成人造口患者发生造口旁疝影响因素的Meta分析  

Meta-analysis of influencing factors of parastomal hernia in adult patients undergoing ostomy

作　　者：许莹莹 朱蓓[2] 阎蕾[3] 魏青[4] 陈圣枝 Xu Yingying;Zhu Bei;Yan Lei;Wei Qing;Chen Shengzhi(School of Nursing,School of Medicine,Jiangsu University,Zhenjiang 212001,China;Outpatient Service,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,China;Department of Nursing,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,China;Department of General Surgery,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,China)

机构地区：[1]江苏大学医学院护理系,镇江212001 [2]江苏大学附属医院门诊部,镇江212001 [3]江苏大学附属医院护理部,镇江212001 [4]江苏大学附属医院普外科,镇江212001

出　　处：《中华现代护理杂志》2020年第17期2327-2332,共6页Chinese Journal of Modern Nursing

摘　　要：目的分析造口术后患者发生造口旁疝的影响因素,为造口旁疝的早期预防提供科学依据。方法计算机检索数据库PubMed、Embase、Web of Science、ScienceDirect、CNKI、万方数据库(Wanfang Data)、维普数据库和中国生物医学文献数据库,搜集建库至2019年6月关于造口患者发生造口旁疝影响因素的文献,利用RevMan 5.3软件对13个研究结果进行Meta分析,采用固定效应模型和随机效应模型计算合并OR值及95%置信区间(CI)。结果共纳入13篇文献,累计病例组1857例,对照组5888例;各因素的Meta分析合并OR值或加权均数差(WMD)以及95%CI分别为BMI(OR=2.29,95%CI 2.00~2.57)、女性(OR=1.45,95%CI 1.19~1.76)、经腹膜外造口(OR=0.22,95%CI 0.11~0.41)、COPD或慢性咳嗽(OR=1.82,95%CI 1.21~2.73)、高血压(OR=2.46,95%CI 1.45~4.15)、经腹腔镜手术(OR=1.39,95%CI 1.30~1.50)、造口感染(OR=2.11,95%CI 1.26~3.53)。结论基于现有证据,造口患者发生造口旁疝的危险因素有高BMI、女性、COPD或慢性咳嗽、高血压、经腹腔镜手术、造口感染,经腹膜外造口是造口旁疝的保护因素。吸烟、糖尿病、术前放/化疗、既往腹部手术史与造口旁疝的发生无关。造口孔径、低蛋白血症、经腹直肌造口、既往疝修补史、类固醇药物的使用需要更多研究进一步验证。医务人员应重视这些影响因素,采取措施进行针对性预防,提高护理服务质量。Objective To explore the influencing factors of parastomal hernia in patients undergoing ostomy,and provide a scientific basis for the early prevention of parastomal hernia.Methods Articles concerning the influencing factors of parastomal hernia in patients undergoing ostomy which were published up to June 2019 were retrieved from PubMed,Embase,Web of Science,ScienceDirect,China National Knowledge Infrastructure(CNKI),Wanfang,VIP and Chinese Biomedical Literature Database(CBM).RevMan 5.3 was used to conduct a Meta-analysis on 13 research results,and a fixed effect model and a random effect model were employed to calculate the combined OR value and 95%confidence interval(CI).Results A total of 13 articles were included,involving totally 1857 cases in the case group and 5888 cases in the control group.The Meta-analysis of various factors combined with OR or weighted mean difference(WMD)and 95%CI were BMI(OR=2.29,95%CI 2.00-2.57),female(OR=1.45,95%CI 1.19-1.76),extraperitoneal ostomy(OR=0.22,95%CI 0.11-0.41),chronic obstructive pulmonary disease(COPD)or chronic cough(OR=1.82,95%CI 1.21-2.73),hypertension(OR=2.46,95%CI 1.45-4.15),laparoscopic surgery(OR=1.39,95%CI 1.30-1.50),stoma infection(OR=2.11,95%CI 1.26-3.53).Conclusions Based on the available evidence,the risk factors for parastomal hernia in patients undergoing ostomy include high BMI,female,COPD or chronic cough,hypertension,laparoscopic surgery and stoma infection,while extraperitoneal ostomy is a protective factor for parastomal hernia.Smoking,diabetes,preoperative radiotherapy/chemotherapy and previous history of abdominal surgery is not associated with the occurrence of parastomal hernia.Stoma size,hypoproteinemia,rectus abdominis stoma,previous history of hernia repair and the use of steroids need to be further verified through more studies.Medical staff should pay attention to these influencing factors,take pertinent measures to prevent them,and improve the quality of nursing services.

关 键 词：成年人 造口旁疝 危险因素 META分析 

分 类 号：R473.6[医药卫生—护理学]