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Cost-effectiveness Analysis of Perioperative No Indwelling Urinary Catheter in Lung Cancer Patients with Pulmonary Lobectomy

Objective To investigate cost-effectiveness of no indwelling urinary catheter in pulmonary lobectomy patients and to confirm the advances of no indwelling urinary catheter. Methods We recruited 148 lung cancer patients who were scheduled for pulmonary lobectomy under general anesthesia in West China Hospital from July through December 2015. These patients were divided into two groups including an indwelling urinary catheter group (74 patients, 45 males and 29 females, at age of 52.55±19.87 years) and a no indwelling urinary catheter group (74 patients, 42 males and 32 females, at age of 54.03±16.66 years). Indexes of cost-effectiveness of the two groups were compared. Results There was no statistical difference between the two groups in duration of indwelling catheter (1.56±0.0.65 d versus 1.68±0.91 d, P=0.077). Material expense(4 811.48 yuan versus 296.74 yuan, P=0.045), cost of nursing care (7 413.32 yuan versus 457.32 yuan, P=0.013), and total expense (12 224.8 yuan versus 754.06 yuan, P=0.000) in the indwelling catheter group were higher than those in the no indwelling catheter group. Material expense per patient (65.02±5.62 yuan/patient-time versus 4.01±0.00 yuan/patient-time, P=0.000), cost of nursing care per patient (100.18±7.19 yuan/patient-time versus 6.18±1.22 yuan/patient-time, P=0.000), and total cost per patient (165.20±12.81 yuan/patienttime versus 10.19±1.22 yuan/patient-time, P=0.000) in the indwelling catheter group were higher than those in the no indwelling catheter group. Conclusion Both costs and labor of nurse can be cut down for appropriate lung cancer patients undergoing lobectomy without routine indwelling urinary catheter.

Effect of evidence-based nursing of catheterization on urinary tract infection in patients with spinal cord injury and catheterization

ObjectiveTo explore the influence of evidence-based nursing care of catheterization on the incidence of urinary tract injury and urinary tract infection in patients with spinal cord injury and long-term indwelling catheters.MethodsFrom July 1st, 2017 to November 30th, 2018, 100 patients with spinal cord injury indwelling catheters in Department of Spinal Surgery were prospectively selected as the research objects. According to the admission time, patients admitted between July 2017 and February 2018 were assigned into the control group (n=50), and patients admitted between March 2018 and November 2018 were assigned into the observation group (n=50). Traditional catheter placement was used in the control group, while evidence-based catheter placement was used in the observation group. The incidences of catheter-related urethral injury and urinary tract infection after the catheterization were compared between the two groups.ResultsThere was no statistically significant difference in gender, age, diagnosis, or length of hospital stay between the two groups (P>0.05). Catheter placement was performed 57 times in the control group and 59 times in the observation group during hospitalization. After catheterization, the incidences of urethral hemorrhage and gross hematuria in the control group [22.80% (13/57) and 15.78% (9/57), respectively] were higher than those in the observation group [both were 1.69% (1/59)], with statistical differences between the two groups (P<0.05). The incidence of urinary tract infection in the control group differed from that in the observation group [42.0% (21/50) vs. 18.0% (9/50), P=0.009].ConclusionThe evidence-based urinary catheterization method for patients with spinal cord injury and long-term indwelling catheter can effectively prevent catheter-related urinary tract injury, reduce the incidence of catheter-related urinary tract infection during hospitalization, and improve the quality of clinical care.

全膝關節置換術不安置尿管的可行性研究

目的探討對行全膝關節置換術（TKR）患者不安置尿管的可行性。 方法采用前瞻性同期對照方法，選取2013年8月－12月年齡＜60歲且行TKR患者20例，依照同月入院、人口學特征、病情、合并癥基本一致且由同一醫生施行手術的2例患者按1︰1配對，共10對計算機隨機編入試驗組和對照組。對照組患者留置尿管，試驗組則不留置尿管，觀察術后兩組患者第1次自解小便的時間、尿量、是否發生尿路感染、患者自覺舒適度等指標。 結果兩組患者均能自解小便；試驗組術后第1次解出小便時間[（2.3±0.7） h]早于對照組[（5.6±0.9） h]，差異有統計學意義（P＜0.05）；且試驗組無尿路感染發生，對照組發生2例尿路感染；試驗組患者舒適度明顯高于對照組（P＜0.05）。 結論在TKR的一定范圍人群內推行不留置尿管可行，既可減少安置保留尿管的煩惱和尿路刺激征，減少術后尿路感染的危險因素，又可減少護理工作量。

安置保留尿管病人的護理質量調查分析與對策

目的:規范保留尿管的過程管理。方法：自行設計安置保留尿管病人的過程管理調查表。結果：85例安置保留尿管病人中，優30例，占總數的35.29％；良45例，占總數的58.82％；優良率94.11％；中5例，占總數的5.88％；差0例。結論：在調研的基礎上制定具體的管理措施，注重細節管理，同時使管理有章可循。

留置導尿管相關性尿路感染目標監測結果與分析

目的　了解留置導尿管相關性尿路感染發生率，為制定預防控制措施提供參考依據。 方法　2012年3月－8月在神經內科、神經外科、老年內科、泌尿外科對留置導尿管的患者進行醫院感染目標性監測。 結果　導尿管相關尿路感染發病率為6.46%，感染率最高的科室為老年內科13.95%，其次為神經外科12.96%和泌尿外科3.59%。神經內科導尿管0.00%。 結論　針對監測結果，采取適當的干預措施，可有效降低留置導尿管相關性感染的發生率。

微通道經皮腎輸尿管鏡聯合氣壓彈道碎石術在基層醫院的應用分析

目的探討微通道經皮腎輸尿管鏡聯合氣壓彈道碎石取石術（mini-PCNL）在基層醫院的應用療效和安全性。 方法對2010年3月－2013年3月收治的108例上尿路結石患者采用mini-PCNL予以治療，并就手術方式、手術時間、結石清除率等情況進行分析表述。 結果107例患者成功在B型超聲引導下建立經皮腎穿刺通道，1例腎下盞結石因腎臟大出血改開放手術行腎部分切除術，3例患者術中建立通道后出血較多安置腎造瘺管后行二期手術。手術時間為20～190 min，平均（78.0±40.1）min，結石總清除率78.5%，其中輸尿管上段結石單次清除率100.0%、腎結石單次清除率70.1%。術中平均出血量（105.0±45.6）mL，無胸膜、腹腔臟器、結腸損傷；平均住院7～14 d。 結論mini-PCNL治療上尿路結石具有較高的結石清除率、良好的安全性，同時具有術后恢復快、費用適中等優點，值得在基層醫院推廣應用。

原發性輸尿管腫瘤的影像學診斷

【摘要】 目的 探討影像學檢查對原發性輸尿管腫瘤的檢查方法及征像。 方法 回顧性分析2001年1月-2010年12月經手術病理證實的23例原發輸尿管腫瘤影像學表現及征像。 結果 根據影像學表現，輸尿管原發腫瘤多發生于中老年男性輸尿管下段，靜脈腎盂造影21例檢查中，僅3例輸尿管腔內充盈缺損。逆行腎輸尿管檢查18例中，10例插管受阻，顯示腫瘤遠端呈杯口狀改變，5例導管可通過，顯示充盈缺損。CT掃描17例中，3例發現輸尿管腫塊，2例誤診為膀胱腫瘤。B超檢查22例中，3例直接探及輸尿管腫瘤。 結論 逆行腎輸尿管造影檢查對診斷輸尿管腫瘤意義重大，診斷符合率為83.3%，CT、B超及靜脈腎盂造影遠不及逆行腎輸尿管造影。膀胱鏡檢查對某些輸尿管下段腫瘤有診斷意義。

Risk factors for intravesical recurrence after radical nephroureterectomy of upper tract urothelial carcinoma: a meta-analysis

ObjectiveTo systematically review the risk factors for intravesical recurrence (IVR) after radical nephroureterectomy (RNU) of upper tract urothelial carcinoma (UTUC).MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect case-control studies about the risk factors for IVR after RNU of UTUC from inception to August 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by RevMan 5.3 software.ResultsA total of 23 studies involving 8 614 patients were included. The results of meta-analysis showed that the history of bladder cancer (HR=1.77, 95%CI 1.42 to 2.22, P<0.001), tumor stage (≥T2) (HR=1.41, 95%CI 1.09 to 1.82,P=0.009), ureteral tumor (HR=1.34, 95%CI 1.20 to 1.49, P<0.000 01), tumor multifocality (HR=1.51, 95%CI 1.34 to 1.69,P<0.001), lymphovascular invasion (HR=1.43, 95%CI 1.20 to 1.70,P<0.000 1), laparoscopic surgery (HR=1.52, 95%CI 1.08 to 2.15,P=0.02), positive surgical margins (HR=1.87, 95%CI 1.17 to 2.99, P=0.009), and preoperative ureteroscopy (HR=1.46, 95%CI 1.21 to 1.75, P<0.001) were the risk factors for IVR after RNU.ConclusionsCurrent evidence shows that the risk factors for IVR after RNU include history bladder cancer, tumor stage (≥T2), ureteral tumor, etc. Due to the limited quality of the included studies, more high quality studies are required to verify the above conclusion.

引流袋接頭帽在封閉三腔尿管中的應用

醫護合作-快速康復模式在經輸尿管鏡鈥激光碎石術中的應用及效果評價

目的 探討醫護合作-快速康復模式在經輸尿管鏡鈥激光碎石手術中的臨床應用及效果的評價。 方法 將 2015 年 10 月—2016 年 3 月入住的 166 例輸尿管結石患者隨機分為對照組和試驗組各 83 例，對照組按傳統方法進行住院治療及圍手術期護理，試驗組按照醫護合作-快速康復模式進行診治及護理，包括門診評估、術前檢查的完善、麻醉評估、流程辦理、家庭護理的注意事項、圍手術期的飲食活動指導和疼痛管理、健康保健等。比較兩組患者的住院時間、住院費用、術后并發癥、術后首次進食時間和滿意度的差異。 結果 試驗組患者住院時間[（22.46±0.89）h]少于對照組[（76.46±0.75）h]，住院費用[（8 275.21±789.45）元]低于對照組[（12 859.11±1 047.54）元]，并發癥發生率[10.8%（9/83）]低于對照組[41.0%（34/83）]，患者滿意度[（99.87±5.12）%]高于對照組[90.66±5.95）%]，差異均有統計學意義（P<0.05）。 結論 醫護合作-快速康復模式應用于輸尿管鏡鈥激光碎石手術，能充分利用醫療資源，促進醫患關系協調，縮短患者的住院日，減少患者的住院費用，降低術后并發癥的發生，促進術后康復，早日恢復患者的正常生活。