临时性肠造口患者健康教育的最佳证据总结

doi:10.3761/j.issn.0254-1769.2024.12.007

摘要/Abstract

摘要：

目的系统检索、汇总临时性肠造口患者健康教育的高质量循证证据，为临床实践提供循证依据。方法计算机检索UpToDate、BMJ Best Practice、美国卫生健康研究与质量管理署网站、英国国家卫生与临床优化研究所网站、加拿大安大略省注册护士协会网站、医脉通、世界造口治疗师协会网站、美国造口协会联盟网站、加拿大伤口造口失禁专科护士协会网站、澳大利亚国家卫生和医学研究委员会网站、中华护理学会网站、中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Web of Science、CINAHL、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、Cochrane协作网数据库中与临时性肠造口患者健康教育相关的证据，包括临床决策、指南、专家共识、证据总结和系统评价。检索时限为2013年1月1日—2023年8月1日。2名经过系统循证知识培训的研究者根据纳入和排除标准，独立进行文献筛选、质量评价、提取和汇总证据。结果共纳入文献16篇，其中包含指南5篇、临床决策2篇、证据总结4篇、系统评价2篇、专家共识2篇、团体标准1篇。从健康教育者资质、健康教育对象、健康教育时机、健康教育方式与评价指标、术前健康教育、术后健康教育、居家随访管理7个方面汇总了24条最佳证据。结论该研究总结的临时性肠造口患者健康教育的最佳证据具有一定科学性和实用性，为医护人员实施临时性肠造口患者的健康教育提供了循证依据。

关键词: 临时性肠造口, 健康教育, 证据总结, 循证护理学

Abstract:

Objective To systematically retrieve and summarize high-quality evidence on health education for patients with temporary enterostomies to provide an evidence-based basis for clinical practice. Methods We searched UpToDate，BMJ Best Practice，AHRQ，NICE，RNAO，MEDLIVE，WCET，UOAA，NSWOCC，NHMRC，CNA，CNKI，Wanfang，VIP，CBM，PubMed，Web of Science，CINAHL，JBI，and Cochrane Collaboration databases of evidence related to health education for patients with temporary enterostomies，including clinical decisions，guidelines，expert consensuses，evidence summaries，and systematic reviews. The search time limit was from January 1，2013 to August 1，2023. 2 researchers who were trained in systematic evidence-based knowledge independently conducted literature screening，quality assessment，extraction and summarization of evidence based on inclusion and exclusion criteria. Results A total of 16 articles were included，including 5 guidelines，2 clinical decisions，4 evidence summaries，2 systematic reviews，2 expert consensuses，and 1 standard. The 24 pieces of the best evidences were summarized in 7 aspects：qualification of health educators，subjects of health education，opportunity of health education，mode and evaluation index of health education，preoperative health education，postoperative health education and home follow-up management. Conclusion The best evidence of health education for patients with temporary enterostomies summarized in this study is scientific and practical，providing evidence-based basis for healthcare professionals to implement health education for patients with temporary enterostomies.

Key words: Temporary Enterostomy, Health Education, Evidence Summary, Evidence-Based Nursing

李丹阳, 庄嘉元, 林华燕, 林娜, 朱芮, 王艳. 临时性肠造口患者健康教育的最佳证据总结[J]. 中华护理杂志, 2024, 59(12): 1454-1461.

LI Danyang, ZHUANG Jiayuan, LIN Huayan, LIN Na, ZHU Rui, WANG Yan. Summary of the best evidence on health education for patients with temporary enterostomies[J]. Chinese Journal of Nursing, 2024, 59(12): 1454-1461.

图/表 5

表1 中国知网和PubMed的文献检索式

Table 1 Literature search format of CNKI and PubMed

图1 文献筛选流程图

Figure 1 Flow chart of literature search and Screening

表2 纳入文献的基本特征（n=16）

Table 2 The characteristics of the included studies（n=16）

表3 纳入指南的质量评价结果（n=5）

Table 3 Quality evaluation of clinical practice guidelines（n=5）

表4 临时性肠造口患者健康教育的最佳证据

Table 4 Summary of the best evidence for health education for TE patients

参考文献 36

[1]	甄莉, 叶连风, 温海飞, 等. 98例临时性肠造口还纳术患者的护理[J]. 护理学报, 2015, 22(19):44-46.
	Zhen L, Ye LF, Wen HF, et al. Nursing care of 98 patients with temporary enterostomy restitution[J]. J Nurs(China), 2015, 22(19):44-46.
[2]	Pérez Domínguez L, García Martínez MT, Cáceres Alvarado N, et al. Morbidity and mortality of temporary diverting ileostomies in rectal cancer surgery[J]. Cir Esp, 2014, 92(9):604-608.
[3]	Lindgren R, Hallböök O, Rutegård J, et al. What is the risk for a permanent stoma after low anterior resection of the rectum for cancer?A six-year follow-up of a multicenter trial[J]. Dis Colon Rectum, 2011, 54(1):41-47. DOI PMID
[4]	Wang SY, Chang TH, Han CY. Effectiveness of a multimedia patient education intervention on improving self-care knowledge and skills in patients with colorectal cancer after enterostomy surgery:a pilot study[J]. Adv Skin Wound Care, 2021, 34(2):1-6.
[5]	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 mois-ture-associated skin damage in patients with stoma[J]. Chin J Nurs Educ, 2021, 18(8):749-754.
[6]	Bradley RD, Michael AV, Joel EG, et al. The American society of colon and rectal surgeons clinical practice guidelines for ostomy surgery[J]. Dis Colon Rectum, 2022, 65(10):1173-1190. DOI PMID
[7]	World Councill of Enterostomal Therapists. 2020 international ostomy guideline[EB/OL]. (2020-12-30)[2023-02-02]. https://wcetn.org/store/viewproduct.aspx?id=18085461&hhSearchTerms=%22guideline%22.
[8]	Registered Nurses’ Association of Ontario. Supporting adults who anticipate or live with an ostomy[EB/OL]. (2019-04)[2023-02-02]. https://rnao.ca/bpg/guidelines/ostomy.
[9]	Wound,Ostomy and Continence Nurses Society. WOCN society clinical guideline:management of the adult patient with a fecal or urinary ostomy[EB/OL]. (2018)[2023-02-15]. http://www.wocn.org.
[10]	Miller D, Pearsall E, Johnston D, et al. Enhanced recovery after surgery:best practice guideline for care of patients with a fecal diversion[EB/OL]. (2017)[2023-02-02]. http://links.lww.com/JWOCN/A36.
[11]	中国医师协会肛肠医师分会造口专业委员会, 中国医师协会肛肠医师分会, 中华医学会外科学分会结直肠外科学组, 等. 中低位直肠癌手术预防性肠造口中国专家共识(2022版)[J]. 中华胃肠外科杂志, 2022, 25(6):471-478.
	Ostomy Professional Committee, Chinese Society of Coloproctology, Chinese Medical Doctor Association; Chinese Society of Colorectal Surgery, Chinese Society of Surgery, Chinese Medical Association; Colorectal Tumor Professional Committee, Chinese Medical Doctor Association, et al. Chinese expert con-sensus on protective ostomy for mid-low rectal cancer(2022 edition)[J]. Chin J Gastrointest Surg, 2022, 25(6):471-478.
[12]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
	Zhu Z, Hu Y, Xing WJ, et al. Components of different types of evidence-based questions[J]. J Nurses Train, 2017, 32(21):1991-1994.
[13]	The AGREE Next Steps Consortium. Apprasial of guidelines for research & evaluation Ⅱ 2017[EB/OL]. (2017)[2023-02-19]. https://www.agreetrust.org/wp-content/uploads.
[14]	The Joanna Briggs Institute. The Joanna Briggs Institute reviews’ manual:2016 edition[EB/OL]. (2016-03-18)[2022-11-30]. https://www.joannabriggs.org.
[15]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI pregrading of evidence and level of evidence recommendation system(2014 edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[16]	Landmann RG, Cashman AL. Ileostomy or colostomy care and complications[EB/OL]. (2021-11-16)[2023-02-02]. https://www.uptodate.cn/contents/ileostomy-or-colostomy-care-and-complications.
[17]	Francone TD. Overview of surgical ostomy for fecal diversion[EB/OL]. (2021-04-06)[2023-02-02]. https://www.uptodate.cn/contents/overview-of-surgical-ostomy-for-fecal-diversion.
[18]	Sivapuram MS. Stoma:care and assessment[EB/OL]. (2022-03-30)[2023-02-10]. https://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=jbi&AN=JBI85.
[19]	Minooee S. Stoma care:preoperative patient assessment and education[EB/OL]. (2022-01-19)[2023-02-10]. https://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=jbi&AN=JBI21700.
[20]	Minooee S. Stoma care:post-operatively discharge and follow-up[EB/OL]. (2021-03-04)[2023-02-02]. https://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=jbi&AN=JBI21699.
[21]	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 best evidence for the prevention and management of peristomal moisture-associated skin damage in adults[J]. Chin J Nurs, 2022, 57(2):223-230. DOI URL
[22]	Goodman W, Allsop M, Downing A, et al. A systematic review and meta-analysis of the effectiveness of self-management interventions in people with a stoma[J]. J Adv Nurs, 2022, 78(3):722-738.
[23]	Dulskas A, Smolskas E, Kildusiene I, et al. Treatment possibilities for low anterior resection syndrome:a review of the literature[J]. Inter J Colorectal Dis, 2018, 33(3):251-260.
[24]	North J, Osborne W. ASCN UK guideline:parastomal hernias[J]. British J Nurs, 2017, 26(22):S6-S13.
[25]	中华护理学会. 成人肠造口护理标准[EB/OL]. (2021-01-03)[2023-02-02]. http://www.cna-cast.org.cn/cnaWebcn/article/2127.
	Chinese Nursing Association. Standards of care for adult en-terostomies[EB/OL].(2021-01-03)[2023-02-02]. http://www.cna-cast.org.cn/cnaWebcn/article/2127.
[26]	Gray M, Colwell JC, Doughty D, et al. Peristomal moisture-associated skin damage in adults with fecal ostomies:a com-prehensive review and consensus[J]. J Wound Ostomy Continence Nurs, 2013, 40(4):389-399.
[27]	Dissemond J, Assenheimer B, Gerber V, et al. Moisture-associated skin damage(MASD):a best practice recommendation from Wund-D.A.CH[J]. J Dtsch Dermatol Ges, 2021, 19(6):815-825. DOI PMID
[28]	李瑞华, 刘海妮, 杨群草, 等. 伤口造口失禁专科护士培养的研究进展[J]. 中华护理教育, 2019, 16(7):551-554.
	Li RH, Liu HN, Yang QC, et al. Research progress in the training of wound ostomy incontinence specialist nurses[J]. Chin J Nurs Educ, 2019, 16(7):551-554.
[29]	郭彤, 刘心菊, 刘力平, 等. 跨专科护理健康教育平台的应用研究[J]. 中国护理管理, 2021, 21(6):922-925.
	Guo T, Liu XJ, Liu LP, et al. The establishment and applica-tion of a cross-specialty mobile health education platform[J]. Chin Nurs Manag, 2021, 21(6):922-925.
[30]	马登慧, 史宇欣, 张乖, 等. 国外跨学科护理人才培养的现状及启示[J]. 中华护理教育, 2021, 18(6):564-567.
	Ma DH, Shi YX, Zhang G, et al. Nursing interdisciplinary talents training outside China:its current status and implications[J]. Chin J Nurs Educ, 2021, 18(6):564-567.
[31]	俞德梁, 霍婷婷, 刘小南. 围手术期综合管理新理念[J]. 医学与哲学(B), 2017, 38(12):5-7.
	Yu DL, Huo TT, Liu XN. New concept of perioperative management[J]. Med Philos(B), 2017, 38(12):5-7.
[32]	司龙妹, 刘飞, 张佩英, 等. 造口患者围手术期健康教育的最佳证据总结[J]. 中华护理杂志, 2021, 56(3):452-457. DOI URL
	Si LM, Liu F, Zhang PY, et al. Evidence summary of perioperative health education for patients undergoing ostomy surgery[J]. Chin J Nurs, 2021, 56(3):452-457. DOI URL
[33]	贺育华, 杨婕, 蒋理立. 结直肠癌病人术后非计划性再入院的研究进展[J]. 护理研究, 2019, 33(2):290-293.
	He YH, Yang J, Jiang LL. Research progress on unplanned postoperative readmission of colorectal cancer patients[J]. Chin Nurs Res, 2019, 33(2):290-293.
[34]	中国营养学会. 中国居民膳食指南(2022)[M]. 北京: 人民卫生出版社, 2022:258-259.
	Chinese Nutrition Society. Dietary guidelines for Chinese residents(2022)[M]. Beijing: People’s Medical Publishing House, 2022:258-259.
[35]	郑美春, 吴晓丹, 姜武, 等. 生物反馈训练对预防直肠癌患者保肛术后前切除综合征的效果评价[J]. 中华护理杂志, 2019, 54(7):1032-1037. DOI URL
	Zheng MC, Wu XD, Jiang W, et al. Effects of biofeedback training on prevention of anterior resection syndrome in rectal cancer patients underwent anuspreserving surgery[J]. Chin J Nurs, 2019, 54(7):1032-1037.
[36]	胡娇娇, 王建宁, 詹梦梅, 等. 肠造口患者居家护理需求质性研究的Meta整合[J]. 中华护理杂志, 2023, 58(3):357-365. DOI URL
	Hu JJ, Wang JN, Zhan MM, et al. Meta integration qualitative research on home care needs of patients with enterostomy[J]. Chin J Nurs, 2023, 58(3):357-365.