延續(xù)護(hù)理干預(yù)對(duì)直腸癌根治術(shù)并行結(jié)腸造口術(shù)患者的研究

高曉紅 陶崴

延續(xù)護(hù)理干預(yù)對(duì)直腸癌根治術(shù)并行結(jié)腸造口術(shù)患者的研究

高曉紅 陶崴

目的探討延續(xù)護(hù)理干預(yù)對(duì)直腸癌根治術(shù)并行結(jié)腸造口術(shù)患者的影響。方法50例行直腸癌根治術(shù)的患者,隨機(jī)分為試驗(yàn)組和對(duì)照組,各25例。對(duì)照組采取普通護(hù)理措施,試驗(yàn)組在對(duì)照組的基礎(chǔ)上采用延續(xù)護(hù)理干預(yù),比較兩組患者心理功能、自護(hù)技能、生活質(zhì)量總分。結(jié)果兩組患者干預(yù)前觀察指標(biāo)比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05),試驗(yàn)組在使用延續(xù)護(hù)理后心理功能(62.32±2.51)分、自護(hù)技能(59.39±2.23)分、生活質(zhì)量總分(65.12±2.56)分均優(yōu)于對(duì)照組(27.02±2.77)、(12.81±1.39)、(5.35±2.19)分,差異均有統(tǒng)計(jì)學(xué)意義(P＜0.05)。結(jié)論對(duì)直腸癌根治術(shù)并行結(jié)腸造口術(shù)患者采用延續(xù)護(hù)理干預(yù),可以明顯提高其心理功能,提高自我護(hù)理能力,從整體上提高患者的生活質(zhì)量,值得在臨床推廣。

延續(xù)護(hù)理干預(yù)；直腸癌根治術(shù)；結(jié)腸造口術(shù)；生活質(zhì)量

直腸癌是我國(guó)常見(jiàn)的消化道惡性腫瘤,目前手術(shù)治療已經(jīng)相當(dāng)成熟,其中經(jīng)腹會(huì)陰聯(lián)合切除,永久性乙狀結(jié)腸腹壁造口術(shù)較為常見(jiàn)［1］。合理的延續(xù)護(hù)理可以提高患者的生活質(zhì)量［2］。作者從2015年起對(duì)直腸癌根治術(shù)并行結(jié)腸造口術(shù)患者行延續(xù)護(hù)理,現(xiàn)報(bào)告如下。

1 資料與方法

1.1一般資料 選取2015年1月～2016年1月在本院就診的50例行直腸癌根治術(shù)的患者,隨機(jī)分為試驗(yàn)組和對(duì)照組,各25例。對(duì)照組中男12例,女13例,年齡45～67歲,平均年齡(50±6.1)歲,基礎(chǔ)疾病：高血壓5例,糖尿病7例,冠心病4例；試驗(yàn)組中男13例,女12例,年齡44～66歲,平均年齡(51±6.2)歲,基礎(chǔ)疾?。焊哐獕?例,糖尿病8例,冠心病4例。兩組患者年齡、性別、基礎(chǔ)疾病等一般資料比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05),具有可比性。

1.2方法 對(duì)照組術(shù)后采取普通的護(hù)理,試驗(yàn)組在對(duì)照組的基礎(chǔ)上使用延續(xù)護(hù)理。在患者出院后,由專業(yè)的護(hù)理人員使用延續(xù)護(hù)理,干預(yù)時(shí)間為6個(gè)月。①信息登記：根據(jù)患者術(shù)后恢復(fù)情況進(jìn)行相關(guān)信息登記,建立檔案,制定個(gè)性化的護(hù)理措施。②延續(xù)護(hù)理方式：采用電話、短信、網(wǎng)絡(luò)等媒介與患者和家屬進(jìn)行溝通,時(shí)刻了解患者的情況,給予相應(yīng)的護(hù)理指導(dǎo)。③心理護(hù)理：每次與患者聯(lián)系時(shí)耐心傾聽(tīng),了解患者當(dāng)時(shí)的心理狀態(tài),進(jìn)行疏導(dǎo),并且讓患者逐步接受自己的新形象。④運(yùn)動(dòng)指導(dǎo)：根據(jù)患者的恢復(fù)情況對(duì)患者進(jìn)行有根據(jù)的運(yùn)動(dòng)指導(dǎo),先慢走、逐漸延長(zhǎng)運(yùn)動(dòng)時(shí)間等。⑤飲食指導(dǎo)：對(duì)患者進(jìn)行飲食指導(dǎo),以容易消化的食物為宜,平衡營(yíng)養(yǎng),減輕患者負(fù)擔(dān)。⑥造口周圍的護(hù)理：對(duì)患者造口周圍進(jìn)行護(hù)理指導(dǎo),勤消毒,防止由于細(xì)菌導(dǎo)致感染。指導(dǎo)患者如何有便感,形成排便規(guī)律,降低造口袋給患者帶來(lái)的不便感等。

1.3觀察指標(biāo) 比較兩組患者護(hù)理后心理功能、自護(hù)技能、生活質(zhì)量總分,使用生活質(zhì)量綜合評(píng)定量表(GQOLI-74)進(jìn)行評(píng)定。

1.4統(tǒng)計(jì)學(xué)方法 采用SPSS17.0統(tǒng)計(jì)學(xué)軟件進(jìn)行統(tǒng)計(jì)分析。計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(±s)表示,采用t檢驗(yàn)；計(jì)數(shù)資料以率(%)表示,采用χ2檢驗(yàn)。P＜0.05表示差異具有統(tǒng)計(jì)學(xué)意義。

2 結(jié)果

兩組患者觀察指標(biāo)比較：試驗(yàn)組和對(duì)照組在干預(yù)前心理功能、自護(hù)技能、生活質(zhì)量總分比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05)；試驗(yàn)組在使用延續(xù)護(hù)理后心理功能、自護(hù)技能、生活質(zhì)量總分均優(yōu)于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P＜0.05)。見(jiàn)表1。

表1 兩組患者觀察指標(biāo)比較(±s,分)

表1 兩組患者觀察指標(biāo)比較(±s,分)

注：與對(duì)照組比較,aP＜0.05

干預(yù)后心理功能 自護(hù)技能 生活質(zhì)量總分 心理功能 自護(hù)技能 生活質(zhì)量總分試驗(yàn)組 25 26.03±2.72 10.31±2.46 3.26±2.42 62.32±2.51a59.39±2.23a65.12±2.56a對(duì)照組 25 26.09±3.72 10.17±2.39 3.34±3.56 27.02±2.77 12.81±1.39 5.35±2.19組別 例數(shù) 干預(yù)前

3 討論

患者在永久性乙狀結(jié)腸腹壁造口術(shù)治療后,在手術(shù)后永久性造口會(huì)一直存在,給患者的生理、心理和社交上帶來(lái)問(wèn)題,合理的延續(xù)護(hù)理和科學(xué)的指導(dǎo)對(duì)患者意義重大［3］。合理的延續(xù)護(hù)理可以幫助患者熟悉術(shù)后如何感知便意、幫助患者形成排便規(guī)律,讓患者學(xué)會(huì)自己更換造口袋等,可以明顯提高患者的生活質(zhì)量。作者通過(guò)延續(xù)護(hù)理,將造口袋給患者帶來(lái)的不適降到最低,提高了患者的生活質(zhì)量。

綜上所述,對(duì)直腸癌根治術(shù)并行結(jié)腸造口術(shù)患者采用延續(xù)護(hù)理,可以明顯提高其心理功能,提高自我護(hù)理能力,從整體上提高患者的生活質(zhì)量,值得在臨床推廣。

［1］李慧,龔曉波,李麗.腹腔鏡下結(jié)直腸癌根治術(shù)圍術(shù)期綜合護(hù)理干預(yù)的效果觀察.現(xiàn)代中西醫(yī)結(jié)合雜志,2014,23(3):325-326.

［2］薛瑜,吳海珍.延續(xù)護(hù)理干預(yù)對(duì)直腸癌根治術(shù)并行結(jié)腸造口術(shù)患者的影響研究.實(shí)用臨床醫(yī)藥雜志,2015,19(2):69-70.

［3］韋健賢,李麗.高齡結(jié)直腸癌的圍于術(shù)期處理及護(hù)理要點(diǎn).結(jié)直腸肛門外科,2012,18(5):325-326.

Research of continuous nursing intervention for patients receiving radical resection of rectal carcinoma and colostomy

GAO Xiao-hong,TAO Wei.Department of General Surgery,Dalian City Friendship Hospital,Dalian 116001,China

ObjectiveTo investigate influence by continuous nursing intervention on patients receiving radical resection of rectal carcinoma and colostomy.MethodsA total of 50 patients who received radicalresection of rectal carcinoma were randomly divided into experimental group and control group,with 25 cases in each group.The control group received common nursing measures,and the experimental group received additional continuous nursing intervention to common nursing measures.Comparison was made on psychological function,self-nursing skill and total quality of life scores between the two groups.ResultsThere was no statistically significant difference of observational indexes between the two groups before intervention(P＞0.05).After receiving continuous nursing intervention,the experimental group had all better psychological function as (62.32±2.51) points,self-nursing skill as (59.39±2.23) points and total quality of life score as (65.12±2.56) points than (27.02±2.77),(12.81±1.39) and (5.35±2.19) points in the control group.Their differences all had statistical significance(P＜0.05).ConclusionImplement of continuous nursing intervention for patients receiving radical resection of rectal carcinoma and colostomy can remarkably improve their psychological function,self-nursing skill and quality of life overall.This method is worth clinical promotion.

Continuous nursing intervention; Radical resection of rectal carcinoma; Colostomy; Quality of life

10.14164/j.cnki.cn11-5581/r.2016.17.151

2016-05-12］

116001 大連市友誼醫(yī)院普外科 (高曉紅)；大藥劑科(陶崴)