永久性肠造口患者造口适应水平影响因素分析

Analysis of influencing factors of adaptation level in patients with permanent enterostomy

目的调查永久性肠造口患者的造口适应水平并分析其影响因素。方法通过方便抽样法选取2022年1月—12月上海交通大学医学院附属第一人民医院虹口北院和松江南院的260名行永久性肠造口手术的患者。采用一般资料调查表、中文版造口社会心理适应量表、医院焦虑抑郁量表、造口患者自我效能量表、中文简体版身体意象量表、修订版婚姻调适量表,调查患者的造口适应水平及其影响因素。经Shapiro-Wilk正态性检验后,满足正态分布的定量资料使用x±s进行统计描述;定性资料使用n(%)进行统计描述。采用t检验、方差分析进行单因素分析,采用Spearman相关分析对连续变量进行相关性分析,采用多元线性回归分析探索永久性肠造口患者造口适应水平的影响因素。结果永久性肠造口患者的适应水平总分为42.28±11.47,处于中低水平的适应情况。单因素分析发现,居住地区(P=0.001)、收入情况(P=0.000)和造口相关并发症(P=0.000)对适应水平的影响具有统计学意义;相关性分析得出焦虑抑郁和身体意象与适应水平呈负相关(r=-0.391,P=0.000;r=-0.523,P=0.000),造口自我效能和婚姻调适与适应水平呈正相关(r=0.713,P=0.000;r=0.645,P=0.000);经多元回归分析后,造口相关并发症、焦虑、造口照护自我效能和婚姻满意度共计4个变量进入回归方程,可共同解释总变量的59.8%(P=0.000)。结论大多数永久性肠造口患者的适应水平较低,造口相关并发症、焦虑情绪、造口照护自我效能和婚姻满意度是影响适应水平的主要因素。

Objective To investigate the level of stoma adaptation in patients with permanent enterostomy and its influencing factors.Methods In this cross-sectional study,260 patients with permanent enterostomy from North Campus in Hongkou and South Campus in Songjiang of Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine were recruited by convenience sampling approach from January to December,2022.The level and the influencing factors of stoma adaptation were investigated by general information questionnaire,Chinese version of Ostomy Adjustment Inventory-20(OAI-20),Hospital Anxiety and Depression Scale,Stoma Self-Efficacy Scale,Body Image Scale,and The Revised Dyadic Adjustment Scale.Statistical description used mean and standard deviation,frequency and percentage.T test,ANOVA,Spearman correlation and multiple linear regression analyses were preformed to explore the influencing factors of the level of stoma adaptation.Results The mean score of OAI-20 was(42.28±11.47).One-way ANOVA results showed the effects of registered residence(P=0.001),monthly income(P=0.000)and the ostomy-related complications(P=0.000)on the OAI-20 score were statistically significant.Spearman correlation analysis results showed that the OAI-20 score was positively correlated with stoma self-efficacy and marital adjustment score(r=0.713,P=0.000;r=0.645,P=0.000),but negatively correlated with anxiety and depression and body image score(r=−0.391,P=0.000;r=−0.523,P=0.000).Four of the eleven variables,ostomy-related complications,anxiety,self-efficacy of ostomy caring and marital satisfaction,were selected by the multiple linear stepwise regression analysis,and could explain 59.8%of total variance(P=0.000).Conclusion Most patients with permanent enterostomy have a low level of adaptation.Ostomyrelated complications,anxiety,self-efficacy of ostomy caring and marital satisfaction are the main influencing factors of the level of stoma adaptation.