直肠癌肠造口患者综合护理干预的临床观察

The effects of integrative nursing intervention on rectal cancer patients with colostomy

目的探讨直肠癌肠造口患者实施造口师参与的综合护理干预的临床效果。方法将2009年12月4日至2013年5月15日收治的直肠癌肠造口患者80例按照入院先后顺序依次交替归属为对照组和观察组，每组各40例，分别接受常规护理和造口师参与的综合护理干预。回顾性比较2组间患者焦虑程度、生命质量情况以及并发症发生率的差异。结果观察组术后当日、术后1个月、术后1年焦虑自评量表（SAS）评分明显低于对照组[（58．22±8．23）分比（64．46±9．82）分、（50．55±7．53）分比（59．76±9．83）分、（42．26±2．88）分比（58．46±9．82）分]，P〈0．05；观察组感染、造口出血、造口坏死及其他并发症的发生率明显低于对照组[7．50％（3／40）比25．00％（10／40）、5．00％（2／40）比25．00％（10／40）、2．50％（1／40）比30．00％（12／40）、5．00％（2／40）比15．00％（6／40）]，P〈0．01或〈0．05；采用QLQ—C30欧洲生命质量核心问卷评价，排便功能、心理功能、社会功能、物质生活、恶心呕吐和疲惫疼痛的表现观察组均优于对照组[（92．55±20．56）分比（84．03±24．60）分、（83．05±23．66）分比（61．86±18．20）分、（79．95±36．02）分比（71．09±27．56）分、（59．08±28．56）分比（50．55±25．96）分、（10．15±3．67）分比（18．99±7．29）分、（12．05±7．90）分比（22．10±9．56）分]，P〈0．05。结论综合护理手段可有效舒缓焦虑情绪，提高直肠癌肠造口患者生命质量，同时减少术后并发症的发生，值得在临床推广应用。

Objective To explore the clinical effects of integrative nursing for rectal cancer patients with colostomy. Methods A total of 80 cases of rectal cancer patients after colostomy were selected from our hospital from December 4, 2009 to May 15, 2013. They were assigned to the control group and the observation group according to the admission sequence with 40 patients in each group. The control group had been treated with conventional care, the observation group had been treated with integrative care intervened by ostomy technician. Postoperative anxiety, quality of life and complication rates were analyzed between the two groups. Results Anxiety score from the Self-Rating Anxiety Scale was lower in the treatment group respectively on the day of the operation, one month after operation and one year after operation （58.22 ± 8.23 vs. 64.46 ± 9.82, 50.55 ± 7.53 vs. 59.76 ± 9.83, 42.26 ± 2.88 vs. 58.46 ± 9.82）, P 〈 0.05. the incidences of complications were significantly rarer than the control group such as the postoperative infection [7.50% （3/40） vs. 25.00% （10/40） ], eolostomy hemorrhage [5.00% （2/40） vs. 25.00% （10/40）], colostomy necrosis [2.50% （1/40） vs. 30.00% （12/40）],other complications [5.00% （2/40） vs. 15.00% （6/40）], P 〈0.01 or 〈0.05. Moreover, the defecation function,psychological function, social function and material life （92.55 ± 20.56 vs. 84.03 ± 24.60, 83.05 ± 23.66 vs. 61.86 ± 18.20, 79.95 ± 36.02 vs. 71.09 ± 27.56, 59.08 ± 28.56 vs. 50.55 ± 25.96） were improved obviously in the observation group, while the incidences of nausea and vomiting and pain （10.15 ± 3.67 vs. 18.99 ± 7.29, 12.05 ± 7.90 vs. 22.10 ± 9.56） were lower than the control group, based on QLQ- C30 core questionnaire for the European Quality of Life Evaluation, P 〈 0.05. Conclusions Integrative nursing may effectively improve rectal cancer patients＇ quality of life after colostomy, reduce the postoperative complications and relieve anxiety,which may be useful in the clinical application.