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    舒適護(hù)理對(duì)前列腺增生聯(lián)合治療的影響

    2013-12-31 00:00:00劉水英童炎岳萬(wàn)里軍
    中國(guó)現(xiàn)代醫(yī)生 2013年25期

    [摘要] 目的 研究擬膽堿能藥物聯(lián)合經(jīng)尿道前列腺電切治療前列腺增生過(guò)程中輔助舒適護(hù)理措施的治療效果。方法 選取前列腺增生并發(fā)逼尿肌無(wú)力患者66例,隨機(jī)分為研究組(n = 34)和對(duì)照組(n = 32)兩組。對(duì)照組采取擬膽堿能藥物聯(lián)合經(jīng)尿道前列腺電切治療,在治療前后采取傳統(tǒng)的常規(guī)護(hù)理;研究組采取擬膽堿能藥物聯(lián)合經(jīng)尿道前列腺電切治療,治療前后在傳統(tǒng)的常規(guī)護(hù)理基礎(chǔ)上再對(duì)患者進(jìn)行舒適護(hù)理措施。 結(jié)果 研究組術(shù)后IPSS低于對(duì)照組,且明顯低于術(shù)前(P < 0.05或P < 0.01);研究組術(shù)后QOL低于對(duì)照組,且明顯低于術(shù)前(P < 0.05或P < 0.01);研究組術(shù)后Qmax高于對(duì)照組,且明顯高于術(shù)前(P < 0.05或P < 0.01)。研究組護(hù)理前后SAS評(píng)分分別為(57.02±3.36)分、(48.12±4.34)分,護(hù)理后SAS評(píng)分低于護(hù)理前(P < 0.01);研究組護(hù)理前后SDS評(píng)分分別為(56.19±3.36)分、(48.14±4.36)分,護(hù)理后SDS評(píng)分低于護(hù)理前(P < 0.01);研究組和對(duì)照組護(hù)理后SAS評(píng)分分別為(48.12±4.34)分、(52.73±3.36)分,研究組低于對(duì)照組(P < 0.01);研究組和對(duì)照組護(hù)理后SDS評(píng)分分別為(48.14±4.36)分、(52.02±3.26)分,研究組低于對(duì)照組(P < 0.01)。 結(jié)論 擬膽堿能藥物聯(lián)合經(jīng)尿道前列腺電切治療伴發(fā)逼尿肌無(wú)力的前列腺增生患者可以獲得比較好的治療效果,在治療過(guò)程中對(duì)患者輔助舒適護(hù)理措施,可以減少患者治療過(guò)程中焦慮和抑郁等不良情緒的產(chǎn)生,從而增強(qiáng)治療效果,值得臨床進(jìn)一步推廣和應(yīng)用。

    [關(guān)鍵詞] 前列腺增生;逼尿肌無(wú)力;擬膽堿能藥物聯(lián)合經(jīng)尿道前列腺電切治療;舒適護(hù)理

    [中圖分類號(hào)] R473.6 [文獻(xiàn)標(biāo)識(shí)碼] B [文章編號(hào)] 1673-9701(2013)25-0084-03

    The effect of comforting care in the combined treatment of prostate hyperplasia

    LIU Shuiying TONG Yanyue WAN Lijun

    Department of Urology, Central Hospital of Quzhou City in Zhejiang Province, Quzhou 324000, China

    [Abstract] Objective To study the auxiliary therapeutic effect of comforting care measures in the process of combined cholinergic drugs and transurethral resction of prostate treating prostatic hyperplasia. Methods Sixty-six patients with prostatic hyperplasia complicated with detrusor weak were selected as the study objects, randomly divided into the research group and the control group. The research group included 34 patients, who received comforting care measures on the basis of conventional nursing. The control group included 32 patients, who received conventional nursing care alone. Results The IPSS after surgery of 34 patients in the research group was lower than that in the control group, and was also significantly lower than that before surgery(P < 0.05 or P < 0.01); The QOL after surgery of 34 patients in the research group was lower than that in the control group, and was also significantly lower than that before surgery(P < 0.05 or P <0.01); The Qmax after surgery of 34 patients in the research group was higher than that in the control group, and was also significantly higher than that before surgery(P < 0.05 or P < 0.01). SAS scores before and after care in the research group were respectively:(57.02±3.36)points、(48.12±4.34) points . SAS scores after care in the research group were lower than that before care in the research group (P < 0.01). SDS scores before and after care in the research group were respectively: (56.19±3.36) points, (48.14±4.36) points. SDS scores after care in the research group were lower than that before care in the research group (P < 0.01). SAS scores after care in the research group and in the control group were (48.12 ±4.34) points, (52.73±3.36) points respectively. SAS score after care in the research group was lower than that in the control group (P < 0.01); SDS scores after care in the research group and in the control group were (48.14±4.36) points, (52.02±3.26) points respectively. SDS score after care in the research group was lower than that in the control group (P < 0.01). Conclusion The comprehensive effect of comforting care measures, in the process of the treatment of prostatic hyperplasia complicated with detrusor weak, is higher than that of conventional nursing measures. It is worth clinical extensive application and being promoted.

    [Key words] Prostatic hyperplasia; Detrusor weak; Treatment of cholinergic drugs combined with transurethral resection of prostate; Comforting care

    前列腺增生是老年男性患者的常見疾病之一。開放手術(shù)和經(jīng)尿道前列腺電切術(shù)是治療合并膀胱出口梗阻的前列腺增生的重要方法,但有一部分患者手術(shù)效果不理想。國(guó)內(nèi)外臨床研究表明,前列腺增生往往容易并發(fā)逼尿肌無(wú)力,其比例在11%~21%左右,嚴(yán)重者可以導(dǎo)致患者逼尿肌功能紊亂,從而引起患者小便困難,嚴(yán)重影響患者生活質(zhì)量[1,2]。研究表明,擬膽堿能藥物聯(lián)合經(jīng)尿道前列腺電切治療伴發(fā)逼尿肌無(wú)力的前列腺增生患者,可以獲得比較好的療效,且在治療過(guò)程中同時(shí)對(duì)患者輔助舒適護(hù)理措施,可以增強(qiáng)治療效果,有利于患者盡快康復(fù)[3]。本文旨在研究擬膽堿能藥物聯(lián)合經(jīng)尿道前列腺電切治療前列腺增生過(guò)程中輔助舒適護(hù)理措施的療效。

    1 資料與方法

    1.1 一般資料

    本研究選取2011年5月~2012年12月我院收治的前列腺增生并發(fā)逼尿肌無(wú)力患者66例,隨機(jī)分為研究組和對(duì)照組兩組。對(duì)照組32例患者皆采取擬膽堿能藥物聯(lián)合經(jīng)尿道前列腺電切治療,在治療前后采取傳統(tǒng)的常規(guī)護(hù)理;研究組34例患者,皆采取擬膽堿能藥物聯(lián)合經(jīng)尿道前列腺電切治療,治療前后在傳統(tǒng)的常規(guī)護(hù)理基礎(chǔ)上再對(duì)患者進(jìn)行舒適護(hù)理措施。兩組患者一般臨床資料比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P > 0.05),見表1。

    表1 兩組患者一般資料比較(x±s)

    1.2護(hù)理措施

    1.2.1對(duì)照組 患者皆采取擬膽堿能藥物聯(lián)合經(jīng)尿道前列腺電切治療,在治療前后采取傳統(tǒng)的常規(guī)護(hù)理。

    1.2.2研究組 患者皆采取擬膽堿能藥物聯(lián)合經(jīng)尿道前列腺電切治療,治療前后在傳統(tǒng)的常規(guī)護(hù)理基礎(chǔ)上再對(duì)患者進(jìn)行舒適護(hù)理措施。

    1.3舒適護(hù)理

    1.3.1心理舒適護(hù)理 ①于患者入院前為患者準(zhǔn)備安靜、溫馨的病房,患者入院后熱情向其介紹醫(yī)院環(huán)境及醫(yī)護(hù)人員,消除患者的陌生感。主動(dòng)向患者講解疾病及治療的相關(guān)知識(shí),對(duì)患者及家屬的問(wèn)題給予耐心解答。在溝通中注意患者的情緒變化,對(duì)其不良情緒給予疏導(dǎo)和安慰。②患者進(jìn)入手術(shù)室后,保持室內(nèi)衛(wèi)生、舒適、合適的溫濕度,鼓勵(lì)并和患者適當(dāng)交流,以緩解其緊張感、提升心理舒適度。

    1.3.2生理舒適護(hù)理 ①體位舒適護(hù)理 術(shù)中術(shù)后協(xié)助患者采取舒適體位,對(duì)其病情密切觀察,對(duì)可能出現(xiàn)的不良反應(yīng)做出相關(guān)說(shuō)明。②疼痛 對(duì)患者術(shù)中可能發(fā)生的疼痛進(jìn)行耐心說(shuō)明,通過(guò)播放一些令人愉悅放松的音樂(lè)讓患者保持輕松狀態(tài),于術(shù)中助其保持合適的體位,并將操作做到準(zhǔn)確,減少可能產(chǎn)生疼痛的不必要步驟,必要時(shí)進(jìn)行藥物止痛。③術(shù)后舒適護(hù)理 對(duì)患者術(shù)后飲食進(jìn)行指導(dǎo),并告知可能出現(xiàn)的不適癥狀,囑其家屬給予患者盡可能多的關(guān)懷,以利于患者早日康復(fù)[4,5]。

    1.4 觀察指標(biāo)

    統(tǒng)計(jì)記錄兩組患者術(shù)后的尿流動(dòng)力學(xué)、國(guó)際前列腺增生癥狀評(píng)分(IPSS)和生活質(zhì)量評(píng)分(QOL)等臨床資料。并使用焦慮自評(píng)量表(SAS)評(píng)分和抑郁自評(píng)量表(SDS)評(píng)分對(duì)兩組患者焦慮及抑郁情緒進(jìn)行評(píng)價(jià)[6,7]。

    1.5 統(tǒng)計(jì)學(xué)方法

    采用SPSS 16.0軟件統(tǒng)計(jì)處理,計(jì)量資料以x±s表示,兩獨(dú)立樣本及組內(nèi)的計(jì)量資料采用t檢驗(yàn),如果方差不齊,則進(jìn)行t′檢驗(yàn)或秩和檢驗(yàn);P < 0.05為差異有統(tǒng)計(jì)學(xué)意義, P< 0.01為差異有高度統(tǒng)計(jì)學(xué)意義。

    2結(jié)果

    2.1兩組患者術(shù)后情況比較

    由表2可見,研究組患者術(shù)后IPSS低于對(duì)照組,且明顯低于術(shù)前(P < 0.05或P < 0.01);研究組患者術(shù)后QOL低于對(duì)照組,且明顯低于術(shù)前(P < 0.05或P < 0.01);研究組患者術(shù)后Qmax高于對(duì)照組,且明顯高于術(shù)前(P < 0.05或P <0.01)。

    2.2 兩組患者護(hù)理前后SAS、SDS評(píng)分比較

    由表3可見,研究組護(hù)理前后的SAS分別為(57.02±3.36)分、(48.12±4.34)分;對(duì)照組護(hù)理前后的SAS分別為(56.97±3.32)分、(52.73±3.36)分;研究組護(hù)理前后的SDS分別為(56.19±3.36)分、(48.14±4.36)分;對(duì)照組護(hù)理前后的SDS分別為(55.92±3.37)分、(52.02±3.26)分;研究組患者護(hù)理后SAS評(píng)分低于護(hù)理前,兩者相比差異有高度統(tǒng)計(jì)學(xué)意義(t = 9.347 4,P = 0.000 0 < 0.01);研究組護(hù)理后SDS評(píng)分低于護(hù)理前,兩者相比差異有高度統(tǒng)計(jì)學(xué)意義(t = 8.430 9,P = 0.000 0 < 0.01);兩組患者護(hù)理后SAS評(píng)分,研究組低于對(duì)照組,兩者相比差異有高度統(tǒng)計(jì)學(xué)意義(t = 4.804 0,P = 0.000 0 < 0.01);兩組患者護(hù)理后SDS評(píng)分,研究組低于對(duì)照組,兩者相比差異有高度統(tǒng)計(jì)學(xué)意義(t = 4.074 4,P = 0.000 1 < 0.01)。

    表3 兩組患者護(hù)理前后SAS、SDS評(píng)分比較(x±s,分)

    注:與治療前比較,aP < 0.05,bP < 0.01;與對(duì)照組比較,*P < 0.05,**P <0.01

    3討論

    前列腺增生常見于老年男性患者,目前對(duì)治療前列腺并發(fā)逼尿肌無(wú)力的看法不一。有研究評(píng)估1974~1988年之間經(jīng)尿道前列腺電切治療逼尿肌無(wú)力的前列腺增生患者的長(zhǎng)期療效,研究認(rèn)為對(duì)逼尿肌無(wú)力患者進(jìn)行經(jīng)尿道前列腺電切治療,對(duì)尿動(dòng)力學(xué)的長(zhǎng)期改善效果不明顯[7]。國(guó)內(nèi)有學(xué)者認(rèn)為,存在膀胱出口梗阻的前列腺增生患者,即使伴發(fā)逼尿肌無(wú)力也應(yīng)手術(shù)治療[8]。

    根據(jù)作用機(jī)制不同,臨床使用的擬膽堿藥可分為作用于膽堿受體的擬膽堿藥和作用于膽堿酯酶的抗膽堿酯酶藥。國(guó)外有研究認(rèn)為,擬膽堿能藥物聯(lián)合經(jīng)尿道前列腺電切治療伴發(fā)逼尿肌無(wú)力的前列腺增生患者,可以取得比較好的療效,且治療過(guò)程中并發(fā)癥較少[9]。

    聯(lián)合應(yīng)用擬膽堿能藥物和經(jīng)尿道前列腺電切治療逼尿肌無(wú)力的前列腺增生患者,由于該治療為一種有創(chuàng)治療,其手術(shù)創(chuàng)傷比較大,必然對(duì)患者產(chǎn)生一定的損傷;前列腺增生患者自身的生理心理決定其在術(shù)前及手術(shù)過(guò)程中會(huì)存在焦慮、抑郁等不良情緒,對(duì)患者的治療及術(shù)后康復(fù)存在不良影響[10,11]。

    有國(guó)內(nèi)外研究表明,對(duì)伴發(fā)逼尿肌無(wú)力的前列腺增生患者在手術(shù)前后進(jìn)行以人為本的舒適護(hù)理,給患者以人文關(guān)懷,有利于獲得較好的療效,且患者術(shù)后康復(fù)較快[12-15]。

    本研究表明,研究組術(shù)后IPSS低于對(duì)照組,且明顯低于術(shù)前(P < 0.05或P < 0.01);研究組術(shù)后QOL低于對(duì)照組,且明顯低于術(shù)前(P < 0.05或P < 0.01);研究組術(shù)后Qmax低于對(duì)照組,且明顯高于術(shù)前(P < 0.05或P < 0.01)。說(shuō)明聯(lián)合應(yīng)用擬膽堿能藥物和經(jīng)尿道前列腺電切治療逼尿肌無(wú)力的前列腺增生患者,在治療過(guò)程中對(duì)其采用舒適護(hù)理措施,可以改善患者的IPSS、QOL及Qmax,有利于提高患者的治療效果,從而有利于患者快速康復(fù)。

    本研究顯示,研究組護(hù)理后SAS評(píng)分低于護(hù)理前(P < 0.01);研究組護(hù)理后SDS評(píng)分低于護(hù)理前(P < 0.01);兩組患者護(hù)理后SAS評(píng)分,研究組低于對(duì)照組(P < 0.01);兩組患者護(hù)理后SDS評(píng)分,研究組低于對(duì)照組(P < 0.01)。說(shuō)明聯(lián)合應(yīng)用擬膽堿能藥物和經(jīng)尿道前列腺電切治療逼尿肌無(wú)力的前列腺增生患者,在治療過(guò)程中對(duì)患者進(jìn)行舒適護(hù)理,可以減少患者治療過(guò)程中焦慮和抑郁等不良情緒的產(chǎn)生,有利于患者的心理康復(fù),從而促進(jìn)患者的盡快康復(fù)。分析其原因,主要是由于患者作為個(gè)體,其心理因素對(duì)疾病的進(jìn)展和治療療效影響很大,因此,如何在治療中減少其焦躁等負(fù)面情緒對(duì)療效的影響,往往影響最終療效。而舒適護(hù)理作為一種可以給予患者人文關(guān)懷、緩解患者不良情緒、提高其配合程度并提升療效的護(hù)理措施,不僅獲得比較好的療效,還能建立良好的醫(yī)患關(guān)系。

    總之,擬膽堿能藥物聯(lián)合經(jīng)尿道前列腺電切治療伴發(fā)逼尿肌無(wú)力的前列腺增生患者,可以獲得較好的療效,在治療過(guò)程中對(duì)患者輔助舒適護(hù)理措施,可以減少患者治療過(guò)程中焦慮和抑郁等不良情緒的產(chǎn)生,增強(qiáng)治療效果,值得臨床進(jìn)一步推廣和應(yīng)用。

    [參考文獻(xiàn)]

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    [2] Mamoulakis C,Ubbink DT,Sofras F,et al. Bipolar transurethral resection of the prostate causes deeper coagulation depth and less bleeding than monopolar transurethral prostatectomy[J]. Urology,2013,81(5):1113-1115.

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    [4] 王寶枝. 針對(duì)性心理護(hù)理對(duì)高齡前列腺電切患者生活滿意度的影響[J]. 中國(guó)現(xiàn)代醫(yī)生,2011,49(8):88-89.

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    [6] 張景云,白玉紅,田維蘭,等. 綠激光汽化術(shù)治療前列腺增生患者的圍手術(shù)期護(hù)理[J]. 中國(guó)實(shí)用護(hù)理雜志,2011,27(32):32-33.

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    [8] 王寧蘭,范永紅,張?chǎng)┫?,? 腔鏡下治療前列腺增生合并膀胱結(jié)石的圍手術(shù)期護(hù)理[J]. 中國(guó)藥物與臨床,2012,12(7):972-974.

    [9] Woo H,Thangasamy I,Chalasani V. Photoselective vaporization with the green light laser vs transurethral resection of the prostate for treating benign prostate hyperplasia:A systematic review and meta-analysis[J]. BJU Int,2013,111(4):E137.

    [10] 劉雙菊. 經(jīng)尿道電切除術(shù)治療前列腺增生的護(hù)理[J]. 護(hù)理實(shí)踐與研究,2011,8(23):70-71.

    [11] Kwon O,Park S,Jeong MY,et al. Application of the modified clavien classification system to 120W greenlight high-performance system photoselective vaporization of the prostate for benign prostatic hyperplasia: Is it useful for less-invasive procedures[J]. Korean J Urol,2013,54(4):239-243.

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    (收稿日期:2013-05-02)

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