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

doi:10.3761/j.issn.1672-9234.2021.08.016

摘要/Abstract

摘要：

目的探索肠造口患者术后3个月内造口周围潮湿相关性皮肤损伤（peristomal moisture-associated skin damage,PMASD）影响因素。方法采取前瞻性队列设计,便利选取2019年11月—2020年9月在上海4所三级甲等医院接受肠造口术的329例患者为研究对象,采用自制的肠造口患者调查表对其进行调查。结果肠造口患者PMASD发生率为42.8%（141/329）。Logistic回归分析显示：性别（OR=0.527,P=0.029）、造口开口高度值（OR=0.323,P<0.001）、底盘区域手术伤口（OR=3.143,P=0.004）、造口部位（OR=4.109,P<0.001）、底盘渗漏次数>（3次）（OR=2.679,P=0.009）、软食（OR=2.854,P=0.003）、半流质饮食（OR=2.977,P<0.001）为PMASD的影响因素。结论 PMASD为肠造口术后 3个月内常见并发症,可为患者提供造口开口高度观察、造口产品选择、特殊敷料使用、饮食过渡时机及方法等方面的指导,以降低并发症发生风险。

关键词: 肠造口术, 创伤和损伤, 前瞻性研究, 影响因素分析

Abstract:

Objective To analyze the risk factors of peristomal moisture-associated skin damage（PMASD） in patients with stoma during the first three months after surgery. Methods The prospective study design was adopted and participants were selected by convenience sampling. A total of 329 patients from 4 hospitals in Shanghai were enrolled from November 2019 to September 2020. A self-made questionnaire for assessment of PMASD was used in this study. Results The incidence of PMASD was 42.8%（141/329）. Logistic regression analysis showed that gender（OR=0.527,P=0.029）,height of stoma opening（OR=0.323,P<0.001）,surgical wound in plate area（OR=3.143,P=0.004）,type of stoma（OR=4.109,P<0.001）,times（>3） of leakage（OR=2.679,P=0.009）,soft diet（OR=2.854,P=0.003）,and semi-fluid diet（OR=2.977,P<0.001） were independent influencing factors of PMASD. Conclusion PMASD is a common complication within 3 months after surgery. It is suggested to provide guidance on the observation of the height of stoma opening,selection of stoma care products,use of special dressing,timing and method of dietary transition to reduce the risk of complications for patients.

Key words: Enterostomy, Wounds and Injuries, Prospective Studies, Root Cause Analysis

刘莺歌,吴燕,曹秋君,邱群,吕桂芬. 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 Ying-ge,WU Yan,CAO Qiu-jun,QIU Qun,LÜ Gui-fen. Risk factors of peristomal moisture-associated skin damage in patients with stoma[J]. Chinese Journal of Nursing Education, 2021, 18(8): 749-754.

图/表 3

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