预防性回肠造口患者营养状况及影响因素分析

doi:10.3761/j.issn.0254-1769.2025.04.002

摘要/Abstract

摘要：

目的了解预防性回肠造口患者的营养状况并分析其影响因素，为医护人员制订营养干预策略提供依据。方法采用便利抽样法，于2023年11月—2024年7月选取在广州市4所三级甲等医院复诊或住院等待还纳的239例预防性回肠造口患者为调查对象，采用一般资料调查问卷和患者主观整体营养状况评估工具进行调查，采用单因素分析和多因素有序Logistic回归分析预防性回肠造口患者营养状况的影响因素。结果共回收有效问卷227份，有效问卷回收率为94.98%，其中营养良好或可疑营养不良组64例（28.19%），中度营养不良组104例（45.81%），重度营养不良组59例（25.99%）。多因素有序Logistic回归分析结果显示，术前累计化疗周期、术后时间、年龄、当前饮食类型、有无摄入口服营养补充剂（oral nutritional supplements，ONS）、有无肠造口并发症和造口自我护理能力是预防性回肠造口患者营养状况的影响因素（P<0.05）。结论预防性回肠造口患者的中、重度营养不良发生率较高，ONS的摄入并未有效改善其营养状况。术前累计化疗周期多、术后时间较短、年龄≥65岁、流质饮食或半流质饮食、存在肠造口并发症和造口自我护理能力不足的患者营养状况较差。建议医护人员根据相关影响因素制订干预策略，以改善预防性回肠造口患者的营养状况。

关键词: 回肠造口术, 营养状况, 影响因素分析, 护理

Abstract:

Objective To assess the nutritional status of patients undergoing preventive ileostomy and identify the factors that influence the status, thereby providing guidance for medical staff to formulate nutritional intervention strategies. Methods Convenient sampling was used to select 239 patients undergoing preventive ileostomy who were attending follow-up visits or hospitalized while awaiting stoma closure at 4 tertiary hospitals in Guangzhou from November 2023 to July 2024. Data was collected by a general information questionnaire and the Patient-Generated Subjective Global Assessment tool. Factors influencing nutritional status were analyzed by multivariable ordinal Logistic regression. Results Of the 239 patients，227 provided valid responses. The nutritional status was categorized as follows: 64 patients（28.19%） had good nutrition or were at risk of malnutrition；104 （45.81%） exhibited moderate malnutrition；59（25.99%） had severe malnutrition. Multivariable ordinal Logistic regression analysis revealed that preoperative cumulative chemotherapy cycles, postoperative duration, age, current dietary type，use of oral nutritional supplements（ONS），enterostomy-related complications，and stoma self-care ability were significant predictors of nutritional status（P<0.05）. Conclusion Patients undergoing preventive ileostomy are at a high risk of moderate to severe malnutrition and ONS provided to patients did not result in a meaningful improvement in their nutritional health. Specifically，those patients with a higher number of cumulative preoperative chemotherapy cycles，shorter postoperative recovery time，aged ≥65 years，liquid diet or semi-liquid diet， experiencing enterostomy-related complications, or poor stoma self-care ability，are particularly vulnerable to malnutrition. These findings underscore the need for medical staff to formulate intervention strategies based on these factors to improve nutritional status of patients undergoing preventive ileostomy.

Key words: Ileostomy, Nutritional Status, Root Cause Analysis, Nursing Care

李瑞华, 甄莉, 朱木兰, 叶新梅, 秦芳, 张星星, 林梅燕, 李国新. 预防性回肠造口患者营养状况及影响因素分析[J]. 中华护理杂志, 2025, 60(4): 396-403.

LI Ruihua, ZHEN Li, ZHU Mulan, YE Xinmei, QIN Fang, ZHANG Xingxing, LIN Meiyan, LI Guoxin. Nutritional status and influencing factors in patients undergoing preventive ileostomy[J]. Chinese Journal of Nursing, 2025, 60(4): 396-403.

图/表 3

表1 调查对象的一般资料及营养状况单因素分析结果（n=227）

Table 1 General information of the respondents and results of univariate analysis on the influencing factors of nutritional status（n=227）

表2 自变量赋值情况

Table 2 Assignment of independent variables

表3 预防性回肠造口患者营养状况影响因素的有序Logistic回归分析结果（n=227）

Table 1 Ordinal Logistic regression analysis of the influencing factors of nutritional status in patients undergoing preventive ileostomy（n=227）

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