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

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