造瘘袋及伤口保护罩护理在重症急性胰腺炎患者中的应用效果

Nursing care of ostomy bag and incision shield for the patients with severe acute pancreatitis

目的探讨造瘘袋及伤口保护罩护理在重症急性胰腺炎患者中的应用效果。方法选取2013年1月至2015年12月在本院治疗的98例重症急性胰腺炎患者，将其随机分为对照组和观察组。其中对照组给予上腹联合侧腹壁切口术后常规护理，观察组患者则在对照组基础上给予包括造瘘袋及伤口保护罩护理的综合护理措施。观察比较两组患者的感染消退时间、二次手术发生率、住院时间、住院期间病死率、日平均换药次数、日平均更换床单次数及伤口缩小30％时间；并对两组患者对护理人员的满意度进行调查。结果（1）观察组患者皮炎发生率为58．0％，显著小于对照组（87．5％）；观察组患者感染消退时间、二次手术发生率、住院周期及住院期间病死率分别为（14．5±6．0）d、8．0％、（47．1±8．5）d、6．0％，均显著低于对照组[分别为（30．5±15．8）d、27．1％、（62．0±8．9）d、20．8％]，均P〈0．05。（2）观察组患者日平均换药次数、日平均更换床单次数及伤口缩小30％时间分别为（2．1±0．9）次、（1．2±0．5）次、（21．5±5．5）d，均显著低于对照组[分别为（8．5±3．8）次、（5．5±1．5）次、（35．5±8．5）d]，且观察组护理满意度评分为（95．5±5．5）分，显著高于对照组[（88．0±6．1）分]，以上差异均具有统计学意义（均P〈0．05）。结论重症急性胰腺炎上腹联合侧腹壁切口术后患者给予包括造瘘袋及伤口保护罩护理的综合护理措施可显著缩短患者感染消退时间和住院周期，降低二次手术发生率和住院期间病死率，且可显著降低患者护理成本，提高患者对护理人员满意度，值得进一步在临床护理中应用。

Objective To study the effect of nursing care of ostomy bag and incision shield for the patients with severe acute pancreatitis. Methods 98 patients with severe acute pancreatitis treated at our hospital from January, 2013 to December, 2015 were selected and randomly divided into a control group and an observation group. The control group was conventionally cared; in addition, the observation group patients received comprehensive nursing care, including the nursing care of ostomy bag and incision shield. The infection- fading time, incidence of secondary surgery, hospital stay, mortality during hospitalization, average daily dressing change times, average daily sheet-replacing times, and time for the wound reducing 30% were compared between these two groups. The satisfaction degree was investigated in both groups. Results The incidence of dermatitis was 58.0% in the observation group and was 87.5% in the control group. The infection-fading time, incidence of secondary surgery, hospital stay, and mortality during hospitalization were （ 14.5±6.0 ）d, 8.0%, （ 47.1 ±8.5 ）d, and 6.0% in the observation group and were （ 30.5±15.8 ） d, 27.1%, （ 62.0±8.9 ） d, and 20.8% in the control group （P 〈 0.05 ） . The average daily dressing change times, average daily sheet-replacing times, and time for the wound reducing 30% were （ 2.1±0.9 ）times, （ 1.2±0.5 ）times, and （21.5±5.5）d in the observation group and were （ 8.5±3.8 ） times, （ 5.5±1.5 ） times, and （35.5±8.5）d in the control group. The satisfaction score was （ 95.5±5.5 ） in the control group and was （ 88.0±6.1 ） in the control group. Conclusions Comprehensive nursing care, including the nursing care of ostomy bag and incision shield, for patients with severe acute pancreatitis after lateral incision can significantly shorten the infection-fading time and hospital stay, reduce the incidence of secondary surgery and mortality during hospitalization, significantly reduce the cost of patient care, and improve the patients＇ satisfaction, so it deserves further application in clinical nursing care.