预防性回肠造口术后粪水性皮炎的危险因素及护理对策

中华结直肠疾病电子杂志2019年8月 第8卷 第4期 Chin J Colorec Dis ( Electronic Edition ) , August 2019, Vol.8, No.4·413·

?护理天地?预防性回肠造口术后粪水性皮炎的危险因素及护理对策

云红　张怡　郑薇　于洪霞

【摘要】　目的　探讨预防性回肠造口术后粪水性皮炎发生的危险因素，提出护理对策及预防措施。方法　采取查阅病历、延续性护理记录、造口门诊就诊记录的方式，回顾性分析在中国医学科学院北京协和医学院肿瘤医院结直肠外科2017年10月至2018年10月间收治的直肠癌行低位前切除＋预防性回肠造口手术的患者的资料共161例，分析粪水性皮炎发生的危险因素。结果　161例研究对象中，粪水性皮炎发生43例，占26.7%。肠造口存在位置不当、周围皮肤不平整、排便出口肠黏膜低或平于皮肤的患者粪水性皮炎的发生率高于肠造口不存在这些问题的患者（P＜0.01）；BMI偏高患者粪水性皮炎的发生率高于BMI正常的患者（χ2=3.938，P＜0.01）；接受专科护士个性化指导

2

的患者发生粪水性皮炎的比例明显低于未接受个性化指导的患者，差异有统计学意义（χ=29.625，

P＜0.01）。结论　术前由患者和家属、肠造口专科护士及医生三方共同帮助患者选择理想的造口位置；术中医生缝合造口时，保证肠造口周围皮肤平坦，注意近端造口黏膜高于皮肤且排便开口不能偏向一侧；术后住院期间专科护士根据患者的造口特点给予个性化护理指导，帮助患者选择适合的造口用品、提高护理技能；出院后加强延续性护理，预防粪水性皮炎发生。

【关键词】　结肠造口术；　护理工作；　预防性回肠双腔造口术；　粪水性皮炎；　危险因素；护理对策

Risk factors and nursing strategies of fecal dermatitis after prophylactic ileostomy　Yun Hong, Zhang Yi, Zheng Wei, Yu Hongxia. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

Corresponding author: Yun Hong, Email: yunhong00563@126.com

【Abstract】　Objective　To explore the risk factors of fecal dermatitis after prophylactic ileostomy, and to propose nursing strategies and preventive measures. Methods　Take the method of reviewing medical records, continuous nursing records, and ostomy clinic records. Retrospective analysis of 161 patients with rectal cancer undergoing low anterior resection＋preventive ileostomy in colorectal surgery from October 2017 to October 2018 in Chinese Academy of Medical Sciences and Peking Union Medical College, to analysis the risk factors for fecal dermatitis. Results　Among the 161 subjects, forty-three cases of fecal dermatitis occurred, accounting for 26.7%. Patients with improper position of the intestine, uneven skin around the skin, low intestinal mucosa or ?at skin, have a higher incidence of fecal dermatitis than those with no such problems (P＜0.01); The incidence of fecal dermatitis in patients with high BMI is higher than that in patients with normal BMI (χ2=3.938, P＜0.01); Patients who received specialist guidance from specialist nurses had significantly lower rates of fecal dermatitis than patients who did not receive personalized guidance, The difference was statistically significant (χ2=29.625, P＜0.01). Conclusion　Before the operation, the patient and the family, the enterostomy specialist nurse and the doctor jointly help the patient to choose the ideal stoma position; When the intraoperative doctor sutures the stoma, it is ensured that the skin around the intestine is ?at. Note that the proximal stoma is higher than the skin and the opening of the bowel cannot be biased to one side; During the postoperative hospitalization, the specialist nurses gave personalized

DOI：10.3877/cma.j.issn.2095-3224.2019.04.018

作者单位：100021　北京，国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科

通信作者：云红，Email：yunhong00563@126.com