机器人辅助下根治性膀胱全切除术后肠梗阻的危险因素分析及护理干预对策

袁媛; 陈庆丽; 杨潇

doi:10.7619/jcmp.20201857

机器人辅助下根治性膀胱全切除术后肠梗阻的危险因素分析及护理干预对策

南京医科大学第一附属医院/江苏省人民医院泌尿外科, 江苏南京, 210029

基金项目:

国家自然科学基金资助项目 81602235

江苏省“六大人才高峰”高层次人才项目 2015-wsw-033

详细信息

通讯作者:
陈庆丽, E-mail: jssmnhl@163.com

中图分类号: R473.6;R694
计量
- 文章访问数: 337
- HTML全文浏览量: 181
- PDF下载量: 27
出版历程
- 收稿日期: 2020-12-28
- 网络出版日期: 2021-04-28
- 发布日期: 2021-05-14

Analysis in risk factors of intestinal obstruction afterradical total cystectomy with robotic assistance and related nursing interventions

Department of Urology Surgery, First Affiliated Hospital of Nanjing Medical University, Jiangsu Provincial People's Hospital, Nanjing, Jiangsu, 210029

摘要

摘要:
目的探讨机器人辅助下根治性膀胱全切除术后发生肠梗阻的危险因素及护理干预对策。
方法回顾性分析接受机器人辅助下根治性膀胱全切除术的102例患者的临床资料，根据术后是否发生肠梗阻将患者分为肠梗阻组（n=18）和非肠梗阻组（n=84），比较2组年龄、性别、体质量指数（BMI）、吸烟史、饮酒史、既往高血压史、糖尿病病史、既往腹部手术史、术前化疗史、术前血清白蛋白水平、手术方式、手术时间、术中输血情况、术中出血量、术后24 h盆腔引流量和术后TNM分期、平均每日活动量、首次下床时间、盆腔引流管保留时间，并对术后发生肠梗阻的危险因素进行单因素和多因素分析。
结果肠梗阻组术后24 h盆腔引流量、术后平均每日活动量少于非肠梗阻组，盆腔引流管保留时间长于非肠梗阻组，差异有统计学意义（P < 0.05）。多因素回归分析显示，术后24 h盆腔引流量少（OR=0.978，95% CI为0.957~0.999，P=0.039）和术后平均每日活动量少（OR=0.822，95% CI为0.707~0.955，P=0.011）是肠梗阻发生的独立危险因素。
结论术后引流不畅、盆腔引流管长时间保留、活动量少易引起机器人辅助下根治性膀胱全切除术后肠梗阻，术后应鼓励患者早期下床活动，保持盆腔引流管通畅，并制订个性化活动方案，从而减少术后肠梗阻的发生。
- 肠梗阻 /
- 机器人 /
- 根治性膀胱全切除术 /
- 盆腔引流量 /
- 活动量 /
- 危险因素
Abstract:
Objective To analyze the risk factors of intestinal obstruction after radical cystectomy under the assistance of robots and its nursing interventions.
Methods Clinical data of 102 patients treated with robotic radical cystectomy under the assistance of robots was analyzed. According to presentation of postoperative intestinal obstruction, they were divided into postoperative intestinal obstruction group (n=18) and postoperative non-intestinal obstruction group (n=84). Their age, gender, body mass index(BMI), smoking history, drinking history, and hypertension history, history of diabetes, history of previous abdominal surgery, historyof preoperative chemotherapy, preoperative serum albumin levels, surgical methods, operation time, intraoperative blood transfusion, intraoperative blood loss, 24 hour pelvic drainage, postoperative TNM staging, average daily activity, the time to get out of bed after the first operation and the retention time of the pelvic drainage tube after the operation were compared in the two groups. The risk factors of postoperative intestinal obstruction were analyzed by univariate and multivariate analysis.
Results Pelvic drainage volume 24 h after surgery and average daily activity after surgery in the intestinal obstruction group were significantly less than those in the non-intestinal obstruction group, and the retention time of pelvic drainage tube was significantly longer than that in the non-intestinal obstruction group (P < 0.05). Multivariate regression analysis showed that low pelvic drainage volume 24 h after surgery (OR=0.978, 95%CI, 0.957~0.999, P=0.039) and low postoperative average daily activity (OR=0.822, 95%CI, 0.707~0.955, P=0.011) were independent risk factors for the occurrence ofintestinal obstruction.
Conclusion Poor drainage, long-term retention of the pelvic drainage tube and less postoperative activity are easy to cause postoperative intestinal obstruction in robotic-assisted radical cystectomy. Therefore, encouraging patients to get out of bed in early period after surgery, keeping the drainage tube unobstructed and implementing personalized activity plan will help reduce the occurrence of postoperative intestinal obstruction.
- intestinal obstruction /
- robot /
- radical cystectomy /
- pelvic drainage volume /
- activity /
- risk factors

HTML全文

表 1 患者术前一般资料比较(x±s)[n(%)]

指标	全组(n=102)	肠梗阻组(n=18)	非肠梗阻组(n=84)	t/χ²	P
性别男	82(80.39)	12(66.67)	70(83.33)	2.612	0.106
女	20(19.61)	6(33.33)	14(16.67)
年龄/岁	64.88±11.12	66.00±9.90	64.67±11.43	0.308	0.759
体质量指数/(kg/m²)	24.13±3.52	23.90±3.07	24.18±3.63	0.201	0.741
吸烟史	26(25.49)	4(22.22)	22(26.19)	0.045	0.832
饮酒史	20(19.61)	2(11.11)	18(21.43)	0.453	0.501
既往高血压史	32(31.37)	4(22.22)	28(33.33)	0.412	0.521
既往糖尿病史	16(15.69)	2(11.11)	14(16.67)	0.053	0.817
既往腹部手术史	26(25.49)	6(33.33)	20(23.81)	0.295	0.587
术前化疗史	42(41.18)	6(33.33)	36(42.86)	0.555	0.456
血清白蛋白/(g/L)	37.90±2.68	36.90±2.77	38.09±2.66	1.149	0.256

下载: 导出CSV

表 2 患者术中及术后资料比较(x±s)[n(%)][M(P₀~P₁₀₀)]

指标		全组(n=102)	肠梗阻组(n=18)	非肠梗阻组(n=84)	t/χ²	P
手术类型	输尿管腹壁造口术	32(31.37)	4(22.22)	28(33.33)	0.494	0.482
	回肠代膀胱术	52(50.98)	12(66.67)	40(47.62)
	回肠原位新膀胱术	18(17.65)	2(11.11)	16(19.05)
手术时间/min		370.34±89.84	374.63±104.51	369.45±88.19	0.148	0.995
术中输血		13(12.75)	3(16.67)	10(11.90)	0.026	0.873
术中出血量/mL		310.0(100.0~1 500.0)	400.0(100.0~1 500.0)	300.0(100.0~1 100.0)	0.552	0.583
TNM分期	Ⅰ期	18(17.65)	2(11.11)	16(19.05)	0.066	0.482
	Ⅱ期	56(54.90)	12(66.67)	44(52.38)
	Ⅲ期	12(11.76)	2(11.11)	10(11.90)
	Ⅳ期	16(15.69)	2(11.11)	14(16.67)
术后24 h盆腔引流量/mL		277.02±125.63	186.32±84.84	294.32±125.32	2.329	0.024
术后平均每日活动量/m		27.42±16.04	13.05±11.81	30.07±15.44	2.870	0.002
术后首次下床时间/d		2.0(1.0~6.0)	3.0(1.0~5.0)	2.0(1.0~6.0)	0.527	0.600
术后盆腔引流管保留时间/d		10.0(3.0~38.0)	14.5(7.0~29.0)	9.5(3.0~38.0)	2.305	0.042

下载: 导出CSV

表 3 机器人辅助下根治性膀胱全切除术后肠梗阻的多因素Logistic回归分析

因素	B	标准误	P	OR	95%CI
术后24 h盆腔引流量	-0.022	0.011	0.039	0.978	0.957~0.999
术后每日活动量	-0.196	0.077	0.011	0.822	0.707~0.955
术后盆腔引流管保留时间	-0.149	0.151	0.319	1.159	0.865~1.565

下载: 导出CSV

参考文献(13)

[1]	WOLDU S L, BAGRODIA A, LOTAN Y. Guideline of guidelines: non-muscle-invasive bladder cancer[J]. BJU Int, 2017, 119(3): 371-380. doi: 10.1111/bju.13760
[2]	PHILIPPE E S, NEERAJ A, RICK B, et al. Bladder cancer, version 5.2017, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2017, 15(10): 1240-1267. doi: 10.6004/jnccn.2017.0156
[3]	徐金山, 刘安伟, 任乾, 等. 机器人辅助与开放式根治性膀胱切除术后早期并发症的对比研究[J]. 中华泌尿外科杂志, 2017, 38(2): 99-102. doi: 10.3760/cma.j.issn.1000-6702.2017.02.006
[4]	谢冬玲, 李扬, 冀志勇. 某肿瘤医院非计划再次手术回顾性分析[J]. 中国病案, 2020, 21(9): 57-60. doi: 10.3969/j.issn.1672-2566.2020.09.022
[5]	孟一森, 苏杨, 范宇, 等. 根治性膀胱全切术后肠梗阻的危险因素分析(附740例报道)[J]. 北京大学学报: 医学版, 2015, 47(4): 628-633. doi: 10.3969/j.issn.1671-167X.2015.04.016
[6]	何威, 徐兆平, 谢欣, 等. 机器人根治性膀胱切除术加双U原位膀胱术治疗肌层浸润性膀胱癌[J/CD]. 中华腔镜泌尿外科杂志: 电子版, 2016, 10(6): 383-387.
[7]	李志伟, 金红旭, 曹志强. 腹腔镜膀胱癌根治术联合快速康复外科理念治疗浸润性膀胱癌临床效果研究[J]. 临床军医杂志, 2017, 45(4): 346-348. https://www.cnki.com.cn/Article/CJFDTOTAL-JYGZ201704006.htm
[8]	魏亮, 王东文. 加速康复外科理念在泌尿外科的发展现状与展望[J]. 中华泌尿外科杂志, 2017, 38(5): 398-400. doi: 10.3760/cma.j.issn.1000-6702.2017.05.022
[9]	瓦斯里江·瓦哈甫, 高建东, 刘赛, 等. 加速康复外科在腹腔镜根治性膀胱切除术围手术期应用的早期效果[J]. 中华泌尿外科杂志, 2018, 39(3): 178-182. doi: 10.3760/cma.j.issn.1000-6702.2018.03.005
[10]	PÉDZIWIATR M, KISIALEUSKI M, WIERDAK M, et al. Early implementation of Enhanced Recovery After Surgery (ERAS^®) protocol-Compliance improves outcomes: a prospective cohort study[J]. Int J Surg, 2015, 21: 75-81. doi: 10.1016/j.ijsu.2015.06.087
[11]	张学平, 张敏, 宋超, 等. 加速康复外科理念在行腹腔镜膀胱根治性切除术患者围术期中应用的临床观察[J]. 临床肿瘤学杂志, 2018, 23(7): 631-634. doi: 10.3969/j.issn.1009-0460.2018.07.011
[12]	李合, 周晓华, 陈兴超. 四十例术后炎性肠梗阻诊疗分析[J]. 中华普外科手术学杂志: 电子版, 2021, 15(1): 101-103. doi: 10.3877/cma.j.issn.1674-3946.2021.01.029.
[13]	INMAN B A, HAREL F, TIGUERT R, et al. Routine nasogastric tubes are not required following cystectomy with urinary diversion: a comparative analysis of 430 patients[J]. J Urol, 2003, 170(5): 1888-1891. doi: 10.1097/01.ju.0000092500.68655.48