.com.cn/Article/CJFDTOTAL-YYJT201810402.htmQIU Y. Application of PDCA cycle management in urology pipeline nursing[J]. Chongqing Medicine, 2021, 50(1): 431-433. https://www.cnki.com.cn/Article/CJFDTOTAL-YYJT201810402.htm [12] 邬嘉梅, 贾国荣. 基于PDCA管理对白血病PICC置管患者影响及发生血行感染的危险因素探讨[J]. 中国全科医学, 2021, 24(S2): 73-76. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX2021S2022.htmWU J M, JIA G R. The Impact of PDCA Management on Patients with PICC Catheterization of Leukemia and the Risk Factors of Blood Infection[J]. Chinese General Practice, 2021, 24(S2): 73-76. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX2021S2022.htm [13] 王华静, 周雪琴, 王义霞, 等. 应用PDCA循环管理模式对降低腹膜透析相关感染效果的研究[J]. 中国消毒学杂志, 2022, 39(11): 874-876. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXD202211023.htmFU Y Y, WANG X J, SHI Y W, et al. Analysis of risk factors of urinary tract infection in elderly patients after laparoscopic radical prostatectomy[J]. Geriatrics & Health Care, 2022, 39(11): 874-876. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXD202211023.htm [14] 彭丽红. 泌尿外科手术患儿导尿管相关尿路感染危险因素分析、预测模型构建及护理对策[J]. 医学临床研究, 2022, 39(12): 1778-1781.JIA Y H. Influencing factors of urinary tract infection after undergoing extraperitoneal laparoscopic radical prostatectomy of prostate cancer[J]. J Clin Res, 2022, 39(12): 1778-1781. [15] KAUR R, KAUR R. Symptoms, risk factors, diagnosis and treatment of urinary tract infections[J]. Postgrad Med J, 2021, 97(1154): 803-812. [16] 唐桂良, 周毅, 骆振刚, 等. 腔内泌尿外科手术尿路感染危险因素分析[J]. 中华全科医学, 2016, 14(1): 63-64, 165. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.021TANG G L, ZHOU Y, LUO Z G, et al. Logistic regression analysis on urinary tract infections after endourological surgery[J]. Chinese Journal of General Practice, 2016, 14(1): 63-64, 165. doi: 10.16766/j.cnki.issn.1674-4152.2016.01.021 [17] PEARCE S M, PARISER J J, KARRISON T, et al. Comparison of perioperative and early oncologic outcomes between open and robotic assisted laparoscopic prostatectomy in a contemporary population based cohort[J]. J Urol, 2016, 196(1): 76-81. [18] 厉波, 胡明森, 高兴超, 等. 前列腺增生术后医院感染影响因素及与维生素D受体基因多态性关系[J]. 中华医院感染学杂志, 2021, 31(15): 2342-2346. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY202115021.htmLI B, HU M S, GAO X C, et al. Influencing factors for nosocomial infection in patients with benign prostatic hyperplasia after surgery and its relationship with the polymorphisms of vitamin D receptor gene[J]. Chinese Journal of Nosocomiology, 2021, 31(15): 2342-2346. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY202115021.htm -
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