基于HALF分级的上尿路结石围手术期感染预防和管理的应用研究

Perioperative infection prevention and management for upper urolithiasis based on HALF grouping

摘要

目的 评价基于HALF（高风险high risk，H；无症状菌尿asymptomatic bacteriuria，A；低风险low risk，L；发热fever，F）分级的医护协作管理在改善上尿路结石围术期感染预防和治疗的效果。 方法 检索证据，形成以分级管理、尿脓毒症筛查和1 h集束化管理为主的方案。采用非同期前后对照研究，以重庆医科大学附属第一医院2023年1至12月收治的上尿路结石患者为干预组（n=2 142），实施以HALF分组为基础的围术期预防和管理；2022年1至12月的病例为对照组（n=1 938），实施常规管理。比较2组患者抗菌药疗程合理率、全身炎症反应综合征检出率、脓毒症发生率等。 结果 与对照组相比，干预组抗菌药术前使用疗程合理率提高（60.99% vs. 76.24%，P=0.000），术后疗程合理率提高（76.62% vs. 83.94%，P=0.000）；全身炎症反应综合征检出率提高（5.21% vs. 6.91%，P=0.024），术后脓毒症发生率下降（0.98% vs. 0.42%，P=0.030），脓毒症抗菌药物使用窗口期缩短［（57.45±17.32） min vs.（50.90±16.08） min，P=0.039］，差异有统计学意义（P<0.05）。 结论 基于HALF分级的医护协作管理能改善上尿路结石的围术期感染预防和治疗效果，值得推广。

Abstract

Objective To evaluate the effectiveness of doctor-nurse collaboration management based on HALF（high risk，asymptomatic bacteriuria，low risk，fever） grouping in improving perioperative infection prevention and treatment of upper urolithiasis. Methods Evidence was retrieved to form the plan mainly composed of grouping management，the screening for urinary sepsis，and 1-hour management bundle. A controlled before-and-after study was implemented. The patients with upper urolithiasis admitted in January to December 2023 were included in intervention group（n=2 142） and received perioperative infection prevention and management based on HALF grouping. The patients admitted in January to December 2022（n=1 938） were included in control group and received conventional management. The rate of rational antibiotic treatment course，detection rate of systemic inflammatory response syndrome，and incidence of sepsis were compared between the two groups. Results Compared with the control group，the intervention group showed significantly higher rates of rational antibiotic treatment course before operation（60.99% vs. 76.24%，P=0.000） and after operation（76.62% vs. 83.94%，P=0.000），a significantly higher detection rate of systemic inflammatory response syndrome （5.21% vs. 6.91%，P=0.024），a significantly lower postoperative incidence of sepsis（0.98% vs. 0.42%，P=0.030），and a significantly narrower window of antibiotic use for sepsis［（57.45±17.32） min vs. （50.90±16.08） min，P=0.039］ （P<0.05）. Conclusion The doctor-nurse collaboration management based on HALF grouping can improve the quality of perioperative infection prevention and treatment in upper urolithiasis，and is worth promoting.

关键词

尿路结石 / 尿路感染 / 质量改进 / 医护协作 / 患者安全

Key words

urolithiasis / urinary tract infection / quality improvement / doctor-nurse collaboration / patient safety

基金资助

重庆医科大学未来医学青年创新团队支持计划资助项目(W0009)