襻式造口支撑棒装置的设计及应用

doi:10.3761/j.issn.0254-1769.2021.07.026

摘要/Abstract

摘要：

目的设计襻式造口支撑棒装置并探讨其在造口护理中的应用效果。方法自行设计和制作襻式造口支撑棒装置,该装置由2片固定翼硬片、2片固定翼软片、1根支撑棒棒体组成。选取2019年8月—2020年10月浙江省某三级甲等综合医院收治的拟行直肠肿瘤切除+回肠襻式造口手术的患者及其照顾者作为研究对象,将患者随机分为试验组、对照组1和对照组2,试验组采用自制的襻式造口支撑棒装置,对照组1和对照组2分别使用传统缝合法和环套法固定支撑管,比较3组的一般资料、护士和照护者更换造口袋操作时间、操作时患者的疼痛程度、造口相关并发症发生率等指标。结果 3组的一般资料、护士和照护者更换造口袋操作时间比较,差异无统计学意义（P>0.05）;护士和照护者更换造口袋操作时患者局部疼痛程度评分比较,试验组分别为（1.90±0.64）分、（1.33±0.83）分,对照组1分别为（4.11±0.77）分、（4.21±0.64）分,对照组2分别为（2.52±0.68）分、（2.63±0.60）分,3组比较,差异均有统计学意义（均P<0.001）;患者压力性损伤、造口黏膜皮肤分离、造口周围皮炎并发症发生率比较,试验组分别为0、3.23%、12.90%,对照组1分别为32.26%、32.26%、54.84%,对照组2分别为20.00%、26.67%、40.00%,差异均有统计学意义（均P<0.05）。结论自行设计的襻式造口支撑棒装置应用于造口护理,能有效降低患者造口相关并发症的发生率,减轻护理时局部的疼痛程度,提高患者的舒适度。

关键词: 回肠造口术, 襻式造口, 支撑棒, 护理工具, 围手术期护理

Abstract:

Objective To design a loop stoma support rod device and to explore its application effect in stoma care. Methods The support rod device was self-designed and self-manufactured with 2 fixed wing hard films,2 fixed wing soft films and 1 support rod. Patients who were planned to undergo a loop stoma in a Level A tertiary hospital in Zhejiang Province from August 2019 to October 2020 were enrolled and randomized to 3 groups,namely the experimental group with a self-made loop stoma support rod device,the control group 1 and group 2 with traditional suture method and loop method respectively to fix the support tube. The general information of patients and caregivers,the operation time of nurses and caregivers to change stoma bag,the pain degree during the operation,the incidence of stoma and surroundings complications,and other indicators were compared between the 3 groups. Results There was no significant difference in the general information of patients and caregivers,and the operation time of nurses and caregivers among the 3 groups（P>0.05）. The local pain degree scores of patients when nurses and caregivers replaced the stoma bags were（1.90±0.64） points and（1.33±0.83） points in the experimental group,（4.11±0.77）points and（4.21±0.64）points in the control group 1,（2.52±0.68）points and（2.63±0.60） points in the control group 2;there was statistically significant difference between the 3 groups（allP<0.05）. The incidences of complications of patients with pressure injury,mucocutaneous separation,and peristomal dermatitis, were 0,3.23%,12.90% in the experimental group, 32.26%,32.26%,54.84% in the control group 1,and 20.00%,26.67%,40.00% in the control group 2;the differences were statistically significant（allP<0.05）. Conclusion The self-designed loop stoma support rod device can effectively reduce the incidence of stoma and surroundings complications,reduce the local pain during nursing care,and improve patient’s comfort.

Key words: Ileostomy, Loop Stoma, Support Rod, Nursing Instrument, Perioperative Nursing

王群敏,王飞霞,陈叶红,潘喆,李卫珍,李霞,王琴,盛勤松,钟紫凤. 襻式造口支撑棒装置的设计及应用[J]. 中华护理杂志, 2021, 56(7): 1111-1114.

WANG Qunmin,WANG Feixia,CHEN Yehong,PAN Zhe,LI Weizhen,LI Xia,WANG Qin,SHENG Qinsong,ZHONG Zifeng. Design and application of loop stoma support rod device[J]. Chinese Journal of Nursing, 2021, 56(7): 1111-1114.

图/表 4

图1 襻式造口支撑棒装置结构图注：1.支撑棒棒体 2.固定翼硬片3.固定翼软片

Fig 1 Structure picture of loop stoma support rod device

图2 襻式造口支撑棒装置实物图

Fig 2 Physical picture of loop stoma support rod device

表1 3组一般资料比较

Table 1 Comparison of 3 groups of general information

表2 3组造口相关并发症发生率比较[例（百分比,%）]

Table 2 Comparison table of incidence of stoma and related complications in 3 groups[case（percent,%）]

参考文献 12

[1]	郑鹏, 许剑民. 结直肠吻合术后吻合口瘘的防治[J]. 中华胃肠外科杂志, 2016, 19(4):379-382.
	Zheng P, Xu JM. Prevention and control of postoperative anastomotic leak after colorectal anastomosis[J]. Chin J Gastrointest Surg, 2016, 19(4):379-382.
[2]	李春雨, 汪建平. 肛肠外科手术学[M]. 北京: 人民卫生出版社, 2015.
	Li CY, Wang JP. Operative colorectal and anal surgery[M]. Beijing: People’s Medical Publishing House, 2015.
[3]	张卫, 姚琪远, 楼征. 肠造口手术治疗学[M]. 上海: 上海科学技术出版社, 2019.
	Zhang W, Yao QY, Lou Z. Stoma operative treatment and care[M]. Shanghai: Shanghai Scientific & Technical Publishers, 2019.
[4]	Michael RBK, Norman SW. Surgery of The Anus,Rectum & Colon[M]. Beijing: China Science Publishing, 2003.
[5]	McTigue T, Lei J, Kowalski MO, et al. Stoma bridge types and their impact on patient outcomes:a retrospective analysis and prospective global survey of surgical practice[J]. J Wound Ostomy Continence Nurs, 2019, 46(4):309-313. DOI URL
[6]	Mohan HM, Pasquali A, O’Neill B, et al. Stoma rods in abdominal surgery:a systematic review and metaanalyses[J]. Tech Co-loproctol, 2019, 23(3):201-206.
[7]	Franklyn J, Varghese G, Mittal R, et al. A prospective randomized controlled trial comparing early postoperative complications in patients undergoing loop colostomy with and without a stoma rod[J]. Colorectal Dis, 2017, 19(7):675-680. DOI PMID
[8]	国家卫生健康委员会. 中国结直肠癌诊疗规范(2020年版)[J]. 中国实用外志, 2020, 40(6):601-624.
	National Health and Family Planning Commission of the People’s Republic of China. Standards for diagnosis and treatment of colorectal cancer in China(2020 edition)[J]. Chin J Pract Surg, 2020, 40(6):601-624.
[9]	李金蓉, 傅桂芬, 蒙有轩, 等. 微视频联合行动导向教学法在尿路造口住院患者中的应用[J]. 中华护理杂志, 2020, 50(10):1526-1530.
	Li JR, Fu GF, Meng YX, et al. Application of micro-video combined with action-oriented teaching in hospitalized patients with urostomy[J]. Chin J Nurs, 2020, 50(10):1526-1530.
[10]	王飞霞, 王群敏, 潘喆, 等. 自闭保护性回肠插管造口患者并发堵管性肠梗阻的危险因素研究[J]. 中华护理杂志, 2020, 55(8):1212-1216.
	Wang FX, Wang QM, Pan Z, et al. Risk factors of obstructive intestinal obstruction among patients with ileal spontaneously closed intubation stoma[J]. Chin J Nurs, 2020, 55(8):1212-1216.
[11]	Zindel J, Gygax C, Studer P, et al. A sustaining rod increases necrosis of loop ileostomies:a randomized controlled trial[J]. Int J Colorectal Dis, 2017, 32(6):875-881. DOI PMID
[12]	王泠, 胡爱玲. 伤口造口失禁专科护理[M]. 北京: 人民卫生出版社, 2018.
	Wang L, Hu AL. Specialist nursing for wound stoma incontinence[M]. Beijing: People’s Medical Publishing House, 2018.

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