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肾结石是常见泌尿系疾病之一,在过去的50年内,在大多数国家,肾结石的发病率都有所上升[1],在中国,肾结石发病率则从4%上升到6.4%[2-3]。目前国内肾结石微创手术包括经超声体外冲击波碎石(SWL)[4]、经皮肾镜取石术(PCNL)[5]、输尿管软镜碎石取石术(FURS或者RIRS)[6]。肾结石复发率较高,10年的随访发现复发率高达26%~53%[7]。较高的复发率降低了病人生命质量,因此预防肾结石术后复发的护理干预应同治疗同等重要,肾结石复发影响因素较多,大致分为内因性因素和外因性因素[8],外因中肾结石复发具有明显的地理差异特点[3],本研究主要通过对阜阳地区近几年来入住本院的病例进行回顾性分析,通过对实施微创手术治疗的肾结石病人术后1年内复发模型构建,分析短期与健康行为有关的复发危险因素比重,为护理干预提供参考依据。
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结果显示:复发组高血压和糖尿病病人人数高于非复发组,复发组体质量指数(BMI)≥30.0 kg/m2人数比例高于非复发组,差异均有统计学意义(P < 0.05~P < 0.01),2组在性别、年龄、高钙血症、高尿酸血症和微创方式上比较,差异均无统计学意义(P > 0.05)(见表 1)。
分组 n 男 女 年龄(x±s)/岁 BMI/(kg/m2) 高血压 糖尿病 高钙血症 高尿酸血症 微创方式 < 30.0 ≥30.0 有 无 有 无 有 无 有 无 SWL PCNL FURS 复发组 20 13 7 51.55±10.16 8 12 12 8 13 7 12 8 6 14 4 6 10 非复发组 128 88 40 47.47±10.66 87 41 47 81 44 84 83 45 18 110 17 40 71 χ2 — 0.11 1.60* 5.89 3.91 6.85 0.18 2.17 0.65 P — > 0.05 > 0.05 < 0.05 < 0.05 < 0.01 > 0.05 > 0.05 > 0.05 *示t值 表 1 结石复发组和非复发组疾病相关情况比较(n)
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结果显示2组病人在每日饮水量、经常饮用水性质、经常服用鱼油、经常吃腌制食物、摄入蛋白质来源方面比较,差异均有统计学意义(P < 0.05~P < 0.01),而在新鲜水果摄入、因素偏好口味、运动情况比较,差异均无统计学意义(P > 0.05)。其中,饮水量1.5~3 L/d结石复发率低于 < 0.5 L/d和0.5~1.5 L/d(P < 0.01和P < 0.05),经常饮用含果糖苏打水和可乐复发率高于饮用纯净水或者白开水、碱性苏打水(P < 0.05~P < 0.01)(见表 2)。
健康行为 n 复发组(n=20) 非复发组(n=128) χ2 P 新鲜水果摄入 从不 14 7 28 2.75 > 0.05 偶尔 89 8 45 经常 45 5 55 饮水量/(L/d) < 0.5 32 10 22 14.34 < 0.01 0.5~1.5 34 6 28 1.5~3 82**# 4 78 经常饮用水性质 纯净水或者白开水 70 5 65 12.76 < 0.01 含果糖苏打水 17* 4 13 碱性苏打水 26# 1 25 可乐 35**▽ 10 25 经常服用鱼油 有 46 2 44 4.79 < 0.05 无 102 18 84 饮食偏好口味 油腻重盐 92 16 76 3.13 > 0.05 清淡素食 56 4 52 经常吃腌制食物 有 72 14 58 4.22 < 0.05 无 76 6 70 蛋白摄入来源 动物类蛋白偏多 85 16 69 4.82 < 0.05 植物类蛋白偏多 63 4 59 运动情况 从不 39 8 31 2.40 > 0.05 偶尔 66 8 58 经常 43 4 39 与 < 0.5 L/d、纯净水或者白开水比较*P < 0.05,**P < 0.01;与0.5~1.5 L/d、含果糖苏打水比较#P < 0.05;与碱性苏打水比较▽P < 0.05 表 2 结石复发组和非复发组微创术后饮食运动情况比较
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结果显示,非复发组在健康行为能力总分、营养维度、心理安适维度、健康责任维度得分均显著高于复发组(P < 0.05~P < 0.01)(见表 3)。
分组 n 总分 营养 心理安适 运动 健康责任 复发组 20 62.15±16.88 15.18±4.55 16.71±3.76 15.77±3.33 14.49±4.12 非复发组 128 73.14±18.11 18.82±4.12 18.91±3.39 17.46±4.12 17.95±5.25 t — 2.55 3.62 2.66 1.75 2.81 P — < 0.05 < 0.01 < 0.01 > 0.05 < 0.01 表 3 结石复发组和非复发组健康行为能力自评量表评分比较(x±s; 分)
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以结石是否复发为因变量,将单因素中有意义者作为纳入模型,进行logistic回归模型的建立,自变量赋值如下:BMI(< 30.0 kg/m2=0,≥30.0 kg/m2=1)、高血压(无=0,有=1)、糖尿病(无=0,有=1)、饮水量(< 0.5 L/d=0,0.5~ < 1.5 L/d=1,1.5~3 L/d=2)、经常饮用水性质(纯净水或者白开水=000,含果糖苏打水=100,碱性苏打水=010,可乐=001)、经常服用鱼油(无=0,有=1)、经常吃腌制食物(无=0,有=1)、蛋白摄入来源(动物类蛋白偏多=0,植物类蛋白偏多=1)、健康行为能力(分值输入)。构建模型方程=6.122-0.633X1(1)-2.512X1(2)+1.351X2-4.124X3-1.888X4-2.111X5-0.996X6,可见饮水量1.5~3 L/d、健康行为能力、经常服用鱼油、摄入蛋白以植物蛋白为主是结石复发的保护因素,饮水量 < 0.5 L/d、BMI > 30.0 kg/m2、经常吃腌制食物是结石复发的危险因素。由方程系数得知其比重由大到小分别为健康行为能力、每天饮水量、吃腌制食物、BMI、蛋白质来源(见表 4)。
因素 B SE Waldχ2 P OR(95%CI) 常量 6.122 1.999 9.93 < 0.01 — 饮水量X1(以 < 0.5 L/d为参照) 0.5~ < 1.5 L/dX1(1) -0.663 0.311 1.11 > 0.05 1.122(0.098~6.295) 1.5~3 L/dX1(2) -2.512 1.149 4.13 < 0.01 5.678(2.511~26.617) BMIX2(以 < 30.0为参照) ≥30.0 1.351 0.609 4.96 < 0.05 3.865(1.177~18.611) 健康行为能力X3 -4.124 3.111 7.19 < 0.01 11.190(3.577~31.381) 经常服用鱼油X4(以无为参照) 有 -1.888 0.849 5.61 < 0.05 7.299(1.408~28.811) 经常吃腌制食物X5(以无为参照) 有 2.111 0.985 4.43 < 0.05 8.181(3.122~33.198) 蛋白摄入来源X6(以动物蛋白为参照) 植物蛋白 -0.996 0.677 1.67 < 0.05 2.455(1.210~13.401) 表 4 结石复发多因素模型
肾结石微创术后复发风险模型构建及护理干预研究
Study on the construction of recurrence risk model and nursing intervention of kidney stone after minimally invasive surgery
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摘要:
目的通过构建肾结石微创术后复发风险模型,分析阜阳市第二人民医院收治肾结石病人与健康行为有关的复发影响因素,为临床护理干预提供循证策略。 方法回顾性收集行肾结石微创手术的148例病人首次发病时与疾病相关的资料,微创术后复发时与疾病相关的资料,首次结石微创术后饮食运动情况以及健康行为能力自评量表进行健康行为能力评估。通过单因素分析和多因素logistic回归分析构建结石复发模型。 结果复发组高血压和糖尿病病人人数高于非复发组,复发组体质量指数(BMI) > 30.0 kg/m2人数比例高于非复发组,差异均有统计学意义(P < 0.05~P < 0.01);2组病人在每日饮水量、经常饮用水性质、经常服用鱼油、经常吃腌制食物、摄入蛋白质来源方面比较,差异均有统计学意义(P < 0.05~P < 0.01);非复发组在健康行为能力总分、营养维度、心理安适维度、健康责任维度得分均显著高于复发组(P < 0.05);构建模型复发方程LogitP=6.122-0.633X1(1)-2.512X1(2)+1.351X2-4.124X3-1.888X4-2.111X5-0.996X6,结果显示饮水量1.5~3 L/d、健康行为能力、经常服用鱼油、摄入蛋白以植物蛋白为主是结石复发的保护因素,饮水量 < 0.5 L/d、BMI > 30.0 kg/m2、经常吃腌制食物是结石复发的危险因素。由方程系数得知其比重由大到小分别为健康行为能力、每天饮水量、吃腌制食物、BMI、蛋白质来源。 结论预防肾结石术后复发,护理干预应着重提高病人健康行为能力,形成健康的生活方式。 Abstract:ObjectiveTo establish the recurrence risk model after minimally invasive surgery for kidney stones to analyze the influencing factors of recurrence related to health behavior in patients with kidney stones from Fuyang Second People's Hospital for providing the evidence-based strategies in clinical nursing intervention. MethodsThe data of disease at first onset and recurrence after minimally invasive surgery related to disease in 148 kidney stones patients treated with minimally invasive surgery were retrospectively analyzed.The health behavior ability of pateints after the first minimally invasive surgery for calculi were assessed using the health behavior ability self-rating scale.The calculus recurrence model was established by univariate analysis and multivariate logistic regression analysis. ResultsThe number of hypertensive and diabetic patients in recurrent group were higher than that in non-recurrent group, and the proportion of patients with body mass index(BMI) > 30.0 kg/m2 in recurrence group was higher than that in non-recurrence group(P < 0.05 to P < 0.01).The differences of the daily intake of water, nature of regular drinking water, frequent use of fish oil, frequent consumption of preserved foods and intake of protein sources between two groups were statistically significant(P < 0.05 to P < 0.01).The total score of healthy behavior ability, and scores of nutritional dimension, psychological comfort dimension and health responsibility dimension in non-recurrent group were higher than those in recurrent group(P < 0.05).The model recurrence equation was LogitP=6.122-0.633X1(1)-2.512X1(2)+1.351X2-4.124X3-1.888X4-2.111X5-0.996X6.The results showed that the 1.5-3 L/d water intake, healthy behavior ability, frequent use of fish oil, intake mainly plant protein were the protective factors of stone recurrence, and the water intake less than 0.5 L/d, BMI > 30.0 kg/m2 and frequent consumption of preserved food were the risk factors of stone recurrence.According to the coefficient of the equation, the proportion from large to small were healthy behavior ability, daily water intake, pickled food, BMI and protein source in turn. ConclusionsTo prevent recurrence of kidney stones after operation, the nursing intervention should focus on improving patients' healthy behavior ability and forming healthy lifestyle. -
Key words:
- kidney stone /
- risk of recurrence /
- nursing intervention
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表 1 结石复发组和非复发组疾病相关情况比较(n)
分组 n 男 女 年龄(x±s)/岁 BMI/(kg/m2) 高血压 糖尿病 高钙血症 高尿酸血症 微创方式 < 30.0 ≥30.0 有 无 有 无 有 无 有 无 SWL PCNL FURS 复发组 20 13 7 51.55±10.16 8 12 12 8 13 7 12 8 6 14 4 6 10 非复发组 128 88 40 47.47±10.66 87 41 47 81 44 84 83 45 18 110 17 40 71 χ2 — 0.11 1.60* 5.89 3.91 6.85 0.18 2.17 0.65 P — > 0.05 > 0.05 < 0.05 < 0.05 < 0.01 > 0.05 > 0.05 > 0.05 *示t值 表 2 结石复发组和非复发组微创术后饮食运动情况比较
健康行为 n 复发组(n=20) 非复发组(n=128) χ2 P 新鲜水果摄入 从不 14 7 28 2.75 > 0.05 偶尔 89 8 45 经常 45 5 55 饮水量/(L/d) < 0.5 32 10 22 14.34 < 0.01 0.5~1.5 34 6 28 1.5~3 82**# 4 78 经常饮用水性质 纯净水或者白开水 70 5 65 12.76 < 0.01 含果糖苏打水 17* 4 13 碱性苏打水 26# 1 25 可乐 35**▽ 10 25 经常服用鱼油 有 46 2 44 4.79 < 0.05 无 102 18 84 饮食偏好口味 油腻重盐 92 16 76 3.13 > 0.05 清淡素食 56 4 52 经常吃腌制食物 有 72 14 58 4.22 < 0.05 无 76 6 70 蛋白摄入来源 动物类蛋白偏多 85 16 69 4.82 < 0.05 植物类蛋白偏多 63 4 59 运动情况 从不 39 8 31 2.40 > 0.05 偶尔 66 8 58 经常 43 4 39 与 < 0.5 L/d、纯净水或者白开水比较*P < 0.05,**P < 0.01;与0.5~1.5 L/d、含果糖苏打水比较#P < 0.05;与碱性苏打水比较▽P < 0.05 表 3 结石复发组和非复发组健康行为能力自评量表评分比较(x±s; 分)
分组 n 总分 营养 心理安适 运动 健康责任 复发组 20 62.15±16.88 15.18±4.55 16.71±3.76 15.77±3.33 14.49±4.12 非复发组 128 73.14±18.11 18.82±4.12 18.91±3.39 17.46±4.12 17.95±5.25 t — 2.55 3.62 2.66 1.75 2.81 P — < 0.05 < 0.01 < 0.01 > 0.05 < 0.01 表 4 结石复发多因素模型
因素 B SE Waldχ2 P OR(95%CI) 常量 6.122 1.999 9.93 < 0.01 — 饮水量X1(以 < 0.5 L/d为参照) 0.5~ < 1.5 L/dX1(1) -0.663 0.311 1.11 > 0.05 1.122(0.098~6.295) 1.5~3 L/dX1(2) -2.512 1.149 4.13 < 0.01 5.678(2.511~26.617) BMIX2(以 < 30.0为参照) ≥30.0 1.351 0.609 4.96 < 0.05 3.865(1.177~18.611) 健康行为能力X3 -4.124 3.111 7.19 < 0.01 11.190(3.577~31.381) 经常服用鱼油X4(以无为参照) 有 -1.888 0.849 5.61 < 0.05 7.299(1.408~28.811) 经常吃腌制食物X5(以无为参照) 有 2.111 0.985 4.43 < 0.05 8.181(3.122~33.198) 蛋白摄入来源X6(以动物蛋白为参照) 植物蛋白 -0.996 0.677 1.67 < 0.05 2.455(1.210~13.401) -
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