Experience and needs of patients with fecal microbiota transplantation via Naso-jejunal tube：a qualitative study

doi:10.3761/j.issn.0254-1769.2022.17.011

Abstract

Abstract:

Objective To explore the experience and needs of patients with fecal microbiota transplantation via naso-jejunal tube,in order to provide evidence for medical staff to conduct interventions. Methods Descriptive phenomenological method was used in this research. From June 2021 to July 2021,13 patients receiving fecal microbiota transplantation were recruited from a tertiary hospital in Shanghai to conduct a semi-structured interview. Data was analyzed by Colaizzi phenomenon analytical method. Results The treatment experience and needs of patients receiving fecal microbiota transplantation via naso-jejunal tube were grouped into 3 themes,including physiological discomfort during treatment（dry and painful throat,disordered defecation,gastrointestinal irritation）,the change of attitude towards fecal microbiota transplantation （expectation on transplantation before the fecal microbiota transplantation,dislike but compromise when knowing the source of microbiota,disappointment and doubt when the efficacy did not meet expectation,firming faith when disease improved）,needs during treatment（spiritual support from family and friends,education from medical staff,continued support of home rehabilitation）. Conclusion Patients receiving fecal microbiota transplantation via naso-jejunal tube experienced physiological discomfort,and their attitudes towards fecal microbiota transplantation show dynamic changes during treatment and the urgent need for external support. It suggested that medical staff should pay attention to the expression of physiological and inner feelings of patients,and take practical measures to improve physical and mental experience,in order to meet their individualized needs and promote disease recovery.

Key words: Fecal Microbiota Transplantation, Naso-Jejunal Tube, Experience, Need, Qualitative Research, Nursing Care

摘要：

目的深入了解经鼻肠管菌群移植患者治疗期间的体验及需求,为医护人员制订干预措施提供依据。方法采用目的抽样法,对2021年6月—7月在上海市某三级甲等医院肠道微生态诊疗中心接受经鼻肠管菌群移植治疗的13例患者进行半结构式访谈,运用Colaizzi 7步分析法对资料进行编码、归纳后提炼主题。结果将经鼻肠管菌群移植患者的治疗体验及需求归纳为3个主题。①治疗期间生理舒适度较低：咽喉部干涩疼痛;排便形态紊乱;胃肠道刺激。②治疗期间对菌群移植的态度发生变化：菌群移植前,期待移植;知晓菌群来源后,排斥与妥协;未达预期疗效时,失落与质疑;症状日渐改善后,坚定移植信念。③治疗期间的需求：家属、朋友的情感支持;医护人员的专业指导;居家康复的延续性支持。结论经鼻肠管菌群移植患者治疗期间生理舒适度较低,随治疗的推进,患者对菌群移植的态度发生变化,且存在迫切的外部支持需求。医护人员需关注菌群移植患者的生理体验、心理感受和支持需求,并采取有效的干预措施,以提升患者的身心舒适度、促进疾病恢复。

关键词: 菌群移植, 鼻肠管, 体验, 需求, 质性研究, 护理

LI Yan, ZHOU Shailan, WANG Kai, YANG Xiaopei, LIU Qian, YU Xiaoli, TIAN Hongliang, ZHU Xiao-ping. Experience and needs of patients with fecal microbiota transplantation via Naso-jejunal tube：a qualitative study[J]. Chinese Journal of Nursing, 2022, 57(17): 2116-2122.

李燕, 周筛兰, 王开, 杨晓培, 刘倩, 于晓丽, 田宏亮, 朱晓萍. 经鼻肠管菌群移植患者治疗体验及需求的质性研究[J]. 中华护理杂志, 2022, 57(17): 2116-2122.

Figures/Tables 1

References 31

[1]	Thomas S. Human microbiome[M]. Singapore:Springer, 2022.
[2]	Cammarota G, Ianiro G, Tilg H, et al. European consensus conference on faecal microbiota transplantation in clinical practice[J]. Gut, 2017, 66(4):569-580. DOI PMID
[3]	Feng J, Tang YN, Zhou LX, et al. Standardized nursing procedures for fecal microbiota transplantation via upper endoscopy[J]. Gastroenterol Nurs, 2021, 44(4):227-232. DOI URL
[4]	Kao DN, Roach B, Silva M, et al. Effect of oral capsule vs colonoscopy-delivered fecal microbiota transplantation on recurrent clostridium difficile infection: a randomized clinical trial[J]. JAMA, 2017, 318(20):1985-1993. DOI URL
[5]	李宁, 田宏亮, 陈启仪, 等. 菌群移植治疗肠道疾病2 010例疗效分析[J]. 中华胃肠外科杂志, 2019, 22(9):861-868.
	Li N, Tian HL, Chen QY, et al. Efficacy analysis of fecal microbiota transplantation in the treatment of 2 010 patients with intestinal disorders[J]. Chin J Gastrointestinal Surg, 2019, 22(9):861-868.
[6]	Youngster I, Russell GH, Pindar C, et al. Oral,capsulized,frozen fecal microbiota transplantation for relapsing Clostridium difficile infection[J]. JAMA, 2014, 312(17):1772-1778. DOI PMID
[7]	陈启仪, 杨波, 田宏亮, 等. 菌群移植3 932例治疗效果和并发症的5年随访分析[J]. 中华消化杂志, 2020, 40(11):768-777.
	Chen QY, Yang B, Tian HL, et al. A five-year follow-up analysis of efficacy and complications of 3 932 cases of fecal microbiota transplantation treatment[J]. Chin J Dig, 2020, 40(11):768-777.
[8]	van Beurden YH, de Groot PF, van Nood E, et al. Complications, effectiveness, and long term follow-up of fecal microbiota transfer by nasoduodenal tube for treatment of recurrent Clostridium difficile infection[J]. United European Gastroenterol J, 2017, 5(6):868-879. DOI URL
[9]	Hughes JA, Alexander KE, Spencer L, et al. Factors associated with the experience of patients presenting in pain to the emergency department[J]. J Clin Nurs, 2022, 31(9/10):1273-1284. DOI URL
[10]	吴金花, 倪志红, 赵雪萍, 等. 肠造口新生儿家长照护体验的质性研究[J]. 中华护理杂志, 2021, 56(11):1627-1633. DOI
	Wu JH, Ni ZH, Zhao XP, et al. Caring experiences of parents of neonates with enterostomy:a qualitative study[J]. Chin J Nurs, 2021, 56(11):1627-1633.
[11]	中华医学会肠外肠内营养学分会, 中国国际医疗保健促进交流会加速康复外科分会, 中国微生态治疗创新联盟, 等. 菌群移植标准化方法学的建立与临床应用中国专家共识[J]. 中华胃肠外科杂志, 2020, 23(增刊):5-13.
	Parenteral and Enteral Nutrition Branch of Chinese Medical Association, Enhanced Recovery After Surgery Branch of China International Health Care Promotion and Exchange Association, China Microecological Treatment Innovation Alliance, et al. Chinese experts consenus on standardized methodology and clinical application of fecal microbiota transplantation[J]. Chin J Gastrointestinal Surg, 2020, 23(S1):5-13.
[12]	刘明. Colaizzi七个步骤在现象学研究资料分析中的应用[J]. 护理学杂志, 2019, 34(11):90-92.
	Liu M. Using an example to illustrate Colaizzi’s phenomenological data analysis method[J]. J Nurs Sci, 2019, 34(11):90-92.
[13]	田宏亮, 陈启仪, 杨波, 等. 不同移植途径的菌群移植对慢传输型便秘临床疗效的影响[J]. 中华胃肠外科杂志, 2020, 23(增刊):63-68.
	Tian HL, Chen QY, Yang B, et al. Effects of fecal microbiota transplantation in different routes on the clinical efficacy of slow transit constipation[J]. Chin J Gastrointestinal Surg, 2020, 23(S1):63-68.
[14]	张媛, 韩梦丹, 赵倩, 等. 鼻肠管堵塞预防执行单的设计及应用研究[J]. 中华护理杂志, 2021, 56(10):1453-1459. DOI
	Zhang Y, Han MD, Zhao Q, et al. Design and application of nursing prevention and control measurement for patients with obstruction of nasointestinal tube after radical gastrectomy for gastric cancer[J]. Chin J Nurs, 2021, 56(10):1453-1459.
[15]	Ianiro G, Sanguinetti M, Gasbarrini A, et al. Predictors of failure after single faecal microbiota transplantation in patients with recurrent Clostridium difficile infection:results from a 3-year cohort study:authors’ reply[J]. Clin Microbiol Infect, 2017, 23(11):891. DOI URL
[16]	Jalanka J, Salonen A, Saloj rvi J, et al. Effects of bowel cleansing on the intestinal microbiota[J]. Gut, 2015, 64(10):1562-1568. DOI PMID
[17]	Smillie CS, Sauk J, Gevers D, et al. Strain tracking reveals the determinants of bacterial engraftment in the human gut following fecal microbiota transplantation[J]. Cell Host Microbe, 2018, 23(2):229-240. DOI URL
[18]	Drewes JL, Corona A, Sanchez U, et al. Transmission and clea-rance of potential procarcinogenic bacteria during fecal microbiota transplantation for recurrent Clostridioides difficile[J]. JCI Insight, 2019, 4(19):130848.
[19]	Gundling F, Roggenbrod S, Schleifer S, et al. Patient perception and approval of faecal microbiota transplantation (FMT) as an alternative treatment option for obesity[J]. Obes Sci Pract, 2019, 5(1):68-74. DOI PMID
[20]	Chauhan U, Popov J, Farbod Y, et al. Fecal microbiota transplantation for the treatment of ulcerative colitis: a qualitative assessment of patient perceptions and experiences[J]. J Can Assoc Gastroenterol, 2021, 4(6):e120-e129. DOI PMID
[21]	Osman M, Budree S, Kelly CR, et al. Effectiveness and safety of fecal microbiota transplantation for clostridioides difficile infection: results from a 5344-patient cohort study[J]. Gastro-enterology, 2022, 163(1):319-322. DOI URL
[22]	Park L, Mone A, Price JC, et al. Perceptions of fecal microbiota transplantation for Clostridium difficile infection:factors that predict acceptance[J]. Ann Gastroenterol, 2017, 30(1):83-88.
[23]	刘倩, 邱昌翠, 费燕, 等. 积极心理学视角下中青年脑卒中患者住院期感恩体验的质性研究[J]. 解放军护理杂志, 2021, 38(8):31-33,64.
	Liu Q, Qiu CC, Fei Y, et al. Gratitude experience of young and middle-aged hospitalized stroke patients from the perspective of positive psychology: a qualitative study[J]. Nurs J Chin PLA, 2021, 38(8):31-33,64.
[24]	罗丹, 林征, 卞秋桂, 等. 炎症性肠病患者感知病耻感现状及其对生活质量、服药依从性和心理状态的影响[J]. 中华护理杂志, 2018, 53(9):1078-1083.
	Luo D, Lin Z, Bian QG, et al. Perceived stigma in patients with inflammatory bowel disease and its effect on psycholo-gy,medication compliance and quality of life[J]. Chin J Nurs, 2018, 53(9):1078-1083.
[25]	Terveer EM, van Beurden YH, van Dorp S, et al. Is the lower gastrointestinal route really preferred over the upper gastroin-testinal route for fecal microbiota transfer[J]. J Clin Gastroen-terol, 2016, 50(10):895.
[26]	于海荣, 周谊霞, 景秀琛, 等. 食管癌根治术后患者非计划性拔管心理体验质性研究[J]. 护理学报, 2018, 25(16):1-4.
	Yu HR, Zhou YX, Jing XC, et al. Qualitative research of psychological experience of patients with unplanned extubation after radical resection of esophageal cancer[J]. J Nurs China, 2018, 25(16):1-4.
[27]	Zeitz J, Bissig M, Barthel C, et al. Patients’ views on fecal microbiota transplantation:an acceptable therapeutic option in inflammatory bowel disease[J]. Eur J Gastroenterol Hepatol, 2017, 29(3):322-330. DOI URL
[28]	刘晓冰, 李惠惠. 溃疡性结肠炎首次拟行粪微生态移植术患者的健康需求[J]. 解放军护理杂志, 2016, 33(24):28-31.
	Liu XB, Li HH. Analysis of health education demands of inpatients with ulcerative colitis before first fecal microbiota transplantation[J]. Nurs J Chin PLA, 2016, 33(24):28-31.
[29]	马春联, 彭南海, 丁岚, 等. 慢传输型便秘患者粪菌移植治疗的护理[J]. 护理学杂志, 2017, 32(11):23-25.
	Ma CL, Peng NH, Ding L, et al. Nursing care of patients with slow transit constipation treated with fecal microbiota transplant(FMT)[J]. J Nurs Sci, 2017, 32(11):23-25.
[30]	Ng SC, Kamm MA, Yeoh YK, et al. Scientific frontiers in faecal microbiota transplantation:joint document of Asia-Pacific Association of Gastroenterology(APAGE) and Asia-Pacific Society for Digestive Endoscopy(APSDE)[J]. Gut, 2020, 69(1):83-91. DOI URL
[31]	范素云, 贾彦彦, 施雁. 同伴教育对甲状腺癌患者术后服用放射性131I治疗效果的影响[J]. 中华护理杂志, 2017, 52(3):285-288.
	Fan SY, Jia YY, Shi Y. Effects of peer education on treatment among patients using 131I with thyroid cancer after surgery[J]. Chin J Nurs, 2017, 52(3):285-288.