结直肠癌术后留置肛管管理方案的构建与应用研究  

Construction of the care program for postoperative transanal drainage tube in patients with colorectal cancer and its application

作　　者：闫亚敏 陆晶晶 虞正红 胡燕 YAN Yamin;LU Jingjing;YU Zhenghong;HU Yan(Department of Nursing,Zhongshan Hospital Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院护理部,上海200032

出　　处：《护士进修杂志》2023年第20期1835-1841,共7页Journal of Nurses Training

基　　金：复旦大学复星护理科研基金面上项目(编号:FNF202007)。

摘　　要：目的 构建结直肠癌术后留置肛管管理方案并探讨其临床应用效果。方法 基于文献检索、临床调研、半结构访谈构建方案初稿;之后进行2轮专家咨询,形成结直肠癌术后留置肛管管理方案终稿,包括3个一级条目、7个二级条目、28个三级条目。连续纳入2021年3月-2022年2月收治于我院普外科的120例结直肠癌患者为研究对象。采用随机数表法分为观察组和对照组,各60例。观察组采用结直肠癌术后留置肛管管理方案进行管理;对照组实施常规加速康复外科干预。比较2组患者肛管护理相关指标、临床恢复指标和自我评价指标等方面的差异。结果 观察组患者发生导管相关压力性损伤2例(3.3%),大便外溢3例(5.0%),均低于对照组(P<0.05);肛管留置时间平均为4.6 d,短于对照组的5.7 d(P=0.008)。观察组患者术后首次床上自主活动时间和首次下床活动时间均较对照组提前(P<0.05)。观察组患者携管期间的睡眠质量及对导管管理的满意度评分均高于对照组(P<0.001)。结论 本研究构建的结直肠癌术后留置肛管管理方案安全可行,可有效降低导管相关压力性损伤和大便外溢的发生率,促进患者术后早期活动,改善睡眠质量,提高满意度。Objective To construct the care program of postoperative transanal drainage tube,and to evaluate its application effect in colorectal cancer patients.Methods Literature retrieval,clinical investigation,and semi-structured interview were conducted to identify the first draft of the scheme.And then,two rounds of expert consultation were used to construct the final draft of care program for postoperative transanal drainage tube in colorectal cancer patients,including 3 first-level items,7 second-level items,and 28 third-level items.From March 2021 to February 2022,a total of 120 patients with the diagnosis of colorectal cancer admitted to the General Surgery Department in our hospital were included.The patients were divided into intervention group and control group by random number table,with 60 cases in each group.The intervention group was managed by care program of postoperative transanal drainage tube,while the control group was given routine ERAS intervention.The outcome variables,such as TDT nursing related indicators,clinical recovery indicators,and self-evaluation indicators were compared between the two groups.Results Two cases of catheter-related pressure injury(3.3%),and 3 cases of feces spillage(5.0%)occurred in the intervention group,lower than those in the control group(P<0.05).The indwelling time of transanal drainage tube was 4.6 days,shorter than that the control group(5.7 days,P=0.008).Time of the first independent mobilization on bed and off-bed in the intervention group were earlier than those in the control group(P<0.05).The sleep quality and satisfaction score in the intervention group were higher than those in the control group(P<0.001).Conclusion The care program of postoperative transanal drainage tube is safe and feasible,which can effectively reduce the incidence of catheter-related pressure injury and feces spillage,promote early mobilization,improve sleep quality and satisfaction of colorectal cancer patients.

关 键 词：结直肠癌 留置肛管 导管相关压力性损伤 护理 

分 类 号：R473.73[医药卫生—护理学] R735.3[医药卫生—临床医学]