目的 探讨肾移植术后患者膀胱痉挛发生现状及影响因素。方法 选取广州医科大学附属第一医院2022年12月—2024年4月收治的80例肾移植患者为研究对象,记录术后膀胱痉挛发生情况,将15例术后发生膀胱痉挛的患者纳入膀胱痉挛组,其余65例患者纳入非膀胱痉挛组。对比两组一般人口学资料,术前临床资料、术中及术后情况。以合并膀胱痉挛作为因变量纳入Logistics回归模型分析肾移植术后膀胱痉挛发生的影响因素。结果 80例肾移植患者在术后共有15例患者发生膀胱痉挛,占比为18.76%。膀胱痉挛组与非膀胱痉挛组的性别、年龄、体质指数、文化程度、付费方式、家庭收入比较差异无统计学意义（P>0.05）;两组原发疾病、合并基础疾病、透析方式比较差异无统计学意义（P>0.05）,两组患者术前透析时间及术前贫血情况比较差异有统计学意义（P<0.05）;两组手术时间、术中出血量、术后尿管留置时间、术后尿潴留、术后视觉模拟量表评分、C反应蛋白、肿瘤坏死因子-α、白细胞介素-6、碱性磷酸酶、谷草转氨酶、肌酐、尿素氮、胱抑素C比较差异无统计学意义（P>0.05）,两组使用尿管材质、术后7 d平均尿量比较差异有统计学意义（P<0.05）;根据Logistics回归分析结果显示,术前透析时间（95%CI：1.327~9.846,OR：3.614,P=0.012）、术前贫血（95%CI：0.995~1.000,OR：0.997,P=0.045）、尿管材质（95%CI：1.498~3 199.687,OR：69.239,P=0.030）及术后7 d平均尿量（95%CI：1.058~334.543,OR：18.813,P=0.046）为肾移植术后膀胱痉挛发生的独立影响因素（P<0.05）。结论 肾移植患者术前透析时间较长、术前贫血、应用尿管材质较硬、术后尿量少均可增加术后膀胱痉挛发生风险,因此需针对膀胱痉挛高风险患者增加护理评估,监测患者术后尿量,尽量选择软质尿管,预防肾移植术后膀胱痉挛的发生。

Objective To explore the current situation and influencing factors of bladder spasms in patients after kidney transplantation. Methods Selecting 80 kidney transplant patients admitted to the First Affiliated Hospital of Guangzhou Medical University from December 2022 to April 2024 as the research subjects, the occurrence of postoperative bladder spasm was recorded. Fifteen patients who experienced bladder spasm after surgery were included in the bladder spasm group, and the remaining 65 patients were included in the non bladder spasm group. The general demographic data,preoperative clinical data, intraoperative and postoperative conditions between two groups were compared. Incorporating bladder spasm as the dependent variable into the Logistics regression model to analyze the influencing factors of bladder spasm after kidney transplantation. Results A total of 15 out of 80 kidney transplant patients experienced bladder spasms after surgery, accounting for 18. 76%. By comparing general demographic data between the bladder spasm group and the non bladder spasm group, it was found that there were no significant differences in gender, age, Body Mass Index, education level, payment methods, and household income（P>0. 05）. There was no significant differences in primary disease, combined basic disease, and dialysis method between the two groups（P>0. 05）,while there were significant differences in preoperative dialysis time and preoperative anemia between the two groups（P<0. 05）. Surgical time, intraoperative blood loss,postoperative urinary retention, postoperative visual analog scale score, C reactive protein, tumor necrosis factor-α, interleukin-6, alkaline phosphatase, transaminase, creatinine, urea nitrogen, cystatin C were not different between the two groups（P>0. 05）. The difference in the mean urine volume after seven days and urinary catheter material were significant（P<0. 05）. According to the results of the Logistic regression analysis,preoperative dialysis duration（95%CI：1. 327-9. 846,OR：3. 614, P=0. 012）, preoperative anemia（95%CI：0. 995-1. 000,OR：0. 997, P=0. 045）, catheter material（95%CI：1. 498-3 199. 687,OR：69. 239, P=0. 030）, and mean urine output at seven days postoperatively（95%CI：1. 058-334. 543,OR：18. 813, P=0. 046）were identified as independent influencing factors for the occurrence of bladder spasms after kidney transplantation（P<0. 05）. Conclusions Renal transplant patients have a longer preoperative dialysis time, and the use of harder urinary catheter materials and lower postoperative urine output can increase the risk of postoperative bladder spasms. Therefore, it is necessary to increase nursing evaluation for high-risk patients with bladder spasms mentioned above, monitor postoperative urine output, and choose soft urinary catheters as much as possible to prevent the occurrence of bladder spasms after kidney transplantation.

      目的  探讨心脏瓣膜置换术后患者异常出血的判断与处理。方法  选取2020年1月—2024年5月广州医科大学附属第一医院收治的30例心脏瓣膜置换术后异常出血的患者，将其纳入观察组，另选取同期收治的200例心脏瓣膜置换术后未出现异常出血的患者为对照组。对比两组患者预后情况和两组患者舒张压、收缩压、心率、术后3 h内引流量相关异常出血判断相关指标情况。采用Logistics回归模型分析心脏瓣膜置换术后患者异常出血的影响因素。结果   观察组住院时间、左心室射血分数（LVEF）水平高于对照组，左室舒张末期内径低于对照组，且观察组术后感染、心律失常、低心排综合征发生率高于对照组（P＜0.05）；观察组术后舒张压、收缩压、心率及术后3 h内引流量高于对照组（P＜0.05）；观察组与对照组患者吸烟史、合并糖尿病、抗凝依从性比较差异有统计学意义（P＜0.05）；吸烟史、抗凝依从性为心脏瓣膜置换术后患者异常出血的影响因素（P＜0.05）。结论  心脏瓣膜置换术后患者异常出血的发生可严重影响患者预后水平，增加患者并发症发生率，影响心功能恢复，通过舒张压、收缩压、心率及术后3 h内引流量可为异常出血的判断提供参考意见。另外，吸烟史、抗凝依从性为心脏瓣膜置换术后患者异常出血的独立影响因素，因此对异常出血患者进行常规治疗的同时要密切监测患者危险因素，实施科学的护理干预，改善患者抗凝依从性，降低异常出血发生率。

       Objective  To explore the  diagnosis and management of abnormal  bleeding in  patients after  heart valve replacement surgery．Methods  Thirty patients with abnormal bleeding after heart valve  replacement surgery admitted to the First Affiliated Hospital of Guangzhou Medical University from January 2020 to May 2024 were  retrospectively analyzed and divided into an observation group．In addition，200 patients who did not experience abnormal bleeding after heart valve  replacement surgery admitted during the same period were selected as the control group．Prognosis of two groups of patients were compared，and the related indicators of diastolic blood pressure，systolic blood pressure，heart rate，and abnormal bleeding  related to drainage flow within 3 hours after surgery were evaluated．Finally，the logistic  regression model was used to analyze the influencing factors of abnormal bleeding in patients after heart valve replacement．Results  The length of hospital stay and left ventricular ejection fractionin the observation group were higher than those in the control group，and the left ventricular end diastolic diameter was lower in the observation group than in the control group，and the incidence of postoperative infection，arrhythmia，and low cardiac output syndrome was significantly higher in the observation group than in the control group（P＜0.05）．The postoperative diastolic blood pressure，systolic blood pressure，heart rate，and drainage volume within 3 hours in the observation group were significantly higher than those in the control group（P＜0.05）．The smoking history，diabetes，and anticoagulation compliance were different between the observation and control groups（P＜0.05）．A history of smoking and adherence to anticoagulation were independent influencing factors for abnormal bleeding in patients after heart valve replacement（P＜0.05）．Conclusions  The occurrence of abnormal bleeding in patients after heart valve replacement can greartly affect the patient’s prognosis，increase the incidence of complications，and affect cardiac function recovery．Reference opinions can be provided for the diagnosis of abnormal bleeding based on diastolic blood pressure，systolic blood pressure，heart rate，and postoperative drainage volume within three hours．In addition，a history of smoking and adherence to anticoagulation are independent influencing factors for abnormal bleeding in patients after heart valve replacement．Therefore，while routine treatment is performed on patients with abnormal bleeding，close monitoring of patient  risk factors is necessary，scientific nursing interventions should be implemented to improve patient adherence to anticoagulation and reduce the incidence of abnormal bleeding．