膀胱痉挛评分联合改良PDCA循环管理对经尿道铥激光前列腺剜除术后膀胱痉挛发生率的影响

doi:10.3877/cma.j.issn.1674-3253.2026.03.009

目的

探讨膀胱痉挛评分联合改良PDCA循环护理管理模式对经尿道前列腺铥激光剜除术后患者膀胱痉挛发生率的影响。

方法

选择上海市东方医院泌尿外科2022年1月至2024年11月入院行经尿道前列腺铥激光剜除术的患者作为研究对象，其中2022年1月至2023年6月患者为对照组，共246例，行常规护理。2023年7月至2024年11月患者为观察组，共278例，通过自制膀胱痉挛评分联合改良PDCA循环护理。对比两组膀胱痉挛评分及发生率、疼痛评分、术后膀胱冲洗时间、术后第一天血红蛋白下降值、术后住院时间、术后止痛药物使用率、生活质量评分、焦虑评分以及护理满意度等。

结果

本研究纳入524例患者均手术成功，无再次手术患者。其中对照组发生膀胱痉挛69例，术后膀胱痉挛发生率28.05%（69/246）。观察组膀胱痉挛31例，术后膀胱痉挛发生率11.15%（31/278），两组对比差异有统计学意义（P<0.05）。患者术后疼痛视觉评分，观察组1（1，2）分，对照组3（1，5）分，两组对比差异有统计学意义（P=0.016）。观察组与对照组的术后膀胱冲洗时间以及术后住院天数对比差异无统计学意义（P>0.05）。观察组的膀胱痉挛评分为（5.3±2.4）分，对照组为（9.5±2.7）分，两者对比差异有统计学意义（P=0.016）。两组间的生活质量评分、焦虑评分、护理满意度对比差异均有统计学意义（P值分别为0.006，0.002，0.026）。

结论

膀胱痉挛评分联合改良PDCA循环护理管理模式可有效降低前列腺铥激光剜除术后膀胱痉挛的发生率，提高患者对疾病的认知，缓解焦虑，提高患者护理满意度。

关键词: 铥激光, 前列腺剜除术, 膀胱痉挛, 膀胱痉挛评分, PDCA循环管理

Objective

To investigate the impact of bladder spasm score combined with a modified PDCA cycle nursing management model on the incidence of bladder spasm in patients undergoing transurethral thulium laser enucleation of the prostate (ThuLEP).

Methods

The data of patients admitted to the Department of Urology, Shanghai East Hospital, from January 2022 to November 2024 for ThuLEP were retrospectively analyzed. Among them, 246 patients treated between January 2022 and June 2023 were assigned to the control group and received routine nursing care. A total of 278 patients treated from July 2023 to November 2024 were assigned to the observation group and underwent nursing management integrating a self-designed bladder spasm score with a modified PDCA cycle. Comparisons were made between the two groups regarding bladder spasm scores, incidence of bladder spasm, pain scores, postoperative bladder irrigation duration, the decrease in hemoglobin on the first day after the operation, postoperative hospital stay, analgesic usage rate, quality of life (QOL), anxiety scores, and nursing satisfaction.

Results

All 524 enrolled patients successfully completed the surgery without requiring reoperation. In the control group, 69 cases (28.05%) developed postoperative bladder spasm, whereas 31 cases (11.15%) were observed in the observation group, demonstrating a statistically significant difference (P<0.05). The postoperative visual analogue scale (VAS) scores were significantly lower in the observation group [1(1, 2)] compared to the control group [3(1, 5)] (P=0.016). No significant differences were observed in postoperative bladder irrigation duration or hospital stay between the two groups (P>0.05). The bladder spasm score was significantly reduced in the observation group (5.3±2.4) versus the control group (9.5±2.7) (P=0.016). Statistically significant improvements were also noted in quality of life (QOL) scores, anxiety scores, and nursing satisfaction (P=0.006, 0.002, and 0.026, respectively).

Conclusion

The integrated bladder spasm score and modified PDCA cycle nursing management model effectively reduces the incidence of bladder spasm following thulium laser enucleation of the prostate, enhances patients' disease awareness, alleviates anxiety, and improves nursing satisfaction.

Key words: Thulium laser, Enucleation of the prostate, Bladder spasm, Bladder spasm score, PDCA cycle management

图1 自制膀胱痉挛评分量表

表1 两组行经尿道前列腺铥激光剜除术患者临床资料比较

组别	例数	年龄[岁，(±s)]	前列腺大小[mL，(±s)]	PSA[ng/mL，M(Q)]	手术时间[min，M(Q)]	术后疼痛视觉评分M(Q)	膀胱冲洗时间[h，M(Q)]	术后出院时间[d，M(Q)]
对照组	246	71.4±8.5	68.4±12.2	3.9 (1.5，7.2)	95 (70，100)	3 (1，5)	24 (12，36)	4 (3，8)
观察组	278	70.5±10.2	64.3±15.6	3.6 (1.3，6.5)	100 (90，110)	1 (1，2)	24 (12，36)	3 (2，5)
统计值		t=0.324	t=0.976	Z=0.776	Z=-1.486	Z=2.420	Z=0.023	Z=0.442
P值		0.746	0.328	0.438	0.138	0.016	0.982	0.657
组别	膀胱痉挛评分(±s)	膀胱痉挛发情况[例(%)]	血红蛋白下降[g/L，(±s)]	术后止痛药物使用情况[例(%)]	生活质量评分[分，M(Q)]	焦虑评分(±s)	对护理满意情况[例(%)]
对照组	9.5±2.7	69 (28.05)	10.56±5.78	56 (22.76)	3(2，6)	42.5±21.3	218 (88.61)
观察组	5.3±2.4	31 (11.15)	11.38±6.26	38 (13.67)	2(1，4)	30.5±15.3	275 (98.90)
统计值	t=2.405	χ² =24.130	t=0.580	χ² =4.360	Z=2.748	t=3.110	χ² =4.890
P值	0.016	<0.001	0.564	0.038	0.006	0.002	0.026

表1 两组行经尿道前列腺铥激光剜除术患者临床资料比较

组别	例数	年龄[岁，(±s)]	前列腺大小[mL，(±s)]	PSA[ng/mL，M(Q)]	手术时间[min，M(Q)]	术后疼痛视觉评分M(Q)	膀胱冲洗时间[h，M(Q)]	术后出院时间[d，M(Q)]
对照组	246	71.4±8.5	68.4±12.2	3.9 (1.5，7.2)	95 (70，100)	3 (1，5)	24 (12，36)	4 (3，8)
观察组	278	70.5±10.2	64.3±15.6	3.6 (1.3，6.5)	100 (90，110)	1 (1，2)	24 (12，36)	3 (2，5)
统计值		t=0.324	t=0.976	Z=0.776	Z=-1.486	Z=2.420	Z=0.023	Z=0.442
P值		0.746	0.328	0.438	0.138	0.016	0.982	0.657
组别	膀胱痉挛评分(±s)	膀胱痉挛发情况[例(%)]	血红蛋白下降[g/L，(±s)]	术后止痛药物使用情况[例(%)]	生活质量评分[分，M(Q)]	焦虑评分(±s)	对护理满意情况[例(%)]
对照组	9.5±2.7	69 (28.05)	10.56±5.78	56 (22.76)	3(2，6)	42.5±21.3	218 (88.61)
观察组	5.3±2.4	31 (11.15)	11.38±6.26	38 (13.67)	2(1，4)	30.5±15.3	275 (98.90)
统计值	t=2.405	χ² =24.130	t=0.580	χ² =4.360	Z=2.748	t=3.110	χ² =4.890
P值	0.016	<0.001	0.564	0.038	0.006	0.002	0.026

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Impact of bladder spasm score combined with modified PDCA cycle management on the incidence of bladder spasm following transurethral thulium laser enucleation of the prostate

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Impact of bladder spasm score combined with modified PDCA cycle management on the incidence of bladder spasm following transurethral thulium laser enucleation of the prostate