基于Stetler循证实践模式下输尿管支架相关症状管理方案的构建及初步验证

Development and Preliminary Validation of a Symptom Management Protocol for Ureteral Stent-Related Symptoms Based on the Stetler Evidence-Based Practice Model

摘要: 目的：构建上尿路结石术后患者输尿管支架相关症状管理方案，应用并评价该方案的可行性及临床实效性，有效控制输尿管支架相关症状的发生，提高患者自我管理能力，增加患者舒适度，改善患者生活质量。方法：基于循证理念，运用德尔菲法构建输尿管镜碎石术后患者输尿管支架相关症状管理方案，干预方案内容包括评估患者症状经历、认知干预、围术期健康指导、症状评估及管理、其他管理策略5个方面。便利选取四川省某三级甲等医院2024年5月至2024年10月入院的行输尿管镜碎石术患者为研究对象，以2024年5月~7月的34例患者为对照组，采用常规护理方法；以2024年8月~10月的35例患者为干预组，采用常规护理结合输尿管支架相关症状管理方案的方法。分别在术前第1天、术后1个月、术后2个月进行比较两组患者的输尿管支架相关症状发生率，国际前列腺症状评分，泌尿生殖障碍评分，疼痛视觉模拟评分，输尿管支架相关症状评分。结果：两组患者一般资料经分析具有可比性(P > 0.05)。两组患者输尿管支架相关症状发生率呈下降趋势。比较两组患者术前第1天、术后1个月、术后2个月的IPSS得分、UDI-6得分、VAS得分和USSQ得分数据符合正态分布，采用重复测量方差分析；两组患者得分随着时间的变化而呈现下降趋势，干预组优于对照组，得分存在统计学差异显著。结论：本研究构建的上尿路结石患者术后输尿管支架相关症状管理方案的应用可以提高患者的自我管理能力和管理效果，可为上尿路结石患者术后症状管理提供参考。

Abstract: Objective: To develop a symptom management protocol for ureteral stent-related symptoms in patients after upper urinary tract stone surgery, and to evaluate the feasibility and clinical effectiveness of the protocol, so as to effectively control the occurrence of ureteral stent-related symptoms, improve patients’ self-management ability, enhance patient comfort, and improve their quality of life. Methods: Based on evidence-based concepts, a ureteral stent-related symptom management protocol for patients after ureteroscopic lithotripsy was constructed using the Delphi method. The intervention protocol consisted of five aspects: assessment of patients’ symptom experience, cognitive intervention, perioperative health guidance, symptom assessment and management, and other management strategies. Patients who underwent ureteroscopic lithotripsy at a tertiary first-class hospital in Sichuan Province from May 2024 to October 2024 were conveniently selected as the study subjects. Thirty-four patients admitted from May to July 2024 served as the control group and received routine nursing care. Thirty-five patients admitted from August to October 2024 served as the intervention group and received routine nursing care combined with the ureteral stent-related symptom management protocol. The incidence of ureteral stent-related symptoms, International Prostate Symptom Score (IPSS), Urogenital Distress Inventory-6 (UDI-6) score, Visual Analog Scale (VAS) score, and Ureteral Stent Symptom Questionnaire (USSQ) score were compared between the two groups on postoperative day 1, and at 1 month and 2 months after surgery. Results: The general data of the two groups were comparable (P > 0.05). The incidence of ureteral stent-related symptoms showed a decreasing trend in both groups. The IPSS, UDI-6, VAS, and USSQ scores at postoperative day 1, 1 month, and 2 months were normally distributed and analyzed using repeated-measures analysis of variance. The scores in both groups decreased over time, and the intervention group was superior to the control group, with statistically significant differences. Conclusion: The application of the ureteral stent-related symptom management protocol constructed in this study for patients after upper urinary tract stone surgery can improve patients’ self-management ability and management effectiveness, and may serve as a reference for postoperative symptom management in these patients.