多学科协作联合快速康复理念对结直肠癌造瘘术患者自我管理行为和应对方式的影响

The influence of multidisciplinary collaboration combined with fast recovery concept on self-management behaviors and coping strategies of patients with ostomy for colorectal cancer

目的研究多学科协作联合快速康复理念对结直肠癌造瘘术患者自我管理行为和应对方式的影响。方法纳入2019年1~10月我院收治的行结直肠癌造瘘术患者51例为对照组(常规护理),2019年11月至2020年8月收治的行结直肠癌造瘘术患者51例为观察组(多学科协作联合快速康复理念)。比较两组患者围术期指标(排气时间、肠鸣音恢复时间、下床时间、住院时间),术前及术后1 d应激水平C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)、皮质醇(Cor),术前及术后3个月自我管理行为(自我管理行为量表)、应对方式(Jalowies应对方式量表),以及两组并发症发生情况。结果观察组排气时间、肠鸣音恢复时间、下床时间、住院时间均明显低于对照组(P<0.05);术后1 d两组CRP、SAA、Cor水平均较术前显著提升,且观察组低于对照组(P<0.05);术后3个月,观察组自我管理行为、应对方式中的面对、乐观、寻求支持、情感宣泄评分水平明显高于干预前及对照组;应对方式中的逃避、宿命、姑息、依靠自我评分水平明显低于术前及对照组(P<0.05)。两组切口感染、肺部感染、尿路感染、压疮、吻合口漏发生率比较差异无统计学意义(P>0.05)。结论多学科协作联合快速康复理念能够促进结直肠癌造瘘术患者术后恢复,减轻手术应激程度,改善患者自我管理行为及应对方式。

Objective To investigate the influence of multidisciplinary collaboration combined with fast recovery concept on self-management behaviors and coping strategies of patients undergoing ostomy for colorectal cancer.Methods Fifty-one patients who underwent ostomy for colorectal cancer from January 2019 to October 2019 in our hospital were enrolled as control group(routine nursing).Another 51 patients undergoing ostomy for colorectal cancer between November 2019 and August 2020 were enrolled as the experiment group(multidisciplinary collaboration combined with fast recovery concept).The perioperative indicators such as first exhaust time,bowel sound recovery time,first ambulation time and hospital stay(duration)were compared between the two groups.The levels of stress indexes such as C reactive protein(CRP),serum amyloid A(SAA)and cortisol(Cor)were compared between the two groups before and after one day of surgery.Self-management behaviors estimated by using self-management behavior scale and coping strategies estimated by using Jalowies Coping Scale were compared between the two groups before and after 3 months of surgery.The occurrence of complications was compared between the two groups.Results The first exhaust time,bowel sound recovery time,first ambulation time and hospital stay of the observation group were significantly shorter than those in the control group(P<0.05).After one day of surgery,the levels of CRP,SAA and Cor in the two groups were significantly improved when compared with those before surgery,and the levels of the observation group were significantly lower than those of the control group(P<0.05).After 3 months of surgery,the scores of self-management behaviors,confrontation,optimism,support seeking and emotional catharsis of coping strategies in the experiment group were significantly higher than those before intervention and those in the control group.The scores of avoidance,fatalism,withdrawal/resignation and self-reliance of coping strategies were significantly lower than those before surgery and those in the control group during the same period(P<0.05).There were no significant differences in the incidence of incision infection,lung infection,urinary tract infection,pressure sore and anastomotic leakage between the two groups(P>0.05).Conclusion Multidisciplinary collaboration combined with fast recovery concept can promote the postoperative recovery.It also relieves the surgical stress and improves the self-management behaviors and coping strategies of patients with ostomy for colorectal cancer.