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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