广东地区神经源性膀胱康复护理管理及间歇导尿临床应用现况调查

doi:10.3969/j.issn.1006-9771.2021.10.015

Abstract

Abstract:

Objective To investigate the knowledgement and clinical application of neurogenic bladder and intermittent catheterization among nurses in Guangdong.Methods From December, 2020 to January, 2021, 241 nurses in Guangdong were investigated with a questionnaire designed by ourselves.Results The score was low in understanding the neurogenic bladder rehabilitation nursing management and intermittent catheterization through self-assessment. The awareness was deficient in the complication and risk management of neurogenic bladder. Although there were a lot of patients with dysuria in clinical practice, 67.2% of nurses still used indwelling catheter, and only 24.1% used intermittent catheterization. Only 9.9% nurses thought that patients with dysuria were treated positively by doctors. Most of nurses would like to participate in the training and nursing alliance in neurogenic bladder rehabilitation nursing management and intermittent catheterization, and manage patients with neurogenic bladder after discharge.Conclusion The knowledge of guidelines related with neurogenic bladder and intermittent catheterization among nurses is insufficient, and is not applied in clinical practice. More work should be done to improve the knowledge and standardization of management of neurogenic bladder.

Key words: neurogenic bladder, intermittent catheterization, investigation, nursing

CLC Number:

R694

ZHOU Jun-gui,ZHOU Min,PANG Fan,LIU Yu,GUO Meng-meng. Survey of Rehabilitation Nursing Management of Neurogenic Bladder and Clinical Application of Intermittent Catheterization in Guangdong, China[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(10): 1233-1240.

Figures/Tables 5

References 26

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题目	得分
排尿功能障碍的原因	3.30±1.00
尿失禁分型及症状	2.93±1.06
泌尿系统的生理解剖特征	3.10±1.07
排尿功能障碍易导致的并发症	3.12±1.77
留置尿管的并发症	3.41±1.40
NB管理的目标	2.81±1.01
膀胱功能评定方法	2.39±0.97
膀胱容量压力测定方法	2.44±1.18
残余尿的测定方法	2.84±1.14
排尿日记的内容	2.76±1.28
CIC的适应证和禁忌证	2.55±1.04
对CIC的患者需要进行哪些教育	2.91±1.07
CIC有哪些并发症	2.72±1.13
居家CIC的注意事项	2.66±1.14
出院后CIC患者随访的项目及时间	2.46±1.13
CIC患者再次评估的时机	2.35±1.05
CIC患者泌尿系感染的原因	2.71±1.03
CIC停止的指征	2.63±1.19

项目	n	构成比(%)	自我评价得分	F值	P值
性别				3.489	0.630
男	5	2.1	37.20±13.41
女	236	97.9	50.39±15.65
年龄(岁)				6.741	0.001
20~30	48	19.9	42.94±11.81
31~40	118	49.0	51.36±17.09
41~50	75	31.1	52.73±14.35
学历				5.547	0.001
中专	7	2.9	38.86±9.21
大专	53	22.0	45.23±11.94
本科	176	73.0	51.56±16.16
硕士及以上	5	2.1	66.60±20.14
职称				7.760	0.001
初级	66	27.4	43.80±13.69
中级	121	50.2	52.40±15.82
高级	54	22.4	50.11±15.70
工作年限(年)				4.854	0.001
1~5	26	10.8	45.85±12.81
6~10	46	19.1	43.30±14.65
11~15	58	24.1	50.00±15.95
16~20	38	15.8	55.95±17.20
> 20	73	30.3	52.97±14.64
工作城市				0.800	0.527
广州	81	33.6	51.85±17.89
深圳	20	8.3	52.05±12.63
东莞	26	10.8	50.69±14.03
佛山	32	13.3	46.25±15.29
其他城市	82	34.0	49.44±15.70
医院级别				6.868	0.009
三级甲等	143	59.3	52.28±16.21
三级甲等以下	98	40.7	46.95±14.42
工作科室				10.604	< 0.001
康复科	70	29.0	59.07±14.88
神经内外科	66	27.4	48.60±14.79
其他外科其他内科	51 54	21.2 22.4	47.25±14.13 43.24±14.32
是否专科护士				10.570	< 0.001
非专科护士	101	41.9	44.92±15.13
康复专科护士	55	22.8	59.04±14.69
其他专科护士	85	35.3	50.66±14.43

题目	回答正确人数(n)	正确率(%)
NB的病因	131	54.4
膀胱的正常容量	146	60.6
膀胱的安全压力	142	58.9
CIC每日饮水量	211	87.6
NB的评定包含的内容	105	43.6
NB的并发症	103	42.7
留置尿管的并发症	146	60.6
NB泌尿系感染的原因	135	56.0
自主神经过反射易发生的人群	118	49.0
自主神经过反射的症状	124	51.5
自主神经过反射的处理策略	200	83.0
输尿管返流的诱因	216	89.6
诊断输尿管返流的金标准	100	41.5
输尿管返流的处理策略	169	70.1
排尿障碍患者出现漏尿的原因	218	90.5
尿潴留患者出现失禁是否说明膀胱功能恢复向好	168	69.7

题目	回答“是”的人数(n)	百分比(%)
您工作中是否经常遇见排尿障碍或失禁的患者	150	62.2
您工作中是否有长期留置尿管的患者	201	83.4
您工作中是否有排尿障碍的患者出现泌尿系感染	213	88.4
您工作中是否有患者因排尿障碍向您求医	208	86.3
您的科室或医院开展CIC吗	149	61.8
您是否亲自指导过患者进行CIC	121	50.2
您有对出院后居家CIC患者进行跟踪管理吗	76	31.5
您认为指导患者CIC护理会遇到专业问题	163	67.6
您是否参加过NB护理的专项技术培训或进修	67	27.8
您是否想参加NB护理的专项技术培训或进修	173	71.8
您是否愿意加入CIC护理群,共同学习,获得资讯	228	94.6
您是否愿意加入NB护理联盟,为转诊及出院后患者服务	211	87.6

题目	选项	人数	百分比(%)
1.您护理的排尿障碍的患者常见于哪些疾病(多选题)	脊髓损伤	155	64.3
	卒中或颅脑神经损伤	162	67.2
	非外伤脊柱手术前后	87	36.1
	糖尿病	68	28.2
	痴呆、认知障碍或帕金森	145	61.2
2.您所在的科室针对排尿障碍患者的处理方式(单选题)	留置尿管	162	67.2
	CIC	58	24.1
	使用保鲜袋或集尿器	21	8.7
3.您科室医生对排尿障碍的患者是否积极查找原因并给予康复措施(单选题)	从未	27	11.2
	偶尔	73	30.3
	较少	75	31.2
	较多	42	17.4
	经常	24	9.9
4.您认为医生不积极采取应对排尿障碍留置尿管的患者原因(多选题)	知识缺乏	187	77.6
	关注不够	186	77.2
	担心护士不配合	33	13.7
	担心尿道感染及尿道损伤	156	65.6
	不积极接受新技术及指南	63	26.1
5.您认为临床开展CIC的阻力是什么(多选题)	知识缺乏	206	85.5
	培训不足	209	86.7
	医生不支持	89	36.9
	医院及科室未要求	65	26.9
	导尿次数多增加工作量	169	70.1
	担心感染	174	72.3
	患者不接收	150	62.2
	购买尿管增加经济负担	120	49.7

Survey of Rehabilitation Nursing Management of Neurogenic Bladder and Clinical Application of Intermittent Catheterization in Guangdong, China

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