经皮肾脏穿刺术后并发尿潴留的原因分析及护理改进

经皮肾脏穿刺术后并发尿潴留的原因分析及护理改进目的探讨肾脏穿刺后引发尿潴留的原因分析及护理改进。方法选取

2015年8月～2016年8月我院行肾穿刺活检术患者665例作为研究对象，采用

病例对照研究方法，将术后发生尿潴留患者作为观察组，未发生尿潴留患者作为对照组，运用单因素分析和多因素Logistic回归分析两组患者术后尿潴留相关危险因素。结果本研究665例行肾穿刺活检患者中，有35例术后发生尿潴留，尿潴留发生率为5.26%。两组患者在性别、年龄及术后饮水量等方面差异未见统计学意义（P>0.05）。观察组患者术前进行规范化床上排尿训练（执行率）18例（51.28%），对照组患者术前进行排尿练习560例（88.97%），两组术前排尿练习差异有统计学意义（P＜0.05）。观察组术后卧床时间（5.63±1.14）h长于对照组的（4.22±0.89）h，差异有统计学意义（P＜0.05）。Logistic回归分析显示：术前规范化床上排尿训练、卧床体位、仰卧时間是肾穿刺术后合并尿潴留的独立因素。结论术前规范化床上排尿训练、卧床体位、仰卧时间是肾穿刺术后引起尿潴留的独立因素，可导致尿潴留的发生，医护人员应根据患者实际症状，针对性的开展术前宣教、训练等有效护理措施，并实施心理干预护理，术后通过调整卧位、卧床时间，合理应用排尿药物，热敷和按摩腹部等护理措施，预防和避免患者出现排尿困难，使患者术后尿潴留的发生率下降。

[Abstract] Objective To explore the causes of urinary retention caused by renal puncture and nursing improvement. Methods 223 patients from August 2015 to August 2016 in our hospital underwent renal biopsy were selected as the research object. By the method of case-control study，patients with the incidence of postoperative urinary retention were as the observation group，patients without the occurrence of urinary retention were as control group. The single factor analysis and multivariate Logistic regression analysis were used to analyze the related risk factors of patients with postoperative urinary retention. Results In this study，665 cases of renal biopsy in patients with urinary retention occurred in 35 cases，the incidence of urinary retention was 5.26%. There was no significant difference in gender，age and the amount of drinking water between the two groups （P>0.05）. In observation group，there were 18 cases （51.28%）before surgery，in control group，there were 560 cases （88.97%）before the operation of urination exercise. The preoperative urination exercise difference of two groups was statistically significant （P＜0.05）. The postoperative bed time of observation group was （5.63±1.14）h，which was longer than that of control group （4.22±0.89）h，the difference was statistically significant （P＜0.05）. Logistic regression analysis showed that preoperative training，bed position and bed rest time were independent factors of urinary retention after renal puncture. Conclusion Preoperative standardized urination training，bed position and supine time are independent factors causing urinary retention after renal biopsy. They can cause the occurrence of urinary retention. The medical personnel should be based on the actual symptoms of patients，in order to carry out preoperative education and training effective nursing measures，and the implementation of psychological nursing，postoperative bed time，by adjusting the

position，rational use of urination drugs，hot compress and massage abdomen nursing measures such as prevention and avoidance of patients with dysuria，make patients the incidence of postoperative urinary retention decrease.[Key words] Renal biopsy；Urine retention；Nursing；Risk factors

肾穿刺活检术是临床对肾脏各种疾病诊断、治疗及预后评价的重要手段。目前B超引导下经皮肾穿刺活检术是临床上常采用的检查手法，但因其检查过程中对机体造成创伤，可导致出血、感染等严重的并发症[1-2]。尿潴留是肾穿刺术后最常见的并发症[3]，其不仅在生理上还在心理上给患者带来

痛苦，同时还影响医护人员对患者术后早期尿液的观察，直接影响对患者肾穿刺效果及预后恢复情况的判断。本研究通过分析肾穿刺活检术后尿潴留的危险因素，探讨改善有效的临床护理对策。

1 资料与方法

1.1 一般资料

选取2015年8月～2016年8月我院行腎穿刺活检术患者665例作为研究对象，其中男466例，女199例，年龄33～70岁，平均年龄（43.4±8.4）岁，其中肾病综合征、慢性肾炎综合征、慢性肾功能不全急性加重、狼疮性肾炎、2型糖尿病性肾病、蛋白尿、血尿、药物性肾病分别214例、198例、73例、59例、42例、37例、29例和13例。其中术后发生尿潴留35例，约占总例数的5.26%。

1.2 方法

采用病例对照研究方法，将术后发生尿潴留患者作为观察组，未发生尿潴留患者作为对照组。研究因素包括患者性别、年龄、术前训练、术后饮水量、卧床时间、穿刺点疼痛及仰卧体位。

1.3 护理方法

Ⅰ术前对患者进行常规基础护理，并根据患者的意愿，对其展开床上排尿训练同时指导其排尿技巧。Ⅱ心理护理：肾穿刺是一项有创伤性诊断检查，患者对其存在不同程度的紧张、焦虑、恐惧等不良情绪，针对患者这种心理，医护人员应对患者表示理解、关心，向患者及家属讲解肾穿刺的目的、安全性及对疾病诊断及治疗的临床意义。与患者多沟通介绍成功经验及病例，获得患者的信任和配合。Ⅲ术后护理：叮嘱患者多饮水，术后6h内采用平卧，腰部固定不动，上下肢可适当的活动，术后6h后改变患者卧位，为患者营造良好的排尿环境。协助患者行仰卧位，要求患者卧床24h下床活动。并根据患者的实际情况给予适当的补液支持，避免血凝块的发生，防止尿道梗阻[4-5]。

1.4 统计学方法