造口访问对结肠造口患者生活质量的影响

Effect of stoma visitor on the life quality of patients with stoma colostomy

目的探讨造口访问对提高结肠造口患者生活质量的效果。方法用随机数字表法将入院拟行肠造口手术的患者80例分为实验组和对照组各40例。对照组由护士按常规实施术前、术后护理，出院后常规定期复查，接受由造口治疗师主导的个体化教育，出院定时造口门诊复诊。实验组在此基础上安排2名造口访问者（由有相似经历并已在各方面调整较好的既往造口患者担任）在患者术前1～2d及术后4～10d探访患者,出院后定期电话访问或上门探访患者。干预的内容包括为患者及家属提供日常生活、运动、工作，以及情感支持、社会支持、造口自我护理等咨询。干预前后采用欧洲癌症研究与治疗组织开发的生活质量核心量表（EORTC QLQC30）中文版测评患者的生活质量。结果干预前两组人口学资料及生活质量比较，差异均无统计学意义（P〉0.05）。出院后3个月，实验组躯体功能、角色功能、情绪功能、认知功能、社会功能等功能维度和总生活质量得分分别为（85.92±10.06），（70.05±18.85），（89.77±17.03），（90.25±14.85），（73.15±18.70），（77.84±16.94）分，均高于对照组的（69.58±12.86），（41.66±23.35），（70.43±16.98），（71.03±15.64），（40.87±20.88），（53.16±19.12）分，差异均有统计学意义（t值分别为6.329,5.983,5.086,5.636,7.284,6.110；P〈0.01）。实验组疲倦、疼痛等症状维度得分分别为（19.44±10.96），（9.46±4.55）分，均低于对照组的（40.74±17.63），（17.85±8.95）分，差异均有统计学意义（t值分别为-6.489，-5.285；P〈0.01）。实验组单项问题中失眠、食欲缺乏和腹泻的例数分别为17,10,2例，均少于对照组的31,35,8例，差异均有统计学意义（χ2值分别为10.208,31.746,4.114;P〈0.05或P＜0.01）。两组恶心呕吐症状维度得分和气促、便秘单项问题，以及经济困难例数差异均无统计学意义（P〉0.05）。结论造口访问干预能有效提高造口患者的生活质量。

Objective To explore the effect of the visitor with stoma colostomy on improve the quality of life of the patients with stoma eolostomy. Methods A total of 80 patients who were going to receive the colostomy surgery were randomly divided into experimental group （n = 40） and control group （n = 40） according to random number table. All groups received the routine nursing before and after surgery and routine periodic review after discharge. While, on that basis, two visitors were for the experimental group , they visited the patients 1 to 2 days before surgery and 4 to 10 days after surgery, they interviewed the patients by telephone or took a home visit periodically, interventions including provision of counseling of daily life for patients and their families, job, emotional support, stoma self-care, self-image and social support. The quality of life was evaluated by the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire （EORTC QLQ-C30 ） before and after intervention. Results Before intervention, there were no significant differences in the life quality and demographic data between two groups （ P 〉 0. 05 ）. Three months after intervention, the function dimension scores of experimental group were significantly higher than that of the control group, such as physical function （85.92 ± 10.06 vs 69.58 ± 12. 86）, role function （70.05 ± 18.85 vs 41.66 ± 23.35 ）, emotional function （ 89.77 ± 17.03 vs 70.43 ± 16.98 ）, cognitive function （90.25 ± 14.85 vs 71.03 ± 15.64 ）, social function （73.15 ± 18.70 vs 40.87 ± 20.88 ）, and the life quality score of experimental group was significantly higher than that of the control group（77.84 ± 16.94 vs 53. 16 ± 19. 12）,and the difference were statistically significant （ t = 6. 329,5. 983,5. 086,5. 636,7. 284,6. 110, respectively; P 〈0.05）. The score of fatigued and pain of experimental group respectively were （ 19.44 ± 10. 96） and （9.46 ± 4.55）, and that of the control group were （40.74 ± 17. 63 ） and （ 17.85 ± 8.95 ）, and the difference were statistically significant （ t = - 6. 489, - 5. 285, respectively ; P 〈 0. 01 ）. And the cases number of sleep disorder, anorexia, diarrhea in experimental group were significantly lower than that of control group （17 vs 31,10 vs 35,2 vs 8 ; χ2 = 10.208,31. 746,4.114, respectively; P 〈 0. 05 ±：± P 〈 0.01 ）. And there were no significant difference in the score of nausea and vomiting symptoms, single problem of breath shortness and constipation ,and the economic problems between experimental group and control group （ P 〉 0.05 ）. Conclusions The intervention of stoma visitor earl effectively improve the quality of life of patients with stoma colostomy.