基于循证的质量改进项目对产后尿潴留精准识别的效果  

Effect of evidence-based quality improvement project on accurate identification of postpartum urinary retention

作　　者：张焕芳[1] 陈云[1] 刘冰[1] 江紫妍[1] 任红燕 ZHANG Huanfang;CHEN Yun;LIU Bing;JIANG Ziyan;REN Hongyan(The Third Affiliated Hospital of Guangzhou Medical University,Guangdong 510150 China)

机构地区：[1]广州医科大学附属第三医院,广东510150

出　　处：《循证护理》2023年第18期3272-3277,共6页Chinese Evidence-Based Nursing

基　　金：广州市卫生健康科技一般引导项目,编号:20211A011087。

摘　　要：目的:将精准识别有产后尿潴留高危因素病人的证据应用于阴道分娩产妇中,促进早期识别产后尿潴留病人,减少尿潴留的发生。方法:以基于证据的持续质量改进模型为研究框架,于2021年5月—2022年6月通过证据获取、现况审查、证据引入和效果评价4个阶段将循证实践应用于顺产后有产后尿潴留高危因素的病人,比较循证实践应用前后病人膀胱高度评估的准确率、尿潴留病人留置尿管率、尿潴留病人留置尿管后引流出的尿量、尿潴留早期干预后留置尿管时长、产后尿潴留高危病人识别率、产后尿潴留发生率。结果:最终纳入5条证据,共4条审查指标。循证实践后,膀胱高度评估准确率由33.93%提高至78.68%;产后尿潴留病人留置尿管率由82.14%下降至60.00%;尿潴留病人留置尿管后引流出的尿量由(510±90)mL下降至(340±70)mL;尿潴留早期干预后留置尿管时长(36±12)h下降至(24±9)h;产后尿潴留高危病人识别率由66.96%提高至100.00%;显性尿潴留发生率由23.21%降至6.61%,差异均有统计学意义(P<0.05)。结论:在产前、产时、产后对孕产妇进行产后尿潴留高危因素的评估,提高了尿潴留高危病人的识别率,及时发现部分性尿潴留病人,有效降低了显性尿潴留的发生,避免膀胱过度/持久膨胀,减少了产妇因尿潴留带来的不适和住院时间的延长。Objective:To apply the evidence of accurate identification of patients with high risk factors for postpartum urinary retention to vaginal delivery in order to promote early identification of patients with postpartum urinary retention and reduce the occurrence of urinary retention.Methods:Based on the evidence-based continuous quality improvement model as the research framework,evidence-based practice was applied to patients with high risk factors of postpartum urinary retention after vaginal delivery through four stages:evidence acquisition,status review,evidence introduction and effect evaluation from May 2021 to June 2022.The accuracy of bladder height assessment before and after the application of evidence-based practice was compared,the rate of catheter retention in patients with urinary retention,the amount of urine drained after catheter retention in patients with urinary retention,the duration of catheter retention after early intervention,the identification rate of high-risk patients with postpartum urinary retention,and the incidence of postpartum urinary retention.Result:A total of 5 pieces of evidence and 4 review indicators were included in the final analysis.After evidence-based practice,the rate of bladder height assessment was improved from 33.93%to 78.68%.The rate of catheter retention decreased from 82.14%to 60.00%.The drainage volume of patients with urinary retention decreased from(510±90)mL to(340±70)mL after catheter retention.The duration of catheter retention decreased from(36±12)h to(24±9)h after early intervention.The identification rate of high-risk patients with postpartum urinary retention was increased from 66.96%to 100.00%.The incidence of overt urinary retention decreased from 23.21%to 6.61%.The differences were statistically significant(P<0.05).Conclusion:The evaluation of high risk factors of postpartum urinary retention for pregnant and lying in women before,during and after childbirth has improved the recognition rate of high-risk patients with urinary retention,timely found

关 键 词：产后尿潴留 质量改进 精准识别 循证护理 

分 类 号：R473.71[医药卫生—护理学]