| Objective To analyze the occurrence of bladder dysfunction in postoperative patients with gynecologic malignant tumors,and to construct an effective continuation nursing program for patients with bladder dysfunction after gynecologic malignant tumor surgery,to provide clinical rehabilitation for bladder function rehabilitation in patients after gynecologic malignant tumor surgery Reference.Methods(1)Through the current disease management system of the Affiliated Tumor Hospital of Guangxi Medical University,the clinical data of patients with gynecologic malignant tumor surgery from January 2015 to December 2017 were collected,including basic information of patients(age,marriage,ethnicity,place of residence,etc.).Information(disease diagnosis,clinical stage,chronic disease,etc.),treatment-related data(surgical methods,scope of parametrial resection,lymph node dissection,preservation of pelvic autonomic nerve,postoperative indwelling catheter time,postoperative residual urine volume,postoperative urinary tract infection))and the postoperative hospital stay.(2)The chi-square test was used to compare and analyze the differences in the rate of urinary catheterization between patients with gynecologic malignant tumors after discharge.(3)A non-matched case-control study was conducted to analyze the main risk factors for bladder dysfunction in postoperative patients.Patients with postoperative bladder dysfunction were investigated as case group,and patients with no bladder dysfunction during the same period were selected as the control group for comparative analysis.(4)Using the method of evidence-based nursing,search the relevant evidence-based resource database,find the best evidence,sort out the evidence,and formulate the corresponding nursing plan.Results1.General information and disease status of postoperative patients with gynecologic malignant tumors:A total of 689 patients with gynecologic malignancies were enrolled in the study,including 487(70.7%)of cervical cancer and 202(29.3%)of endometrial cancer,with an average age of 50.7±9.3 years.Of the 689 patients with gynecologic malignancies,428(62.1%)were discharged from the urethra,of which 262(61.2%)were rural.There was a difference in the rate of urinary catheterization in patients with gynecologic malignant tumors after discharge(P<0.05).The rate of urinary catheterization in patients with cervical cancer was higher(69.2%)than that in patients with endometrial cancer(45.0%)(P<0.05).The rate of urinary catheterization after discharge from general hysterectomy patients was higher than that of 68.2%.Patients with subtotal hysterectomy(44.3%)(P < 0.05).2.Analysis of risk factors for bladder dysfunction in postoperative patients with gynecologic malignant tumors:(1)Univariate analysis showed that there was a difference in the proportion of patients in the case group,the place of residence,the surgical procedure,the scope of parametrial resection,and the postoperative hospital stay(P<0.05).significance.There was no significant difference in the proportion of patients with pelvic autonomic nerve and postoperative urinary tract infection between the two groups(P>0.05).(2)The results of binary logistic regression analysis showed that the place of residence and postoperative hospital stay were the main risk factors for postoperative bladder dysfunction in patients with gynecologic malignant tumors.The risk of bladder dysfunction in rural residents was higher than that of urban residents.(OR=1.97,95% CI=1.13~3.44).The risk of postoperative bladder dysfunction in patients with gynecologic malignant tumors was not related to the disease type,surgical procedure,and parametrial resection(P>0.05).3.Through the retrieval and summary of evidence,the postoperative bladder function nursing program for patients with gynecologic malignant tumors and the continuing care plan for postoperative discharge patients were formed.Postoperative bladder function nursing program includes two parts: management of postoperative indwelling catheter and promotion of bladder function rehabilitation.The continuation nursing program includes the establishment of continuation nursing group and establishment of postoperative operation.Rehabilitation plan,establishment of follow-up information files,regular follow-up and management,program evaluation and improvement.Conclusion1.In rural areas of gynecological malignant tumors,the risk of postoperative bladder dysfunction is high,and medical personnel should provide individualized postoperative management in a targeted manner.The prolonged postoperative hospitalization period increases the risk of postoperative bladder dysfunction in patients with gynecologic malignant tumors.The medical staff should strengthen the management of postoperative patients,promote the recovery of bladder function,and shorten the postoperative hospital stay.2.The rate of urinary catheterization in patients with gynecologic malignant tumors is high(62.1%).The medical staff should strengthen the management of patients with postoperative indwelling catheters and provide effective continuation care for discharged patients.3.There is a lack of evidence-based nursing care for postoperative bladder function rehabilitation in patients with gynecologic malignancies.Care plans should also be developed and implemented based on individual patient conditions.4.According to the clinical and patient's actual situation,we should develop evidence-based continuation nursing program for postoperative gynecologic malignant tumor patients to deepen the connotation of quality nursing services. |
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