重症溃疡性结肠炎分两期实施IPAA手术的分阶段护理要点分析

Analysis of phased nursing points of ileal pouch-anal anastomosis(IPAA) in two stages for severe ulcerative colitis

目的对重症溃疡性结肠炎(ulcerative colitis,UC)分两期实施IPAA手术的护理要点进行分析和总结。方法成立重症UC外科护理团队,总结护理经验,分析并实施围手术期分阶段护理要点。第1阶段(Ⅰ期术前)护理要点有心理评估和护理、营养治疗护理、食物不耐受检测和饮食指导;第2阶段(Ⅰ期术后至Ⅱ期术前)护理要点有回肠造口周围皮肤护理、肛门功能锻炼指导、回肠贮袋冲洗护理配合;第3阶段(Ⅱ期术后)护理要点有肛周皮肤护理、尿量观察与指导、加强术后随访。结果31例患者IPAA围手术期无死亡病例,均恢复良好出院。结论研究提出的IPAA手术护理要点,能够改善患者预后,具有临床借鉴价值。

Objective To analyze and summarize the phased nursing points of ileal pouch-anal anastomosis(IPAA)in two stages for severe ulcerative colitis.Methods A surgical care team was established to summarize nursing experience,to develop and implement perioperative phased care programs.The main points of nursing in the first stage(stageⅠbefore surgery)included psychological assessment and nursing,nutrition nursing,food intolerance test and diet instruction;The main points of nursing in the second stage(stageⅠafter surgery to stageⅡbefore surgery)included the skin care around the ileostomy,the guidance of the anus function exercise,and the nursing cooperation of the ileal pouch irrigation;The main points of nursing care in the third stage(stageⅡafter surgery)included perianal skin care,urine volume observation and guidance,and postoperative follow-up.Results All the patients with IPAA during the perioperative period recovered well and were discharged from hospital without deaths.Conclusion The nursing points of IPAA surgery proposed in this study can improve the prognosis of patients and have clinical reference value.