造口患者病耻感影响因素的系统评价及Meta分析  

Systematic review and meta-analysis of the influencing factors of stigma in patients with stoma

作　　者：王汐嬅 程悦 李敏[1] 郭淑丽[1] 肖毅[1] Wang Xihua;Cheng Yue;Li Min;Guo Shuli;Xiao Yi(Department of General Surgery,Chinese Academy of Medical Sciences&Peking Union Medical College Hospital,Beijing 100730,China;School of Nursing,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Nursing Department,Chinese Academy of Medical Sciences&Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院基本外科,北京100730 [2]中国医学科学院北京协和医学院护理学院,北京100730 [3]中国医学科学院北京协和医院护理部,北京100730

出　　处：《中华现代护理杂志》2023年第11期1461-1467,共7页Chinese Journal of Modern Nursing

基　　金：国家自然科学基金面上项目(62172437)。

摘　　要：目的系统分析造口患者病耻感的影响因素,为临床制订有效的干预措施提供循证依据。方法系统检索中国知网、中国引文数据库、万方数据库、维普网、中国生物医学文献服务系统、PubMed、Web of Science、Cochrane Library、Embase等中英文数据库,并辅以手工检索,检索时限为建库至2022年6月1日。采用RevMan5.3软件对数据进行Meta分析。结果共纳入17篇文献,包含2900例患者。Meta分析结果显示,年龄(OR=0.51,95%CI:0.28~0.92)、居住地(OR=3.08,95%CI:1.87~5.06)、造口漏味频率(OR=5.81,95%CI:3.53~9.55)、自我护理程度(OR=0.60,95%CI:0.41~0.90)、造口接受程度(OR=0.12,95%CI:0.07~0.22)、与医护人员交流程度(OR=0.33,95%CI:0.20~0.55)、参加造口人活动(OR=0.25,95%CI:0.10~0.63)、造口类型(OR=4.04,95%CI:2.33~7.02)、配偶接受造口程度(OR=0.19,95%CI:0.06~0.58)、护理隐私(OR=0.13,95%CI:0.05~0.32)、家庭关系(OR=0.09,95%CI:0.04~0.19)、粪便渗漏(OR=8.20,95%CI:4.60~14.63)自我隐瞒(OR=0.81,95%CI:0.76~0.85)、屈服(OR=0.57,95%CI:0.27~0.77)、对专业人士及亲友的依赖(OR=0.26,95%CI:0.14~0.39)、抑郁(OR=0.65,95%CI:0.52~0.75)、自尊(OR=0.44,95%CI:0.37~0.51)、社会支持(OR=-0.63,95%CI:-0.67~-0.59)、面对(OR=-0.46,95%CI:-0.66~-0.22)、自我效能(OR=-0.57,95%CI:-0.71~-0.39)是造口患者病耻感的影响因素(P<0.05);而性别、学历、家庭月均收入、造口并发症、对性生活影响程度、身体形象是否改变、除配偶外其他家属对造口的接受程度以及回避对造口患者的病耻感水平无影响,差异无统计学意义(P>0.05)。结论造口患者病耻感的影响因素众多,医护人员应根据影响因素尽早识别高危人群,有针对性地制订干预措施以降低造口患者病耻感水平。Objective To systematically analyze the influencing factors of stigma in patients with stoma,so as to provide evidence-based basis for clinical formulation of effective interventions.Methods We systematically searched Chinese and English databases such as China National Knowledge Infrastructure(CNKI),Chinese Citation Database,WanFang Data,VIP,SinoMed,PubMed,Web of Science,Cochrane Library,Embase,and carried out manual search.The retrieval time limit was from the establishment of the database to June 1,2022.RevMan5.3 software was used to conduct meta-analysis of data.Results A total of 17 articles including 2900 patients were included.Meta-analysis showed that age[OR=0.51,95%CI(0.28,0.92)],residence[OR=3.08,95%CI(1.87,5.06)],stoma leakage frequency[OR=5.81,95%CI(3.53,9.55)],self-care[OR=0.60,95%CI(0.41,0.90)],stoma acceptance[OR=0.12,95%CI(0.07,0.22)],communication with medical and nursing staff[OR=0.33,95%CI(0.20,0.55)],participation in stoma activities[OR=0.25,95%CI(0.10,0.63)],stoma type[OR=4.04,95%CI(2.33,7.02)],spouse's acceptance of stoma[OR=0.19,95%CI(0.06,0.58)],nursing privacy[OR=0.13,95%CI(0.05,0.32)],family relationship[OR=0.09,95%CI(0.04,0.19)],faecal leakage[OR=8.20,95%CI(4.60,14.63)],self-concealment[OR=0.81,95%CI(0.76,0.85)],yield[OR=0.57,95%CI(0.27,0.77)],dependence on professionals and relatives[OR=0.26,95%CI(0.14,0.39)],depression[OR=0.65,95%CI(0.52,0.75)],self-esteem[OR=0.44,95%CI(0.37,0.51)],social support[OR=-0.63,95%CI(-0.67,-0.59)],confrontation[OR=-0.46,95%CI(-0.66,-0.22)],self-efficacy[OR=-0.57,95%CI(-0.71,-0.39)]were the influencing factors of stigma in patients with stoma(P<0.05).In contrast,gender,education,average monthly household income,stoma complications,degree of impact on sexual life,whether body image has changed,acceptance of stoma by family members other than spouse,and avoidance had no effect on the level of stigma of stoma patients,and the differences were not statistically significant(P>0.05).Conclusions There are many factors influencing the stigma of patients with stoma.M

关 键 词：造口术 病耻感 影响因素 系统评价 

分 类 号：R473.6[医药卫生—护理学]