基于正强化理论的护理干预在改善ICU留置导尿管患者排尿功能的效果观察

Observations on the Effects of Nursing Interventions Based on Positive Reinforcement Theory in Improving Micturition Function of ICU Patients with Indwelling Catheters

摘要: 目的：探讨基于正强化理论的护理干预在改善ICU留置导尿管患者排尿功能的效果。方法：本研究为前瞻性非随机对照研究，采用便利抽样，选取2024年5月至2024年12月在青岛市某三级甲等医院重症医学科治疗的216名留置导尿管患者作为研究对象，按照入科时间分为观察组108例和对照组108例。观察组给予常规护理联合集束化护理措施，对照组给予常规护理措施，干预时间为14天，分别于干预前后收集资料，比较两组的导尿管重置率、首次排尿时间、首次排尿量、尿路感染发生率和导尿管留置时间。结果：干预措施实施后，对照组导尿管重置率为51.85%高于观察组导尿管重置率32.41%，观察组自主排尿率为50.00%高于对照组自主排尿率30.56%，两者差异均有统计学意义(P < 0.05)，两组间诱导排尿发生率均为17.59%，差异无统计学意义(P > 0.05)。对照组导尿管留置时间为8.74 ± 1.84 d长于观察组导尿管留置时间8.05 ± 2.17 d，且尿路感染发生率为18.52%高于对照组尿路感染发生率6.48%，差异具有统计学意义(P < 0.05)。对照组首次排尿时间为103 (52, 288) min长于观察组首次排尿时间58.50 (10.4, 336.25) min，两组间差异具有统计学意义(P < 0.05)，对照组和观察组首次排尿量分别为248.50 (189, 336.25) ml和201 (152, 288) ml，差异无统计学意义(P > 0.05)。结论：基于正强化理论，实施超声监测下的多维度排尿功能护理措施有助于缩短ICU患者导尿管留置时间和首次排尿时间，降低导尿管重置率和尿路感染发生率，促进了ICU患者排尿功能的改善。

Abstract: Objective: To investigate the effect of nursing interventions based on positive reinforcement theory in improving the urinary function of ICU patients with indwelling urinary catheters. Methods: This study was a prospective non-randomized controlled trial. Using convenience sampling, 216 patients with indwelling catheters treated in the intensive care unit of a tertiary hospital in Qingdao from May 2024 to December 2024 were selected as the study participants. They were assigned to either an observation group (n = 108) or a control group (n = 108) based on their admission time. The observation group received routine care combined with bundled care measures, while the control group received routine care only. The intervention lasted for 14 days. Data were collected before and after the intervention to compare the catheter reinsertion rate, time to first void, volume of first voiding, incidence of urinary tract infections, and indwelling catheter duration between the two groups. Results: After the intervention, the catheter reinsertion rate in the control group (51.85%) was higher than that in the observation group (32.41%), and the spontaneous voiding rate in the observation group (50.00%) was higher than that in the control group (30.56%), with both differences being statistically significant (P < 0.05). The incidence of induced voiding was 17.59% in both groups, showing no statistically significant difference (P > 0.05). The indwelling catheter duration in the control group (8.74 ± 1.84 days) was longer than that in the observation group (8.05 ± 2.17 days), and the incidence of urinary tract infections in the control group (18.52%) was higher than that in the observation group (6.48%), with the differences being statistically significant (P < 0.05). The time to first void in the control group [103 (52, 288) min] was longer than that in the observation group [58.50 (10.4, 336.25) min], with a statistically significant difference between the groups (P < 0.05). The volume of first voiding in the control group and observation group was 248.50 (189, 336.25) ml and 201 (152, 288) ml, respectively, with no statistically significant difference (P > 0.05). Conclusion: Based on the Positive Reinforcement Theory, the implementation of multidimensional urinary function care measures under ultrasound monitoring helps to shorten the indwelling catheter duration and time to first voiding in ICU patients, reduce the catheter reinsertion rate and incidence of urinary tract infections, thereby promoting the improvement of urinary function in ICU patients.