造口皮肤黏膜分离相关危险因素的前瞻性研究

A prospective study of risk factors for the isolation of the skin and mucous membranes of the stoma

目的：通过对肠造口患者前瞻性调查,分析肠造口皮肤黏膜分离的发生率及平均发生时间,探讨肠造口皮肤黏膜分离的危险因素,以期为实施临床干预、有效降低皮肤黏膜分离的发生率提供依据。方法：对我院2012年1月-2013年12月收治的300例肠造口手术患者,从手术后第1天开始前瞻性随访21 d,记录患者相关资料,观察患者皮肤黏膜分离发生情况,对相关危险因素进行多因素logistic回归分析。结果：300例肠造口手术患者中,发生皮肤黏膜分离49例,发生率为16.33%。皮肤黏膜分离的平均发生时间（11.80±7.21）d。多因素logistic回归分析确定的肠造口皮肤黏膜分离的危险因素有皮下积液感染、黏膜缺血坏死、切口感染、术后白蛋白低于正常、术后血红蛋白低于正常、肠道准备差。结论：针对发生肠造口皮肤黏膜分离的主要危险因素,术前加强营养,做好肠道准备,手术后密切观察并及时发现对预防肠造口皮肤黏膜分离非常有必要。

Objective ：Through the prospective investigation of patients with colostomy, the incidence and the average time of occurrence of stoma skin mucous membrane separation were analyzed and the risk factors of stoma skin mucous membrane separation was explored in order to implement clinical intervention and provide basis for reducing the incidence of skin mucous membrane separation. Methods ： Randomly reviewed 300 patients with colostomy in our hospital from January 2012 to December 2013. The review time started from the first day after operation to 21 days and recorded the related information of the patients and observed the situation of skin mucous membrane separation. Then the related risk factors were analyzed by multiple factor Logistic regression analysis. Results ： Among the 300 cases of patients with intestinal stoma,49 cases occurred skin and mucous membrane separation, with the incidence rate of 16.33%. The average time of the skin and mucous membranes separation is（ 11. 80 ＋ 7.21） d. By multivariate logistic regression analysis, the risk factors of skin and mucous mem-brane separation of stoma included subcutaneous effusion infection, mucosal necrosis, infection of incision, postoperative albumin is lower than normal, post-operative hemoglobin levels below normal and poor bowel preparation. Conclusion ： Regarding the major risk factors of skin mucous membrane separation of colostomy, preoperative nutrition, good bowel preparation, postoperative close observation and timely discovery are very necessary for the prevention of skin mucous membrane separation.