预防性回肠造口术后粪水性皮炎的危险因素及护理对策

目的探讨预防性回肠造口术后粪水性皮炎发生的危险因素,提出护理对策及预防措施。 方法采取查阅病历、延续性护理记录、造口门诊就诊记录的方式,回顾性分析在中国医学科学院北京协和医学院肿瘤医院结直肠外科2017年10月至2018年10月间收治的直肠癌行低位前切除＋预防性回肠造口手术的患者的资料共161例,分析粪水性皮炎发生的危险因素。 结果161例研究对象中,粪水性皮炎发生43例,占26.7%。肠造口存在位置不当、周围皮肤不平整、排便出口肠黏膜低或平于皮肤的患者粪水性皮炎的发生率高于肠造口不存在这些问题的患者（P<0.01）;BMI偏高患者粪水性皮炎的发生率高于BMI正常的患者（χ²=3.938,P<0.01）;接受专科护士个性化指导的患者发生粪水性皮炎的比例明显低于未接受个性化指导的患者,差异有统计学意义（χ²=29.625,P<0.01）。 结论术前由患者和家属、肠造口专科护士及医生三方共同帮助患者选择理想的造口位置;术中医生缝合造口时,保证肠造口周围皮肤平坦,注意近端造口黏膜高于皮肤且排便开口不能偏向一侧;术后住院期间专科护士根据患者的造口特点给予个性化护理指导,帮助患者选择适合的造口用品、提高护理技能;出院后加强延续性护理,预防粪水性皮炎发生。     

非比麸治疗结直肠癌肠造口术后患者19例

目的:观察非比麸颗粒对结直肠癌肠造口术后患者的疗效及其安全性.方法:选取2010-01/2011-07在我科住院的结直肠癌行肠造口术后患者19例,连续口服非比麸颗粒治疗1wk,采用自身前后对照方法观察服药前后大便频率、大便性状、造口周围皮肤及医患双方满意度情况,并进行量化评分比较.结果:非比麸颗粒能明显改善结直肠癌肠造口术后大便频率、大便性状及造口周围皮肤刺激[(1.09±0.78)分vs(2.03±0.63)分,(4.32±0.49)分vs(6.01±0.66)分,(0.44±0.21)分vs(1.57±0.57)分,均P<0.05],服药期间未发现明显不良反应.结论:非比麸颗粒可以改善肠造口术后大便频率、大便性状及造口周围皮肤刺激,安全有效,满意度高.     

肠造口并发症护理研究进展

肠造口并发症在肠造口术后患者中较普遍,肠造口并发症的发生严重影响肠造口患者术后的生活质量,给患者不仅带来护理上的困难,影响患者的术后康复,还增加了其心理负担,经济负担.降低肠造口并发症的发生率,提高护理质量,对提高患者的护理满意度和生活质量有着重要意义.本文就肠造口并发症的影响因素、类型、护理措施及护理模式作一综述.     

直肠癌患者肠造口的护理

目的探讨结直肠癌患者肠造口的术前术后的有效护理方法,以提高临床护理水平和患者的生活质量。方法对我科2011年1月至2013年3月收治的42例直肠癌造口术患者进行精心护理,包括术前肠道准备、心理护理、健康教育,术后观察造口的颜色、水肿、排泄情况,指导患者及家属更换造口袋,观察和处理造口的并发症,并加强患者饮食指导、心理教育。结果术后出现2例造口周围皮肤炎症、2例造口狭窄、1例造口脱垂。全组患者均治愈出院,无死亡病例,且患者均能够在出院后融入日常生活。结论做好结直肠癌造口术前术后的护理,对减少术后并发症、提高医疗质量、提高患者的生活质量具有重要意义。     

肠造口造口袋底盘渗漏标准化护理

目的探讨标准化护理在肠造口造口袋底盘渗漏中的应用价值。方法对2013年12月至2015年12月在中国医科大学肿瘤医院行肠造口术治疗的150例患者资料进行回顾性分析,将其按护理方式不同分为观察组和对照组,各75例,对照组给予常规护理,观察组在对照组的基础上实施标准化护理。比较两组造口袋底盘渗漏发生率,以及造成皮肤损伤和造口周围皮肤并发症情况。结果观察组造口袋底盘渗漏发生率为6.67%,明显低于对照的22.67%(P0.05)。观察组造口周围皮肤损伤发生率为9.33%,明显低于对照组的26.67%(P0.05)。观察组造口周围皮肤并发症发生率为8.00%,明显低于对照组的21.33%(P0.05)。结论对肠造口造口袋底盘渗漏患者实施标准化护理,有利于降低造口袋底盘渗漏发生率,并减少造口周围皮肤损伤和并发症的发生率,在临床中具有重要意义。     

造口旁疝的临床诊断与治疗

造口旁疝是一种与造口有关的腹壁切口疝，根据造口肠段的不同分为结肠和回肠造口，是肠造口术后很常见的并发症，仅次于造口术后肠脱垂。典型腹壁切口疝的诊治，各种文献均有详尽介绍，而对于造口旁疝的大部分文献是小系列和回顾性的，没有一个确定性的、前瞻性的和随机的研究。这就使得对于造口旁疝的外科治疗尚无特定或成形的方案，其术后的并发症发生率和复发率仍较高。所以，外科医生必须重视预防造口旁疝的发生及丰富自己的临床处理经验。     

肠造口10例术后护理体会

2004年1月-2005年1月．我科共行肠造口术10例，其中乙状结肠造口6例，降结肠造口1例．横结肠造口1例，回肠造口1例。盲肠造口1例。经临床治疗及护理均痊愈出院。无并发症。现将护理体会报告如下。     

中老年回肠造口患者自我管理能力现状及影响因素

目的调查经回肠造口术的中老年患者自我管理能力现状及其影响因素。方法对2014年1月至2015年6月在该院行回肠造口术的中老年患者进行现场自我管理能力现状的调查问卷,分析影响自我管理能力的因素。结果共发放问卷89份,回收有效问卷87份,有效率为97.75%。回肠造口患者总体自我管理能力得分(98.27±15.34)分,其中造口护理管理得分(36.21±5.85)分、日常生活管理得分(24.75±3.89)分、症状管理得分(14.23±2.70)分、信息管理得分(12.33±3.68)分、心理管理得分(11.08±3.36)分。自我管理能力差者10例(11.49%),中等者71例(81.61%),好者6例(6.90%)。经多因素Logistic回归分析发现,年龄、文化程度、家庭人均月收入、职业以及造口接受程度是影响自我管理能力的因素(P0.05)。结论接受回肠造口的中老年患者自我管理能力有待加强,医护人员应根据相关影响因素采取有针对性的干预措施提高患者对疾病的自我管理能力,促使患者早日康复。     

疝补片在预防腹部造口旁疝和造口旁疝修补术中的应用

目的总结我院腹部造口旁疝手术病例,评价人工合成补片在腹部造口旁疝修补以及造口术中预防性使用的效果。方法腹部造口旁疝接受无张力修补术患者23例,其中采用网状平片单纯修补9例、防粘连补片和网状平片联合修补14例,直肠癌行M iles手术肠造口预防性使用防粘连疝补片患者10例。对术后有无造口旁疝出现和复发、局部感染、局部症状、造口狭窄、肠梗阻等进行观察随访,预防性使用防粘连疝补片者与常规肠造口发生造口旁疝进行比较。结果9例单纯修补患者中2例复发,14例联合修补患者无造口旁疝出现和复发;肠造口预防性置入补片的病例中未出现造口旁疝,手术后造口旁疝的发生率明显低于常规造口术（P〈0.05）。所有接受修补术患者均无局部感染、造口狭窄以及肠梗阻等发生。结论肠造口旁疝无张力修补安全有效,能降低造口旁疝的复发率;肠造口术时预防性放置补片可防止造口旁疝的发生。     

老年人低位直肠癌前切除术后回肠置管造口与横结肠造口的对比研究

目的 对比研究回肠置管造口术与横结肠造口术对老年低位直肠癌患者施行前切除术(LAR)后发生吻合口漏的预防和治疗特点.方法 选择低位直肠癌患者施行LAR后具有发生吻合口漏高危因素的老年患者60例,随机分为横结肠造口组与回肠置管造口组.观察吻合口漏的发生率、住院时间和费用.结果 两组各发生吻合口漏1例,均经非手术治疗痊愈.住院时间和费用横结肠造口组为17 d,2.8万元;回肠置管造口组为18 d,2.9万元,两组比较差异无统计学意义(均为P＞0.05).结论 回肠置管造口术对LAR手术后发生吻合口漏的预防和治疗作用与横结肠造口术无差异,是一项简单、安全、有效的方法.     

Contact dermatitis treated with new topical products: a case study

Contact dermatitis, an inflammatory response of the skin to an irritant or an allergen, can affect hospital staff. Most clinicians are routinely exposed to irritants such as latex, detergents, and chemicals. Treatment with topical corticosteroids and avoidance of suspect irritants usually resolves the dermatitis. A case study is presented of a licensed practical nurse who developed persistent contact dermatitis. The dermatitis did not resolve with 15 months of traditional treatments. Only after 3 months of treatment with two investigational topical products, which are now available to the public, was the dermatitis resolved and complete healing achieved. This case study discusses the new products and traditional treatment products used and presents results of irritant specificity testing and a series of photographs documenting resolution and healing.     

Peristomal skin complications: prevention and management

Peristomal skin complications are the most common reason ostomy patients visit an outpatient wound, ostomy, and continence nursing service. Prevention and management of peristomal skin complications are critical components of ostomy care. Identifying risk factors for the occurrence of peristomal skin complications according to types of injury and clinical features can help optimize assessment and management approaches. Treatment can further be addressed based on etiology - chemical injury (irritant contact dermatitis, pseudoverrucous lesions, and encrustations); mechanical injury (pressure/shear, stripping, mucocutaneous separation, mucosal transplantation); infection (Candidiasis, folliculitis); immunologic disorders (allergic contact dermatitis); and disease-related lesions (varices, pyoderma gangrenosum, malignancy). The importance of prevention and the impact of having access to knowledgeable care providers cannot be over-emphasized.     

Refractory parastomal ulcers: a multidisciplinary approach

Chronic parastomal ulcers in patients with ileostomy or colostomy stomas are unusual. Previous reports have implicated infections, fistulas, recurrent inflammatory bowel disease (IBD), pyoderma gangrenosum, and trauma. Over the past 8 years we have evaluated 10 cases of such refractory parastomal ulcers that occurred at a mean of 11 years after stomal surgery. Eight patients had had an ileostomy for IBD while two had undergone colostomy for colon cancer. Five patients with IBD were diagnosed as having pyoderma gangrenosum ulcerations. They required systemic treatment for a mean of 25 weeks to effect ulcer healing. The other five patients had either parastomal ulcers on the basis of dermatoses (contact dermatitis, eczema, or bullous pemphigoid) or contact ulcers due to face-plate pressure and parastomal dermatitis. These patients received topical treatment with healing of ulcers in a mean of 4 weeks. We conclude that parastomal ulcers occurring in patients without IBD or IBD patients without classic pyoderma gangrenosum require early dermatologic evaluation as they respond relatively quickly to appropriate local therapy.     

Primary skin closure in reversal of loop ileostomy: an effective technique

Established practice in reversal of loop ileostomy relies upon secondary intention healing of the skin defect. This study demonstrates that rapid, uncomplicated healing of the skin defect can be achieved by primary skin closure of the trephine. A retrospective case note review of 29 consecutive patients who underwent primary skin closure of the stomal trephine during loop ileostomy closure over a 28-month period is presented. Data is examined for complications and healing times with specific reference to wound infection. Results are compared with published data on secondary intention healing of the trephine. Wound infection occurred in 2 cases (7%), both being superficial infections responding to antibiotics and removal of sutures. This compares favourably to published infection rates for secondary intention trephine healing and avoids long healing times with costly wound care. Primary skin closure is a safe and effective technique in loop ileostomy reversal and avoids long healing times associated with traditional methods. Received: 7 July 2000 / Accepted in revised form: 12 October 2000     

一针法预防性回肠造口在直肠癌低位前切除手术中的应用

目的探讨一针法回肠造口方法在直肠癌低位前切除手术中的技术优势。 方法前瞻性分析2016年1月至2019年1月河南省肿瘤医院普外科连续80例行直肠癌低位前切除并预防性回肠造口手术的患者,按随机表法分为一针法回肠造口组（观察组）和传统方法造口组（对照组）,对比两组造口手术操作时间、造口皮肤黏膜分离、粪水性皮炎、造口旁疝、造口脱垂、造口回缩等相关造口并发症指标的发生率。 结果两组患者的基线资料比较差异无统计学意义（均P>0.05）,观察组手术操作时间短于对照组［（2.1±0.9）min vs.（15.2±4.6）min］（t=-17.510,P<0.05）,造口皮肤黏膜分离、粪水性皮炎、造口回缩等发生率与传统方法组比较差异均有统计学意义（观察组造口皮肤黏膜分离患者1例,对照组15例;观察组粪水性皮炎患者3例,对照组32例;观察组造口回缩患者0例,对照组8例）（χ²=15.313,42.717,8.889;P均<0.05）,在造口旁疝、造口脱垂两方面差异无统计学意义（观察组造口旁疝患者2例,对照组6例;观察组造口脱垂患者2例,对照组3例）（χ²=2.222,0.213;P均>0.05）。 结论一针法回肠造口在直肠癌低位前切除术中较传统方法更具操作优势,而且可减少相关造口并发症的发生。     

护理干预在关节镜结合外固定架治疗Pilon骨折后的应用研究

目的通过护理干预观察应用关节镜结合外固定架治疗胫骨远端骨折术后的护理效果。方法总结从2005年9月瑚8年10月共62例Pilon骨折患者临床资料及护理过程,根据手术特点,提出护理问题,制定护理于预计划措施。结果近37％的针眼有渗出（82／248枚）,平均在3～4周左右经局部换药痊愈。62例患者中随访骨折全部愈合,平均愈合时间3．2个月,平均去除外固定架时间为4．2个月。无感染、无骨折不愈合。术后随访时Mazur踝关节症状与功能评分量表评定中,总分达92分以上者,46例;总分为87—92分者,10例;总分为65—86分者,6例。无总分低于65分者。结论早期进行关节功能锻炼的康复护理,能有效保证有效功能训练,防止关节肌腱韧带粘连、挛缩,减少踝关节功能障碍的产生,提高术后的功能恢复,Pilon骨折患者术后功能恢复良好。     

Occupational dermatitis diagnosis

Occupational dermatitis accounts for 30% of occupational skin pathologies. Contact dermatitis, particularly hand dermatitis, is the most frequent and includes irritant contact dermatitis (WD), allergic contact dermatitis or eczema (ACD), protein contact dermatitis (PCD), and contact urticaria (CU). Patient questioning is the essential element of the allergology interview. Patch tests are used to explore allergic contact dermatitis. In addition to the batteries of tests available on the market, the patient must often be tested with products from the workplace because the commercially available tests are often insufficient, and testing these products can identify an occupational cause in a greater number of cases. Prevention of occupational allergic dermatitis or irritant dermatitis is a vital step in therapeutic management. For each profession, or better yet for each work station, written, practical, and validated rules can be provided.     

Allergic and nonallergic reactions to nitroglycerin.

Allergic and nonallergic reactions to nitroglycerin occur. The aims of this study were to review the different manifestations of nitroglycerin allergy, to explain how to evaluate for it, and to discuss its treatment. We reviewed relevant literature in peer-reviewed journals, computerized databases, and references identified from relevant bibliographics. Nitroglycerin's most common side effects are headache, facial flushing, head throbbing, fainting, hypotension, tachycardia, and syncope. The majority of reported skin reactions to topical and transdermal nitroglycerin products are irritant contact dermatitis, allergic contact dermatitis, and urticaria. Five cases of presumed allergic reactions to oral, sublingual, intravenous, or perianal nitroglycerin products have been described. Patch testing may be helpful in subjects with skin reactions to topical or transdermal nitroglycerin. In subjects with positive patch tests to nitroglycerin (allergic contact dermatitis), transdermal nitroglycerin patches and other topical nitroglycerin products should be avoided. Most patients with contact dermatitis to nitroglycerin have tolerated oral nitroglycerin, sublingual nitroglycerin, or oral isosorbide challenges.     

Incontinence-associated skin damage in nursing home residents: a secondary analysis of a prospective, multicenter study

More than half of the nursing home population is incontinent of urine or feces, presenting challenges to perineal skin health. To determine the occurrence and severity of skin damage in nursing home residents with incontinence, a secondary analysis of data collected from a multisite, open-label, quasi-experimental study of cost and efficacy of four regimens for preventing incontinence-associated dermatitis in nursing home residents was performed. Sixteen randomly selected nursing homes from across the US were included in the study. Participating nursing home residents were incontinent of urine and/or feces and free of skin damage. Of the 1,918 persons screened, 51% (n = 981) qualified for prospective surveillance. Perineal skin was assessed over a 6-week period; frequency, type, and severity of skin damage were observed. Skin damage developed after a median of 13 (range 6 to 42) days in 45 out of 981 residents (4.6%), of which 3.4% was determined to be incontinence-associated dermatitis. Some residents (14 out of 45, 31%) had incontinence-associated dermatitis of other skin damage in more than one area. This study is one of the first to report the characteristics of incontinence-associated dermatitis in a large sample of nursing home residents. The sample size and random selection of nursing homes impart generalizability to the findings. Incontinence-associated dermatitis is a risk in nursing home residents, especially those with fecal incontinence. These findings suggest that the rate and severity of incontinence-associated dermatitis are low with close monitoring and use of a defined skin care regimen that includes a pH-balanced cleanser and moisture barrier.