直肠癌Miles术后结肠造口患者生活质量及影响因素研究

目的了解淮南市直肠癌结肠造口患者的生活质量现状及其影响因素,为提高永久性结肠造口患者的生活质量提供依据。方法使用欧洲癌症研究与治疗组织生活质量核心问卷对120例在淮南市3所二级甲等医院行直肠癌结肠造口患者的生活质量进行问卷调查,将所得资料进行统计学分析。结果结肠造口患者总体生活质量得分为60.4±22.8分,角色功能和社会功能得分显著低于常模(P<0.01),腹泻和经济困难得分显著高于常模(P<0.01)。相关分析结果显示,心理状态和造口并发症是影响总体生活质量及各功能维度的主要因素;多元逐步回归分析结果显示,心理状态、术后时间、造口并发症是进入回归方程的因素,心理状态、术后时间与生活质量呈正相关,造口并发症与生活质量呈负相关。结论结肠造口患者角色功能和社会功能显著受影响,腹泻症状和经济困难严重。造口专科护士应为患者提供精神心理支持,训练患者规律排便,采取多种方式重点指导患者正确认识、预防、处理造口并发症,以改善其生活质量。     

结肠癌造口患者心理健康水平的现状及其影响因素

目的了解结肠癌造口患者心理健康水平的现状并分析其影响因素,为制订提升肠造口患者的心理健康水平和生活质量的干预措施提供理论依据。方法采用方便抽样法,选择2015年10月至2016年10月在上海市、浙江省及江苏省5所三级甲等医院造口门诊就诊的409例肠造口患者为研究对象,采用一般资料调查表、中文版造口患者心理健康量表(psychological well-being scale,Chinese version)、肖水源的社会支持评定量表(social support revalued scale,SSRS)及综合医院焦虑抑郁表(hospital anxiety depression scale,HADS)对其进行调查。结果结肠癌造口患者心理健康水平得分为(61.29±20.10)分,多因素分析结果显示,抑郁、焦虑和自理程度、婚姻状态及每月用于造口产品的费用是结肠癌造口患者心理健康水平的影响因素,可解释总变异量的34.6%。结论肠癌造口患者的心理健康处于中等水平,医护人员及社会工作者应采取针对性措施,提高患者的自我照护能力,减轻其焦虑、抑郁水平。     

结肠癌造口患者自我管理能力的现状及影响因素分析

目的:了解结肠癌造口患者自我管理能力的临床现状,并分析其影响因素。方法:选择2018年1至12月在广东省中医院治疗的191例结肠癌造口患者,应用一般情况调查表、社会支持量表(Social Support Rating Scale,SSRS)、肠造口患者自我管理问卷进行调查,数据采用SPSS22.0软件进行统计分析。结果:结肠癌造口患者的自我管理得分为(98.34±10.66)分,得分相对较低,症状管理、信息管理和心理护理的得分率均低于60%。回归分析结果显示:年龄、社会支持情况、文化程度、是否独居、造口护理情况、造口时间和住院次数均为自我管理得分的影响因素,共可解释69.5%的方差变异量。结论:结肠癌造口患者的自我管理能力相对不足,临床医护人员应加强评估并制订有针对性的健康教育策略,以提升其疾病自我管理能力,改善临床预后。     

1例Miles术后造口皮肤黏膜分离合并糖尿病患者的护理

总结1例经腹会阴直肠癌根治术（Miles）后造口皮肤黏膜分离糖尿病患者的护理过程,针对患者造口皮肤黏膜分离的情况,正确选择敷料及造口用品,正确粘贴造口袋,防止渗漏,做好排泄物的管理,防止粪便污染伤口,预防感染,同时定期监测血糖的变化及营养的支持,心理疏导;促使创面的良好愈合。6天后,造口黏膜血运恢复正常,8天后造口皮肤黏膜分离深度缩小2cm。     

Colostomy as treatment for complications of spinal cord injury

We reviewed our experience with colostomy performed in 20 spinal cord injury (SCI) patients to determine the effectiveness and safety of colostomy when it is performed for a late complication of SCI. Objective evaluation of gastrointestinal function, ie, colonic transit time and anorectal manometry, was performed in six patients with chronic gastrointestinal complaints to identify the site and severity of bowel dysfunction. Twelve patients had colostomy performed for chronic gastrointestinal problems, seven as an adjunct in the treatment of perineal pressure ulcers, and one for rectal cancer. When patients with difficult bowel evacuation or incontinence were considered, colostomy reliably simplified bowel care, relieved abdominal distention, and prevented fecal incontinence. The amount of time spent on bowel care decreased from an average of 98.6 min/day to 17.8 min/day (p less than .05) after colostomy. When performed as an adjunct in the treatment of pressure ulcers, colostomy provided a dry, clean environment, and seven of seven ulcers healed. Colostomy was well accepted by all patients; all patients with chronic gastrointestinal complaints reported that colostomy improved the quality of their lives. Objective testing differentiated between failure of the colon to adequately transport material to the rectum and inability to adequately evacuate the rectum. Testing was useful in choosing the level at which a colostomy was created, and, in one instance, it identified a specific syndrome (ischemic proctitis) which required colostomy.     

永久性乙状结肠造口患者生活质量及其影响因素的分析

目的 探讨永久性乙状结肠造口患者的生活质量及其影响因素.方法 对73例直肠癌行永久性乙状结肠造口3个月以上的患者进行生活质量、手术后适应能力、社会支持和自尊的问卷调查.结果 造口患者的生活质量与患者对造口适应能力、社会支持和自尊各变量均呈正相关（r=0.37～0.44,P＜0.01）.感知到的能力,婚姻,社会支持,造口旁疝,造口用品费用,便秘,家庭关系这7个变量进入了造口患者生活质量总分的回归方程等是影响患者生活质量的主要因素.结论 造口治疗师或护士应帮助患者及其家人接受并适应有造口的生活,提高造口自理能力,减少与造口有关的并发症和问题,加快患者的生理和心理康复,从而帮助患者提高生活质量.     

Providing dietary advice for the individual with a stoma

Concerns over diet and nutrition are common among ostomists and their carers. It is important for healthcare professionals involved in the care of patients with a colostomy, ileostomy or urostomy to appreciate that stoma surgery changes the body's usual processes of nutritional absorption and excretion, so that informed support and advice on diet can be provided. A considerable proportion of patients admitted to hospital in the United Kingdom are malnourished, or at risk of becoming so. Patients undergoing gastrointestinal surgery resulting in stoma formation are at particular risk as a result of the potential for preoperative malnutrition caused by the effects of their underlying disease and prolonged periods of fasting during the immediate pre- and postoperative period. Screening and monitoring of the nutritional status of individuals with a stoma should be an ongoing process, beginning preoperatively and continuing after discharge from hospital. This article will examine the effects of stoma formation on diet and consider ostomists' potential for altered absorption of nutrients. Current issues relating to patient nutrition in the hospital setting, their relevance for stoma patients and the role of the nurse in the provision of nutritional care will also be discussed.     

老年患者肠造口的术前定位与护理

目的：探讨老年肠造口患者造口定位及造口护理的方法,减少老年患者肠造口并发症的发生,提高其生存质量。方法：选择2012年1月-2013年3月我科行术前定位的肠造口患者60例,术前由造13治疗师、床位医师、护士、患者共同参与造13定位,急诊手术由手术医师进行;根据老年患者的特点,进行造13护理,预防和治疗造VI并发症。结果：本组术前定位的肠造口患者术后发生皮肤黏膜分离11例,造口周围炎14例,造口回缩6例,造口旁疝4例,造口脱垂1例。结论：术前造13定位使患者更容易接纳造口的存在,主动参与造口的护理,促进了护患关系,减少了造口患者并发症发生。     

Colostomies and the use of colostomy appliances

The surgical formation of a colostomy is indicated as part of the treatment of various conditions, primarily colon cancer, requiring the patient (ostomist) to wear a colostomy pouch. Today's stoma appliances bear no resemblance to those worn three or four decades ago when colostomy, ileostomy and urostomy bags were made entirely from rubber. The patient, who would have two to three bags in circulation at a time, would interchange them allowing for the washing and drying of the previous one, thus minimizing odour and potential perishing of the rubber. The design of these appliances was simple, but they were large and bulky and the outlet resembled that of a hot-water bottle stopper or a cap from an old soda bottle that required the insertion of coinage (2p) to open it. This article explores the range of colostomy appliances and management options available to the nurse when caring for patients with a colostomy.     

由造口治疗师为主体的延续护理对肠造口患者自我护理能力的影响

目的探讨由造口治疗师为主体的延续护理对提高永久性肠造口患者自我护理能力的效果。方法选择78例永久性肠造口患者,按照随机数字表法将患者分为观察组和对照组,每组各39例,对照组由责任护士常规进行出院指导,观察组实施由造口治疗师为主体的延续护理。患者出院3个月后,采用自我护理能力测定量表(exercise of self-care agencyscale,ESCA)对患者进行测评。结果观察组患者ESCA得分高于对照组,两组比较,差异均有统计学意义(P0.01)。结论由造口治疗师为主体的专科护理团队对永久性肠造口患者进行出院后延续护理,能使患者巩固肠造口知识和技巧,从而提高患者自我护理能力。     

Exploring the conditions leading to stoma-forming surgery

The most common disease leading to the formation of a stoma is cancer. However, there are many other diseases that affect the gastrointestinal or urinary system that may also require either a temporary or permanent stoma to be formed (a colostomy, ileostomy or urostomy). Stoma-forming surgery may be undertaken for a number of reasons, such as to eradicate a disease or improve the patient's quality of life. Cancer, inflammatory bowel disease and diverticular disease are the most common conditions that lead to stoma formation. However, faecal incontinence, familial adenomatous polyposis, Hirschsprung's disease, spina bifida and Ehlers-Danlos syndrome may also require a stoma to be formed. The nurse's role in caring for these patients at a potentially traumatic period of their life is discussed.     

永久性结肠造口患者的自我效能及其相关因素的研究

目的调查永久性结肠造口患者自我效能水平,并分析相关的影响因素。方法采用造口相关自我效能量表和自行设计的一般情况调查表对江苏省某三级甲等医院造口门诊的69名永久性结肠造口患者进行问卷调查。结果本组患者自我效能总均分为(87.88±26.89)分,69.57%患者的自我效能处于中、低水平;患者性别、造口术后不同时间与患者的自我效能密切相关。结论应注视永久性结肠造口患者的自我效能,尤其要关注女性患者、术后早期患者。     

结肠造口患者出院早期造口护理情况的调查

目的调查结肠造口患者出院早期造口护理情况。方法方便性抽样选取2008年12月至2009年10月广州市7所三级甲等医院胃肠外科103例结肠造口术后出院患者,分别在其出院后1个月和3个月采用自行设计的造口护理情况表和造口自我护理量表-早期版(stoma self-care scale,early stage version,SSCS-early stage version)进行测试。结果出院后1个月和3个月造口患者的自我护理总分及各条目、造口自理状态、平均每天护理造口的时间以及独立更换造口袋的人数比较,差异均有统计学意义(均P<0.01);但造口不适情况比较,两个时间段差异无统计学意义(P>0.05)。结论造口护士应根据患者的具体情况给予有针对性的指导,以提高患者造口自我护理能力,减少造口不适的发生,促使患者早日回归社会。     

非离断式底盘剪裁在含支架棒袢式造口患者中的应用效果

目的 探讨非离断式造口底盘剪裁法在含支架棒袢式造口护理中的应用效果。方法 选取2019年1-12月因直肠癌、肠梗阻、肠瘘行含支架棒造口术的患者92例,将其随机分为实验组47例,对照组45例,实验组采用非离断式底盘剪裁造口袋底盘,对照组采用常规方法,干预后第3、6、9天比较2组患者造口周围潮湿相关性皮肤损伤、造口底盘渗漏率、更换造口袋耗时。结果 实验组患者术后第9天造口周围潮湿相关性皮肤损伤发生率低于对照组(χ²=8.950,P=0.003);术后第6天、第9天造口底盘渗漏率发生率均低于对照组(χ²=8.644,P=0.003;χ²=8.644,P=0.003);更换造口袋耗时低于对照组(F_组间=860.531,P＜0.001)。结论 非离断式底盘剪裁可有效降低含支架棒袢式造口患者造口相关并发症。     

Role of the stoma care nurse: patients with cancer and colostomy

This case study describes the physical, psychological and emotional problems of a female patient suffering from rectal cancer, who required the formation of a colostomy. It highlights the role of the stoma care nurse from diagnosis, though staging of the disease, to treatment and recovery in hospital and at home, and discusses the problems of altered body image and the need for effective communication to enable the patient to achieve a good quality of life.     

Antegrade continence enema for the treatment of neurogenic constipation and fecal incontinence after spinal cord injury

OBJECTIVE: To describe the effects of an antegrade continence enema stoma formed in a paraplegic man with intractable constipation and fecal incontinence. DESIGN: Case report. SETTING: Spinal cord injury unit, Veterans Affairs hospital. PARTICIPANTS: Spinal cord injury (SCI) patient with T12 paraplegia. INTERVENTION: Surgical formation of antegrade continence enema stoma. MAIN OUTCOME MEASURES: Time of bowel program care, ease of fecal elimination, safety of procedure. RESULTS: Bowel care time was decreased from 2 hours to 50 minutes daily; 6 bowel medications were discontinued; fecal incontinence was eliminated; and no surgical or medical side effects noted after the procedure. CONCLUSION: The antegrade continence enema procedure is a safe and effective means of treating intractable constipation and fecal incontinence in the adult SCI patient. This option should be considered for those persons in whom medical management of bowel care has been unsuccessful.     

Do people with an ileostomy have a different back pain experience to those with a colostomy? A postal survey in Northern Ireland

Background.?The abdominal muscles play a vital role in lumbar stability. The stoma surgery creates a permanent flaw in the abdominal wall and this may increase the risk of low back pain for people with a stoma.

Purpose.?To determine whether there was a difference in back pain experience between the two stoma groups: ileostomy and colostomy.

Method.?A postal questionnaire sent to people in Northern Ireland with an ileostomy or colostomy.

Results.?Over half (56.7%, n?=?417) had back pain in the last 6 months and the primary perceived cause was the stoma surgery. There was a statistically significant deterioration in functional activities in those with back pain when ‘today’ was compared with ‘before surgery’. Those with a colostomy had generally poorer outcomes in respect of pain and disability, than those with an ileostomy.

Conclusion.?Low back pain in people with a stoma is a real and complex issue, especially as there are significant differences between those with an ileostomy when compared with people with a colostomy. Many factors are likely to contribute to a person developing low back pain, not least, the underlying reason for the surgery and the surgical procedure itself.     

What happens to used colostomy pouches outside the acute setting

This article looks at the disposal of used colostomy pouches once a patient is discharged from the acute setting. An overview of the guidance given by stoma care nurses to colostomy patients prior to discharge is given as part of a combined study by a patient association. There are approximately 100,000 ostomates in the UK, although the exact number is not known (McCahon, 1999). Approximately 50% of these are colostomates. There appears to be very little literature on disposability of used stoma pouches or advice given to the ostomate with a newly formed colostomy.     

预防性肠造口术后患者自我管理能力及影响因素分析

目的调查预防性肠造口患者自我管理能力的现状,探讨影响因素。方法采用问卷调查方法对100例预防性肠造口患者进行问卷调查,内容包括患者的一般人口学资料、造口相关资料、自我管理水平。结果预防性肠造口患者的自我管理总分为(90.87±12.68)分,处于中等水平。年龄段、文化程度、造口术前定位、接受程度是影响预防性肠造口患者自我管理能力的主要影响因素(P<0.05)。结论预防性肠造口患者自我管理能力有待加强。医务人员应采取个性化的干预措施,提高患者对疾病的自我管理能力。     

家庭护理干预对提高肠造口病人生活质量的影响

目的探讨家庭护理干预提高肠造口病人生活质量的效果.方法用随机数字表法将出院1个月内的结肠造口病人86例分为实验组44例和对照组42例.对照组按常规定期复查,实验组在此基础上,由有资格认证的造口治疗师(ET)以定期家访和电话访问的形式进行家庭护理干预,包括为病人及家属提供心理咨询、健康教育、护理指导等,每周1次,每次30～60min,持续时间为3个月.干预前后分别测评病人的生活质量,效果评价指标为欧洲癌症研究与治疗组织的生活质量核心量表(EORTC QLQ-C30).结果干预后实验组病人的生活质量高于干预前(P<0.05),亦高于对照组(P<0.05),差异有统计学意义.结论由ET提供家庭护理干预,能有效提高肠造口病人的生活质量.