肠造口周围潮湿相关性皮炎预防及管理的循证实践

doi:10.3761/j.issn.0254-1769.2024.12.001

摘要/Abstract

摘要：

目的开展肠造口周围潮湿相关性皮炎预防及管理的循证实践，评价其在提升护士及患者肠造口周围潮湿相关性皮炎知识水平及降低患者肠造口周围潮湿相关性皮炎的发生率及严重程度的临床效果。方法通过文献筛选、评价与汇总，总结肠造口周围潮湿相关性皮炎预防及管理的最佳证据，2021年10月—2022年3月，以渥太华研究应用模式为基础，依据最佳证据制订审查指标进行临床审查，明确证据应用的障碍与促进因素，并制订行动策略，完善肠造口周围潮湿相关性皮炎预防与管理的循证实践内容。2022年4月—6月在安徽省某三级甲等医院肿瘤外科病房开展循证实践，比较循证实践前后护士各审查指标执行率、护士和肠造口患者的肠造口周围潮湿相关性皮炎知识水平及肠造口患者肠造口周围潮湿相关性皮炎发生率及严重程度。结果循证实践前纳入46例，循证实践后纳入49例。循证实践后，各审查指标执行率均有提升，总体审查指标执行率由0~66.67%上升至83.33%~100%，患者的肠造口周围潮湿相关性皮炎知识问卷得分由（69.67±8.31）分提高至（80.18±8.07）分，护士的肠造口周围潮湿相关性皮炎知识问卷得分由（79.83±5.97）分提高到（88.28±5.43）分，出院4、12周时，患者肠造口周围潮湿相关性皮炎的发生率均有所下降，差异有统计学意义（P<0.05），严重程度亦明显减轻，差异有统计学意义（P<0.05）。结论开展肠造口周围潮湿相关性皮炎预防与管理循证实践可有效提高护士对审查指标的执行率，提升护士与患者的肠造口周围潮湿相关性皮炎的知识水平，降低患者的肠造口周围潮湿相关性皮炎的发生率及严重程度。

关键词: 肠造口术, 造口周围潮湿相关性皮炎, 预防, 管理, 循证护理学

Abstract:

Objective To construct an evidence-based prevention and management programme for peristomal moisture-associated skin damage in patients with enterostomy，and to evaluate its clinical effectiveness in improving the knowledge level of nurses and patients about peristomal moisture-associated skin damage in patients with enterostomy and reducing the incidence and severity of peristomal moisture-associated skin damage. Methods Through literature screening，evaluation，and summary，the best evidence for the prevention and management programme of peristomal moisture-associated skin damage in patients with enterostomy was summarized. From October 2021 to March 2022，based on the Ottawa research application model，review indicators were developed based on the best evidence for clinical review，identifying obstacles and promoting factors in evidence application，and developing action strategies to improve the evidence-based practice content for the prevention and management of peristomal moisture-associated skin damage in patients with enterostomy. From April to June 2022，evidence-based practice was conducted in the oncology surgery ward of a tertiary hospital in Anhui Province. The implementation rate of various review indicators by nurses，the knowledge level of peristomal moisture-associated skin damage of nurses and patients，and the incidence and severity of peristomal moisture-associated skin damage were compared before and after evidence-based practice. Results 46 cases were included before the evidence-based practice and 49 cases were included after the evidence-based practice. After evidence-based practice，the implementation rate of each review index was improved； the overall implementation rate increased from（0—66.67%） to（83.33%—100%）； the score of the patient’s knowledge questionnaire on peristomal moisture-associated skin damage was increased from（69.67±8.31） to（80.18±8.07）. The score of the nurse’s knowledge questionnaire on peristomal moisture-associated skin damage was increased from（79.83±5.97） to（88.28±5.43）. At 4 weeks and 12 weeks of discharge，the incidence of peristomal moisture-associated skin damage was decreased，with a statistically significant difference（P<0.05）； the severity of peristomal moisture-associated skin damage was also significantly reduced，with a statistically significant difference（P<0.05）. Conclusion Conducting evidence-based practice for the prevention and management of peristomal moisture-associated skin damage can effectively improve the implementation rate of nurse review indicators，improve the knowledge level of nurses and patients with peristomal moisture-associated skin damage，and reduce the incidence and severity of peristomal moisture-associated skin damage in patients with enterostomy.

Key words: Enterostomy, Peristomal Moisture-Associated Skin Damage, Prevention, Management, Evidence-Based Nursing

郭琼, 刘春芳, 张静, 汤琪, 张梦媛, 李秀川. 肠造口周围潮湿相关性皮炎预防及管理的循证实践[J]. 中华护理杂志, 2024, 59(12): 1413-1421.

GUO Qiong, LIU Chunfang, ZHANG Jing, TANG Qi, ZHANG Mengyuan, LI Xiuchuan. Evidence-based practice for a prevention and management programme of peristomal moisture-associated skin damage in patients[J]. Chinese Journal of Nursing, 2024, 59(12): 1413-1421.

图/表 6

表1 肠造口周围潮湿相关性皮炎预防与管理的最佳证据、审查指标与审查方法

Table 1 Table of the relationship among best evidence，review indicators and review methods for prevention and management program of peristomal moisture-associated skin damage

表2 肠造口周围潮湿相关性皮炎预防与管理的循证实践方案障碍与促进因素分析

Table 2 Analysis of barriers and facilitators for prevention and management program of peristomal moisture-associated skin damage

表3 两组患者一般资料的比较[例（百分比，%）]

Table 3 Comparison of baseline data of 2 groups of patients[case（percentage，%）]

表4 循证实践前后审查指标执行率的比较[例（百分率，%）]

Table 4 Comparison of the implementation rate of review indicators before and after the application of the programme[cases（percentage，%）]

表5 两组患者肠造口周围潮湿相关性皮炎发生率的比较[例（百分比，%）]

Table 5 Comparison of the incidence of dermatitis between 2 groups of patients[cases（percentage，%）]

表6 两组患者肠造口周围潮湿相关性皮炎严重程度的比较[例（百分比，%）]

Table 6 Comparison of the severity of dermatitis between 2 groups of patients[cases（percentage，%）]

参考文献 21

[1]	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249.
[2]	周雄, 胡明, 李子帅, 等. 2020年全球及中国结直肠癌流行状况分析[J]. 海军军医大学学报, 2022, 43(12):1356-1364.
	Zhou X, Hu M, Li ZS, et al. Colorectal cancer in the world and China in 2020:an analysis of epidemic status[J]. Acad J Naval Med Univ, 2022, 43(12):1356-1364.
[3]	孙燕, 郑树, 万德森, 等. 中国结直肠癌诊疗规范(2020年版)[J]. 中国实用外科杂志, 2020, 40(6):601-625.
	Sun Y, Zheng S, Wan DS, et al. Chinese protocol of diagnosis and treatment of colorectal cancer(2020 edition)[J]. Chin J Pract Sur, 2020, 40(6):601-625.
[4]	Colwell JC, McNichol L, Boarini J. North America wound,ostomy,and continence and enterostomal therapy nurses current ostomy care practice related to peristomal skin issues[J]. J Wound Ostomy Continence Nurs, 2017, 44(3):257-261. DOI PMID
[5]	Wang H, Jiang G, Wang Y, et al. Construction and validation of the perioral moisture-related skin damage(PMASD) risk predic-tion model in patients with colorectal cancer[J]. Int Wound J, 2023, 20(6):2207-2214.
[6]	韩杉, 张海邻, 唐瑾, 等. 肠造口患者及家属焦虑抑郁状况及对患者造口自护能力的影响[J]. 护理学杂志, 2019, 34(13):79-82.
	Han S, Zhang HL, Tang J, et al. Impact of anxiety and depression levels among colostomy patients and their families on patient self-care ability[J]. J Nurs Sci, 2019, 34(13):79-82.
[7]	Wound, Ostomy and Continence Nurses Society,Guideline Development Task Force. WOCN society clinical guideline:management of the adult patient with a fecal or urinary ostomy:an executive summary[J]. J Wound Ostomy Continence Nurs, 2018, 45(1):50-58.
[8]	刘莺歌, 吴燕, 曹秋君, 等. 肠造口患者造口周围潮湿相关性皮肤损伤的影响因素分析[J]. 中华护理教育, 2021, 18(8):749-754.
	Liu YG, Wu Y, Cao QJ, et al. Risk factors of peristomal moisture-associated skin damage in patients with stoma[J]. Chin J Nurs Educ, 2021, 18(8):749-754.
[9]	王慧, 王一涵, 贾宏玉, 等. 结直肠癌患者造口周围潮湿相关性皮肤损伤的影响因素分析[J]. 护士进修杂志, 2022, 37(22):2017-2021.
	Wang H, Wang YH, Jia HY, et al. Analysis of influencing factors of peristomal moisture-associated skin damage(PMASD)in patients with colorectal cancer[J]. J Nurses Train, 2022, 37(22):2017-2021.
[10]	李牧玲, 甄莉, 朱木兰, 等. 肠造口患者造口周围潮湿相关性皮肤损伤预防及护理的最佳证据总结[J]. 护理学报, 2023, 30(1):41-46.
	Li ML, Zhen L, Zhu ML, et al. Best evidence summary for the prevention and nursing of peristomal moisture-associated skin damage in patients with enterostomy[J]. J Nurs(China), 2023, 30(1):41-46.
[11]	董珊, 袁玲, 陈秋菊, 等. 肠造口周围潮湿相关性皮肤损伤预防与管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(2):223-230. DOI URL
	Dong S, Yuan L, Chen QJ, et al. Summary of the evidence for the prevention and management of peristomal moisture-associated skin damage in adults[J]. Chin J Nurs, 2022, 57(2):223-230.
[12]	郭琼, 刘春芳, 张静, 等. 造口周围潮湿相关性皮炎预防管理的证据总结[J]. 护士进修杂志, 2023, 38(5):430-436.
	Guo Q, Liu CF, Zhang J, et al. Summary of evidence based prevention and management programs for peristomal moisture-associated skin damage[J]. J Nurses Train, 2023, 38(5):430-436.
[13]	李加敏, 庞冬, 张剑锋, 等. 造口周围皮肤评估工具的研究进展[J]. 护理研究, 2019, 33(24):4267-4270.
	Li JM, Pang D, Zhang JF, et al. A literature review of peristomal skin assessment tools[J]. Chin Nurs Res, 2019, 33(24):4267-4270.
[14]	Kim YM, Jang HJ, Lee YJ. The effectiveness of preoperative stoma site marking on patient outcomes:a systematic review and meta-analysis[J]. J Adv Nurs, 2021, 77(11):4332-4346.
[15]	中华护理学会伤口、造口、失禁护理专业委员会. 成人肠造口护理标准[J]. 中华护理杂志, 2020, 55(增刊2):15-19.
	Wound,Ostomy,Incontinence Nursing Professional Committee of Chinese Nursing Association. Nursing care for adult stoma patients[J]. Chin J Nurs, 2020, 55(Suppl 2):15-19.
[16]	徐元元, 史广玲, 张燕红, 等. 预防ICU患者大便失禁性皮炎的循证实践[J]. 中华护理杂志, 2021, 56(6):811-817. DOI URL
	Xu YY, Shi GL, Zhang YH, et al. Evidence-based practice in prevention of fecal incontinence associated dermatitis in ICU patients[J]. Chin J Nurs, 2021, 56(6):811-817. DOI URL
[17]	李加敏, 庞冬, 路潜, 等. 尿路造口周围刺激性皮炎患者的循证护理实践[J]. 中华护理杂志, 2020, 55(11):1624-1629. DOI URL
	Li JM, Pang D, Lu Q, et al. Evidence-based nursing practice of peristomal irritant dermatitis in patients with urostomies[J]. Chin J Nurs, 2020, 55(11):1624-1629. DOI URL
[18]	Millard R, Cooper D, Boyle MJ. Improving self-care outcomes in ostomy patients via education and standardized discharge criteria[J]. Home Healthc Now, 2020, 38(1):16-23. DOI PMID
[19]	郭员志, 张红梅, 赵培, 等. 乳腺癌术后淋巴水肿预防与护理的循证实践[J]. 中华护理杂志, 2023, 58(7):773-781. DOI URL
	Guo YZ, Zhang HM, Zhao P, et al. Evidence-based practice of lymphedema prevention and nursing after breast cancer surgery[J]. Chin J Nurs, 2023, 58(7):773-781.
[20]	李雯雯, 王淑云, 陆连芳, 等. 肠造口患者自我照护行为执行意向问卷的研制[J]. 中华护理教育, 2021, 18(8):742-748.
	Li WW, Wang SY, Lu LF, et al. Development and validation of an Entorostomy Self-Care Implementation Intention Questionnaire[J]. Chin J Nurs Educ, 2021, 18(8):742-748.
[21]	程孝惠, 谭丽萍, 李颖, 等. “线下讲堂+线上督导”健康教育方案在肠造口患者家庭护理中的实践[J]. 中华护理教育, 2021, 18(12):1073-1078.
	Cheng XH, Tan LP, Li Y, et al. The application of an “offline lecture + online supervision” health education program in pa-tients with enterostomyat home[J]. Chin J Nurs Educ, 2021, 18(12):1073-1078.