【作者】 吴燕；

【导师】 颜美琼； 卢惠娟；

【作者基本信息】 复旦大学 ， 护理学， 2009， 硕士

【摘要】 背景直肠癌患者肠造口手术后将排便出口移至腹部,这一排便通路的改变给患者身心健康带来很大影响,需要专业、有效的支持来帮助其适应这一改变。近来国内开始培养和使用具有专业资质的造口治疗师以顺应这一需求,然而,她们是否有别于临床医生和普通临床护士以及她们在临床实践中的实际作用均需通过实践来证实。本研究旨在通过对造口治疗师介导的临床护理实践的研究,探讨专科护理在临床上的作用及发展方向,建立造口治疗师临床护理职责和规范,进一步提高造口患者的生命质量。目的评价造口治疗师介导的护理干预对肠造口患者的影响效果。方法将88例行肠造口手术的住院直肠癌患者分为干预组(44例)和对照组(44例),两组在年龄、文化程度、职业、婚姻状况、家庭月收入等情况方面的差别无统计学意义(P>0.05)。在接受常规护理的同时,干预组由造口治疗师给予专业的护理干预,包括疾病基本知识的教育、造口定位、心理辅导、造口护理知识及技能的指导,观看肠造口手术前后护理的录像及健康宣传手册等措施。对照组则接受由病区普通护士实施的常规健康教育和护理指导。评价手术前、出院前患者的焦虑、抑郁、疾病不确定感和肠造口患者健康知识知晓度,手术后一月患者生命质量等指标,采用t检验、卡方检验、Fisher精确概率检验,单向有序资料的行平均分差检验等进行统计分析。结果调查结果显示,患者术前焦虑(SAS)的平均得分为56.51±6.40,处于轻度焦虑水平；术前抑郁(SDS)的平均得分为56.66±7.39,处于轻度抑郁水平；术前疾病不确定感得分在77～122之间,平均分为101.72±8.77,处于中等水平。干预前两组患者焦虑、抑郁得分差异无统计学意义(P>0.05)；干预后两组患者焦虑、抑郁得分差异有显著统计学意义(P<0.01)。干预后干预组焦虑、抑郁得分明显低于对照组,表明干预组的焦虑、抑郁水平低于对照组。干预前两组患者疾病不确定感得分差异无统计学意义(P>0.05)；干预后两组患者疾病不确定感得分差异有显著统计学意义(P<0.01)。两组在患者下床时间、排便时间、造口袋渗漏情况、造口周围皮肤不适情况、住院期间主要换袋者、出院前患者独立换袋情况的比较,差异有统计学意义(P<0.05)；术后一月调查分析显示,两组患者在造口自理、造口位置合适度、造口周围皮肤情况、并发症和现有康复知识应对问题情况等方面,差异有统计学意义(P<0.05)。生命质量调查结果显示,两组患者在躯体功能、角色功能、情绪功能、认知功能、社会功能、总健康状况、失眠、体形、未来看法和与人工肛门有关问题方面,差异有统计学意义(P<0.01)；其中躯体功能、角色功能、情绪功能和与人工肛门有关问题,差异有显著统计学意义(P<0.001)。结论肠造口术前患者普遍存在轻度焦虑、抑郁的心理问题以及中等水平的疾病不确定感；造口治疗师介导的护理干预有助于降低患者的焦虑、抑郁状况,有助于减轻患者的疾病不确定感,减少并发症的发生,提高患者造口自理能力和生命质量。更多还原

【Abstract】 Background The patients with a stoma need special and effective nursing. Our country began to train and use the Enterostomal Therapist in recent years. Are they different from the doctor or the common nurse? The present study was taken clinical nursing practice of Enterostomal Therapist in order to probe the effects and development trend of it.Objectives To evaluate the effectiveness of nursing intervention for patients with colostomy by Enterostomal Therapist.Methods 88 rectal cancer patients undergoing colostomy enrolled were divided into intervention group and control group with 44 patients in each group. There was no statistic differences in age, education, job, marriage status and salary (P>0.05) between two groups. The intervention group received professional nursing intervention by Enterostomal Therapist in addition to routine care, while the control group received routine nursing by commom nurse only. To evaluate patient’s anxiety, depression, illness uncertainty, the rate of acquaintance on health knowledge and quality of life before operation, discharged from hospital and a month after operation. T-test, Chi-square test, Fisher’s exact text, Row Mean Scores Differ and Linear Mixed Model of Repeated Measurements was applied to analyze data.Results The consequence of the study shows the score of patient’s preoperative anxiety was 56.51±6.40, the score of patient’s preoperative depression was 56.66±7.39, all at the mild level; the score of patient’s illness uncertainty was 101.72±8.77, which at the medium level. The anxiety or depression score of patient has no statistic differences (P>0.05) between two groups before operation; there was statistically significant difference after intervention (P<0.01). The illness uncertainty of patient has no statistic differences (P>0.05) between two groups before operation; there was statistically significant difference after intervention (P<0.01). There was statistically significant difference on time of getting out-of-bed, defecation time, leakage of stoma bag, the peristomal skin disorders, the main person change the bag (P<0.05). The questionnaire after a month shows the index of colostomy self-nursing ability, the colostomy complication, the site of stoma, the peristomal skin disorders, and the postoperative rehabilitation knowledge deal with the questions between two groups differed significantly (P<0.05). After intervention, the index of physical functioning, role functioning, emotional functioning, cognitive functioning, social functioning, general health status, insomnia, body image, future perspective, stoma related problems in quality of life between two groups differed significantly (P <0.01)Conclusion The patients have mild anxiety and depression and have medium illness uncertainty before operation; nursing intervention was carried out by Enterostomal Therapist could release anxiety，depression,illness uncertainty and the colostomy complication, promote colostomy self-nursing ability and the quality of life better.更多还原