医院-家庭连续性护理干预模式在Miles术后肠造口患者中的应用

  目的  探讨医院-家庭连续性护理干预模式对Miles术后肠造口患者不良情绪、造口自护效能及生活质量的影响。  方法  选取2017年1月—2018年9月在杭州市富阳区第一人民医院接受Miles手术的直肠癌患者53例设为对照组，另选取2018年10月—2019年12月接受Miles手术的直肠癌患者54例设为观察组。对照组采用常规护理干预方法，观察组采用常规护理与医院-家庭连续性护理模式。比较2组干预前后焦虑自评量表(SAS)、抑郁自评量表(SDS)评分、匹兹堡睡眠质量指数(PSQI)、生活质量、术后肠道功能恢复、并发症发生率及出院后造口适应情况。  结果  干预后，观察组患者SAS、SDS及PSQI评分明显低于对照组(P < 0.05)。观察组患者术后肠鸣音恢复(13.45±4.82)h]和首次肛门排气时间(25.63±5.21) h]均明显低于对照组(19.85±5.24) h，(33.84±6.87) h，P < 0.05]；观察组患者并发症发生率(5.56%)明显低于对照组(18.87%，P < 0.05)。观察组干预后生理功能、心理状态、社会交往及总分(171.83±25.64)分]明显高于对照组(129.53±22.43)分，P < 0.05]；观察组生存质量评分明显高于对照组(P < 0.05)。  结论  医院-家庭连续性护理干预可明显改善Miles术后患者焦虑、抑郁情绪，提高睡眠质量，有助于增强患者造口应对能力，促进术后肠道功能恢复并降低并发症的发生率，对提高其生活质量具有积极作用。 

Application of hospital-family continuous nursing-intervention model in patients with enterostomy after Miles operation

Objective To explore the influence of hospital-family continuous nursing-intervention model on the physiological and psychological status, stoma self-care efficacy and quality of life of patients with enterostomy after Miles. Methods Fifty-three patients with rectal cancer who underwent Miles surgery in our hospital from January 2017 to September 2018 were selected as the control group, and another 54 patients with rectal cancer who underwent Miles surgery in our hospital from October 2018 to December 2019 were selected as the observation group. The control group received routine nursing intervention, whereas the observation group received routine nursing intervention and hospital-family continuous nursing intervention. The anxiety self-rating scale(SAS), depression self-rating scale(SDS), Pittsburgh sleep quality index(PSQI), quality of life, postoperative intestinal function recovery, complication rate, and postoperative stoma adjustment were observed and compared before and after intervention. Results After the intervention, the SAS, SDS, and PSQI scores of the observation group were significantly lower than those of the control group(P<0.05). The recovery time of bowel sounds (13.45±4.82) h] and the first anal exhaust time (25.63±5.21) h] in the observation group were significantly lower than those in the control group (19.85±5.24) h,(33.84±6.87) h, P<0.05]. The incidence of complications in the observation group(5.56%) was significantly lower than that in the control group(18.87%, P<0.05). The physiological function, mental state, social interaction, and total score of the observation group after intervention(171.83±25.64) were significantly higher than those of the control group(129.53±22.43, P<0.05). The quality-of-life score of the observation group was significantly higher than that of the control group(P<0.05). Conclusion Hospital-family continuous nursing intervention can significantly improve the anxiety and depression of patients after Miles by improving the quality of sleep, enhancing the ability to cope with the stoma, promoting the postoperative recovery of intestinal function, reducing the incidence of complications, and improving the quality of life.