造口评估表在结直肠癌造口患者中的应用研究
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摘要
目的探讨自行设计的造口评估表对结直肠癌造口患者生活质量和造口周围皮肤并发症的影响。方法选取2015年11月-2017年3月在我院普通外科因结直肠恶性肿瘤行肠造口手术的257例患者,中途失访37例,最终纳入220例。按手术单双日分为对照组113例和观察组107例。对照组按照常规护理流程由护士完成患者手术后各项护理措施,包括健康教育和出院后造口自我护理方法讲授;观察组则在对照组护理工作的基础之上应用造口评估表指导患者完成造口评估与护理。比较两组患者生活质量的评分情况、造口周围皮肤并发症的发生率。结果观察组患者生活质量评分在出院1个月和出院6个月两个阶段均高于对照组,差异有统计学意义(P<0.05);两组患者出院1个月和6个月时的生活质量评分均优于出院前,差异有统计学意义(P<0.05),但随着时间的延长,两组患者生活质量评分变化趋势却不相同,差异有统计学意义(P<0.05)。观察组患者造口周围皮肤并发症的总发生率和粪水性皮炎的发生率均低于对照组,差异有统计学意义(P<0.05)。结论在造口患者延续护理中应用造口评估表,可有效降低造口周围皮肤并发症的发生率,提高结直肠癌造口患者的生活质量,值得推广使用。
Objective To study the effect of self-designed stoma evaluation scale on quality of life and skin complications around stoma in patients with colorectal cancer. Method From November 2015 to March 2017, 257 patients with colorectal cancer underwent intestinal stoma surgery was selected, 37 cases were lost and 220 cases were included. The patients were divided into control group(113 cases) and observation group(107 cases) according to single and double days of operation. According to the standard nursing process, patients in control group was given various nursing measures, health education and training of stoma nursing methods. Patients in observation group was given the stoma assessment table to guide the patients to complete the self care of the stoma on the basis of the control group, The scores of quality of life were compared between the two groups, and the incidence of skin complications around the stoma was analyzed. Result The quality of life score of patients in observation group was higher than that of the control group in first month and sixth months after discharge(P<0.05). The quality of life scores of the two groups at the first month and sixth months after discharge were better than those before discharge, and the difference was statistically significant(P<0.05). However, with the prolongation of time, the change trend of QOL scores was different between the two groups, and the difference was statistically significant(P<0.05). The total incidence of skin complications around stoma and fecal dermatitis in the observation group were lower than those in control group(P<0.05). Conclusion The application of stoma evaluation form in continuous nursing of patients with colostomy can effectively reduce the occurrence of skin around the stoma and improve the quality of life of patients with colon and rectal cancer, which is worth popularizing.
Objective To study the effect of self-designed stoma evaluation scale on quality of life and skin complications around stoma in patients with colorectal cancer. Method From November 2015 to March 2017, 257 patients with colorectal cancer underwent intestinal stoma surgery was selected, 37 cases were lost and 220 cases were included. The patients were divided into control group(113 cases) and observation group(107 cases) according to single and double days of operation. According to the standard nursing process, patients in control group was given various nursing measures, health education and training of stoma nursing methods. Patients in observation group was given the stoma assessment table to guide the patients to complete the self care of the stoma on the basis of the control group, The scores of quality of life were compared between the two groups, and the incidence of skin complications around the stoma was analyzed. Result The quality of life score of patients in observation group was higher than that of the control group in first month and sixth months after discharge(P<0.05). The quality of life scores of the two groups at the first month and sixth months after discharge were better than those before discharge, and the difference was statistically significant(P<0.05). However, with the prolongation of time, the change trend of QOL scores was different between the two groups, and the difference was statistically significant(P<0.05). The total incidence of skin complications around stoma and fecal dermatitis in the observation group were lower than those in control group(P<0.05). Conclusion The application of stoma evaluation form in continuous nursing of patients with colostomy can effectively reduce the occurrence of skin around the stoma and improve the quality of life of patients with colon and rectal cancer, which is worth popularizing.
引文
[1] 刘永莲,黄小梅,方琴,等.1例肠造口术后多种并发症患者的护理[J].医学信息,2015,28(10):331-331.
[2] 柳益书,侯莉,张清,等.老年直肠癌患者肠造口术后并发症及其影响因素[J].中国老年学杂志,2017,37(12):2976-2977.
[3] Leenen L P,Kuypers J H.Some factors influencing the outcome of stoma surgery[J].Dis Colon Rectum,1989,32:500-504.
[4] Lyon C C,Smith A J,Griffiths C E,et al.The spectrum of skin disorders in abdominal stoma patients[J].Br J Dermatol,2000,143(6):1248-1260.
[5] 王玉珏.ARC换药流程在结直肠癌术后造口周围皮肤的应用研究[J].护士进修杂志,2017,32(14):1302-1304.
[6] 钟海英.失禁相关性皮炎评估量表的研究进展[J].世界临床医学,2016,10(17):117-118.
[7] Lee Y J,Kim J Y.Effects of pressure ulcer classification system education progrmme on knowledge and visual differential diagnostic ability of pressure ulcer classification and incontinence-associated dermatitis for clinical nurses in Korea[J].International Wound Journal,2016,13(S1):26-32.
[8] Jan K,Elisabeth H,Carina T,et al.A multi-center prevalence study and randomized controlled parallel-group pragmatic trial to compare the effectiveness of standardized skin caree regimens on skin health in nursing home residents:A study protocol[J].Int J Nurs Stud,2015,52(2):598-604.
[9] 施洁.中文版IAD严重度分类工具应用于肿瘤患者IAD评估的信效度研究[D].南宁:广西医科大学,2017.
[10] 胡爱玲,郑美春,李伟娟.现代伤口与肠造口临床护理实践[M].北京:中国协和医科大学出版社,2010:184-185.
[11] 万崇华,陈明清,张灿珍,等.癌症患者生命质量测定量表EORTC QLQ-C30中文版评介[J].实用肿瘤杂志,2005,20(4):353-355.
[12] 方积乾,万崇华,史明丽,等.生存质量研究概况与测定量表[J].中国组织工程研究,2000,4(8):1123-1126.
[13] 何振华,徐敏.肠造口患者延续护理的需求及研究进展[J].护士进修杂志,2018,33(11):997-999.
[14] Pringle W,Swan E.Continuing care after discharge form hospiml for stoma patients[J].Br J Nurs,2001,10(19):1275-1288.
[15] 姜志霞.社区医护人员肠造口相关知识认知现状及培训需求的调查与分析[D].石家庄,河北医科大学,2015.
[16] 李葵芬,陈亚燕,陈玉秋.延续性护理干预对直肠癌肠造口患者生活质量的影响[J].中国医学创新,2018,15(1):78-80.
[2] 柳益书,侯莉,张清,等.老年直肠癌患者肠造口术后并发症及其影响因素[J].中国老年学杂志,2017,37(12):2976-2977.
[3] Leenen L P,Kuypers J H.Some factors influencing the outcome of stoma surgery[J].Dis Colon Rectum,1989,32:500-504.
[4] Lyon C C,Smith A J,Griffiths C E,et al.The spectrum of skin disorders in abdominal stoma patients[J].Br J Dermatol,2000,143(6):1248-1260.
[5] 王玉珏.ARC换药流程在结直肠癌术后造口周围皮肤的应用研究[J].护士进修杂志,2017,32(14):1302-1304.
[6] 钟海英.失禁相关性皮炎评估量表的研究进展[J].世界临床医学,2016,10(17):117-118.
[7] Lee Y J,Kim J Y.Effects of pressure ulcer classification system education progrmme on knowledge and visual differential diagnostic ability of pressure ulcer classification and incontinence-associated dermatitis for clinical nurses in Korea[J].International Wound Journal,2016,13(S1):26-32.
[8] Jan K,Elisabeth H,Carina T,et al.A multi-center prevalence study and randomized controlled parallel-group pragmatic trial to compare the effectiveness of standardized skin caree regimens on skin health in nursing home residents:A study protocol[J].Int J Nurs Stud,2015,52(2):598-604.
[9] 施洁.中文版IAD严重度分类工具应用于肿瘤患者IAD评估的信效度研究[D].南宁:广西医科大学,2017.
[10] 胡爱玲,郑美春,李伟娟.现代伤口与肠造口临床护理实践[M].北京:中国协和医科大学出版社,2010:184-185.
[11] 万崇华,陈明清,张灿珍,等.癌症患者生命质量测定量表EORTC QLQ-C30中文版评介[J].实用肿瘤杂志,2005,20(4):353-355.
[12] 方积乾,万崇华,史明丽,等.生存质量研究概况与测定量表[J].中国组织工程研究,2000,4(8):1123-1126.
[13] 何振华,徐敏.肠造口患者延续护理的需求及研究进展[J].护士进修杂志,2018,33(11):997-999.
[14] Pringle W,Swan E.Continuing care after discharge form hospiml for stoma patients[J].Br J Nurs,2001,10(19):1275-1288.
[15] 姜志霞.社区医护人员肠造口相关知识认知现状及培训需求的调查与分析[D].石家庄,河北医科大学,2015.
[16] 李葵芬,陈亚燕,陈玉秋.延续性护理干预对直肠癌肠造口患者生活质量的影响[J].中国医学创新,2018,15(1):78-80.