北京生物医学工程

输尿管软镜钬激光碎石术在上尿路结石合并心衰患者中的应用及其细节护理

Application of ureteroscopic holmium laser lithotripsy and its detail care for patients with upper urinary stone combined with heart failure

作者：隗春燕罗勇李虹姜永光

单位：首都医科大学附属北京安贞医院（北京100029） <p>通信作者：姜永光，教授，博士生导师。E-mail：yongguangjiang@126.com</p> <p> </p>

关键词：输尿管软镜钬激光碎石术；应用；上尿路结石；心衰；细节护理

分类号：R318.6 

出版年·卷·期（页码）：2022·41·3（302-306）

摘要：

目的分析输尿管软镜钬激光碎石术及其细节护理在上尿路结石合并心衰患者的临床应用效果，为该术式的临床推广提供实验依据。方法选取2019年1月至2021年1月北京安贞医院泌尿外科行输尿管软镜激光碎石术的上尿路结石合并心衰患者共82例，并按照围手术期采用细节护理（实验组）和常规护理（对照组）分成两组，每组41例。分析患者的不良反应发生率、手术治疗满意度、患者手术前后的焦虑自评量表(self-rating anxiety scale，SAS)和抑郁自评量表(self-rating depression scale ，SDS)评分，以及疼痛评分和生活能力Barthel量表评分，与此同时比较两种护理模式的差异。结果行输尿管软镜钬激光碎石术82例手术患者中发生不良反应共13例，占比15.9%，其中实验组不良反应发生率低于对照组(P<0.05)。对手术满意有75例，为91.5%，实验组手术满意度高于对照组(P<0.05)。手术后，患者的疼痛和日常生活能力评分都好于术前，且实验组疼痛评分低于对照组(P<0.05)，日常生活能力评分高于对照组(P<0.05)。患者术后的SAS量表和SDS量表评分低于术前(P<0.05)，且实验组SAS量表和SDS量表评分低于对照组(P<0.05)。结论针对上尿路结石合并心衰患者，输尿管软镜钬激光碎石术具有较好的临床应用前景，且细节护理可有效提高临床疗效。

Objective To analyzing the clinical effects of the soft ureteroscope holmium laser lithotripsy and targeted detail nursing in upper urinary stone patients combined with heart failure, and to provide a practice for its clinical promotion. Methods From January 2019 to January 2021, 82 patients with upper urinary tract stones complicated with heart failure, who underwent ureteroscopic holmium laser lithotripsy in Beijing Anzhen hospital, were divided into experimental group and control group, 41 cases each. The experimental group adopted target detail care during the perioperative period, and the control group received routine nursing. The incidence of adverse reactions, satisfaction with the surgical treatment, and the self-rating anxiety scale (SAS) , self-rating depression scale (SDS) scores, pain score and life ability Barthel scale score before and after soft ureteroscope holmium laser lithotripsy were analyzed. Meanwhile, the difference between the two groups was compared. Results A total of 13 patients with adverse reactions occurred in 82 patients, accounting for 15.9%, however the incidence of adverse reactions in the experimental group was lower than the control group ( P <0.05) . Seventy-five patients were satisfied with the operation, accounting for 91.5%, and the satisfaction of the experimental group was higher than that of the control group (P<0.05). After operation, the patient's pain and daily living ability were better than preoperative, and the experimental group pain score was lower than the control group ( P<0.05), daily life ability score was higher than the control group (P<0.05). After the operation, both of the scores of the patients’ SAS and SDS scales were lower than before the operation (P<0.05), and the SAS amount table and SDS scale scores of the experimental group were lower than those of the control group (P<0.05).. Conclusions For patients with upper urinary calculi combined with heart failure, the soft ureteroscopic holmium laser lithotripsy has good clinical application prospects, and targeted detail care can effectively improve its clinical effect.

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