积极心理干预在永久性肠造口患者中的应用研究

doi:10.3761/j.issn.0254-1769.2024.12.002

摘要/Abstract

摘要：

目的探讨积极心理干预对永久性肠造口患者病耻感、造口适应能力及生活质量的影响。方法采用方便抽样法，选取2022年10月—2023年9月在辽宁省某三级甲等医院行永久性肠造口患者，随机分为试验组41例和对照组42例。试验组实施基于幸福理论模式的积极心理干预，对照组接受常规护理，干预时间共计8周，分别在干预前后进行资料收集，并比较两组的病耻感、造口适应能力和生活质量的得分。结果试验组、对照组各40例完成研究。干预后，试验组的病耻感总得分（44.70±9.10）分，低于对照组的（62.15±12.43）分（t=-7.163，P<0.001），试验组的造口适应能力总得分（52.28±5.80）分，高于对照组的（41.53±9.00）分（t=6.349，P<0.001），试验组的生活质量得分（54.08±8.29）分，高于对照组的（42.95±9.19）分（t=5.688，P<0.001），差异均具有统计学意义。结论积极心理干预有利于减轻永久性肠造口患者的病耻感，提升患者的造口适应能力，改善患者的术后生活质量。

关键词: 永久性肠造口, 积极心理干预, 病耻感, 生活质量, 护理

Abstract:

Objective To explore the effects of positive psychological intervention based on PERMA model of wellbeing on stigma，adaptation to ostomy and quality of life in patients with permanent enterostomy. Methods A total of 83 patients with permanent enterostomy were recruited from October 2022 to September 2023 in a tertiary hospital in Liaoning Province. They were randomly divided into an experimental group and a control group. While the control group received routine nursing，the experimental group received nursing intervention based on PERMA. The intervention lasted 8 weeks，and data were collected before and after the intervention. The scores of the Social Impact Scale（SIS），Ostomy Adjustment Inventory-20（OAI-20） and Stoma Quality of Life（Stoma-QOL） in the 2 groups were compared. Results Experimental group and control group were 40 cases each completed the study. After the intervention,the SIS score of the experimental group was（44.70±9.10），which was significantly lower than （62.15±12.43） of the control group, and the difference between 2 groups was statistically significant（t=-7.163，P<0.001）. The OAI-20 score of the experimental group was（52.28±5.80）, which was significantly higher than（41.53±9.00） of the control group, and the difference between the 2 groups was statistically significant（t=6.349，P<0.001）. The Stoma-QOL score of the experimental group was（54.08±8.29），which was significantly higher than（42.95±9.19）of the control group, and the difference between the 2 groups was statistically significant（t=5.688，P<0.001）. Conclusion Nursing interventions based on PERMA are beneficial in reducing stigma of patients with permanent enterostomy，improving their ostomy adjustment and postoperative quality of life.

Key words: Permanent Enterostomy, Positive Psychological Intervention, Stigma, Quality of Life, Nursing Care

曲盛美, 齐向秀, 李群, 李可, 李妍, 韩丽, 李晶莹. 积极心理干预在永久性肠造口患者中的应用研究[J]. 中华护理杂志, 2024, 59(12): 1422-1428.

QU Shengmei, QI Xiangxiu, LI Qun, LI Ke, LI Yan, HAN Li, LI Jingying. Effects of positive psychological intervention in patients with permanent enterostomy[J]. Chinese Journal of Nursing, 2024, 59(12): 1422-1428.

图/表 5

表1 积极心理干预方案

Table 1 The positive psychological intervention program

表2 两组一般资料的比较[例（百分比，%）]

Table 2 Comparison of general information between 2 groups[case（percentage，%）]

表3 两组干预前后社会影响量表得分的比较（分，$\bar{x}±s$）

Table 3 Comparison of stigma scores between 2 groups before and after the intervention （score，$\bar{x}±s$）

表4 两组干预前后造口适应能力得分的比较（分，$\bar{x}±s$）

Table 4 Comparison of OAI-20 scores between 2 groups before and after the intervention （score，$\bar{x}±s$）

表5 两组干预前后生活质量得分的比较（分，$\bar{x}±s$）

Table 5 Comparison of Stoma-QOL scores between 2 groups before and after the intervention（score，$\bar{x}±s$）

参考文献 21

[1]	台瑞, 方芳, 毛晶珏, 等. 永久性肠造口患者造口适应水平影响因素分析[J]. 上海交通大学学报(医学版), 2023, 43(11):1423-1429.
	Tai R, Fang F, Mao JJ, et al. Analysis of influencing factors of adaptation level in patients with permanent enterostomy[J]. J Shanghai Jiao Tong Univ Med Sci, 2023, 43(11):1423-1429.
[2]	李红燕. 肠造口患者术后早期病耻感现状及其影响因素的研究[D]. 合肥: 安徽医科大学, 2019.
	Li HY. Study on the status of early postoperative stigma and its influencing factors in patients with enterostomy[D]. Hefei: Anhui Medical University, 2019.
[3]	严华, 张星. 直肠癌永久性造口患者的心理弹性及其与病耻感和心理痛苦的相关性[J]. 临床与病理杂志, 2018, 38(5):1027-1031.
	Yan H, Zhang X. Psychological resilience of patients with permanent stoma of rectal cancer and its correlation with stigma and psychological pain[J]. J Clin Pathol Res, 2018, 38(5):1027-1031.
[4]	Jin Y, Ma H, Jiménez-Herrera M. Self-disgust and stigma both mediate the relationship between stoma acceptance and stoma care self-efficacy[J]. J Adv Nurs, 2020, 76(10):2547-2558.
[5]	王艳, 杨富国, 鞠陶然, 等. 不同应对方式在结肠造口患者病耻感和造口适应间的中介效应[J]. 解放军护理杂志, 2018, 35(5):29-32.
	Wang Y, Yang FG, Ju TR, et al. The meditating effects of different coping style between stigma and adjustment level among patients with colostomy[J]. Nurs J Chin PLA, 2018, 35(5):29-32.
[6]	郑子秀, 宋润珞, 高焱, 等. 基于PERMA模式的护理干预对中青年脑卒中病人病耻感和日常生活能力的影响[J]. 护理研究, 2023, 37(19):3538-3544.
	Zheng ZX, Song RL, Gao Y, et al. Effect of nursing intervention based on PERMA model on stigma and ability of daily living in young and middle-aged stroke patients[J]. Chin Nurs Res, 2023, 37(19):3538-3544.
[7]	Luo L, Li Y, Zhou Z, et al. Study on the effect of positive psy-chological intervention based on PERMA model on periopera-tive patients with aids complicated with breast cancer[J]. Comput Math Methods Med, 2022, 2022:9788122.
[8]	Tu M, Wang F, Shen S, et al. Influences of psychological intervention on negative emotion,cancer-related fatigue and level of hope in lung cancer chemotherapy patients based on the PERMA framework[J]. Iran J Public Health, 2021, 50(4):728-736.
[9]	梁梦颖. 叙事护理对肠造口患者病耻感影响的应用研究[D]. 南宁: 广西中医药大学, 2020.
	Liang MY. Application of narrative nursing on stigma in patients with enterostomy[D]. Nanning: Guangxi University of Chi-nese Medicine, 2020.
[10]	Fife BL, Wright ER. The dimensionality of stigma:a comparison of its impact on the self of persons with HIV/AIDS and cancer[J]. J Health Soc Behav, 2000, 41(1):50-67. PMID
[11]	Pan AW, Chung L, Fife BL, et al. Evaluation of the psychometrics of the Social Impact Scale:a measure of stigmatization[J]. Int J Rehabil Res, 2007, 30(3):235-238.
[12]	Simmons KL, Smith JA, Maekawa A. Development and psychometric evaluation of the Ostomy Adjustment Inventory-23[J]. J Wound Ostomy Continence Nurs, 2009, 36(1):69-76. DOI PMID
[13]	皋文君, 袁长蓉. 中文版造口患者适应量表的信效度测评[J]. 中华护理杂志, 2011, 46(8):811-813.
	Gao WJ, Yuan CR. The reliability and validity test of a Chinese version of Ostomy Adjustment Inventory[J]. Chin J Nurs, 2011, 46(8):811-813.
[14]	Prieto L, Thorsen H, Juul K. Development and validation of a Quality of Life Questionnaire for patients with colostomy or ileostomy[J]. Health Qual Life Outcomes, 2005, 3:62.
[15]	吴雪, 金晓燕, 尚少梅, 等. 造口病人生活质量量表中文译本的信度、效度分析[J]. 中国护理管理, 2011, 11(7):23-25.
	Wu X, Jin XY, Shang SM, et al. Reliability and validity of the Chinese version of the Stoma-QOL Questionnaire[J]. Chin Nurs Manag, 2011, 11(7):23-25.
[16]	王千心, 张彩云, 张志刚, 等. 积极心理干预对妇科癌症患者病耻感及适应水平的影响[J]. 护理学杂志, 2020, 35(13):71-73.
	Wang QX, Zhang CY, Zhang ZG, et al. The effect of positive psychology interventions on stigma and adjustment in gynecological cancer patients[J]. J Nurs Sci, 2020, 35(13):71-73.
[17]	王汐嬅, 史莉娜, 成颖, 等. 肠造口患者病耻感与出院准备度的关系[J]. 中国心理卫生杂志, 2021, 35(9):710-714.
	Wang XH, Shi LN, Cheng Y, et al. Relation of stigma and readiness for hospital discharge in patients with stoma[J]. Chin Mental Health J, 2021, 35(9):710-714.
[18]	郝沛, 金瑞华, 淮盼盼, 等. 基于PERMA模式的积极心理干预在宫颈癌放化疗病人中的应用[J]. 护理研究, 2023, 37(21):3975-3980.
	Hao P, Jin RH, Huai PP, et al. Application of positive psychological intervention based on PERMA model in patients with cervical cancer chemoradiotherapy[J]. Chin Nurs Res, 2023, 37(21):3975-3980.
[19]	程方方, 张欢, 李嘉宁, 等. 结直肠癌造口术后患者病耻感对心理弹性和生活质量及造口并发症的影响[J]. 中华肿瘤防治杂志, 2021, 28(11):852-857.
	Cheng FF, Zhang H, Li JN, et al. Influence of stigma on resilience,quality of life and complications of colostomy in patients with colorectal cancer after colostomy[J]. Chin J Cancer Prev Treat, 2021, 28(11):852-857.
[20]	常子梦, 王佳丽, 丑静, 等. 结直肠癌患者肠造口早期益处发现与生活质量相关性分析[J]. 护理学杂志, 2022, 37(19):75-77.
	Chang ZM, Wang JL, Chou J, et al. Relationship between benefit finding and quality of life among colorectal cancer patients with stoma at early stage[J]. J Nurs Sci, 2022, 37(19):75-77.
[21]	林丽英, 肖惠敏, 方一芳. 结直肠癌造口患者出院计划的最佳证据总结[J]. 中华护理杂志, 2023, 58(16):2012-2019. DOI URL
	Lin LY, Xiao HM, Fang YF. Best evidence summary of dis-charge planning for colorectal cancer patients receiving colos-tomy[J]. Chin J Nurs, 2023, 58(16):2012-2019.