国际癌症研究机构数据显示,2020 年中国新发结直肠癌 56万例,发病率与死亡率在我国均位于恶性肿瘤的第 3 位[1].手术治疗是结直肠癌最有效的根治方式,术后易出现切口感染等并发症.吻合口瘘(anastomotic leakage,AL)是结直肠癌术后较严重的并发症之一,其发生率高达 15.9％[2].术后一旦出现AL会引发病人腹部及盆腔感染,体内酸碱和水电解质平衡紊乱,吻合口狭窄,甚至造成死亡[3-5].此外,吻合口瘘可能影响病人按期化疗,增加直肠癌病人术后复发的风险,降低病人远期存活率[6].

Objective:To understand the current situation of nurses' willingness to engage in telecare in county-level hospitals in Henan Province and analyze its influencing factors.Methods:Using the convenient sampling method, a total of 1 300 clinical nurses from 6 Class Ⅱ Grade A county-level hospitals in Zhengzhou, Hebi, Zhoukou and other cities in Henan Province were selected as the research objects from August 2022 to January 2023. General Data Questionnaire and Clinical Nurses' Willingness to Engage in Telecare Questionnaire were used to investigate the research objects. Non-parametric test and multiple linear regression were used to analyze the influencing factors of clinical nurses' willingness to engage in telecare.Results:A total of 1 300 questionnaires were sent out in this study, and 1 183 were effectively collected, with an effective recovery rate of 91.00% (1 183/1 300). The total score of Clinical Nurses' Willingness to Engage in Telecare Questionnaire of 1 183 nurses in county-level hospitals was [105.00 (98.00, 112.00) ] points, and all items were scored [3.50 (3.27, 3.73) ]. Multiple linear regression analysis showed that professional title, post, whether they knew about telecare, and the number of times of receiving training on nursing information each year were the influencing factors of nurses' willingness to engage in telecare in county-level hospitals ( P<0.05) . Conclusions:In Henan Province, 1 183 nurses in county-level hospitals have a high willingness to engage in telecare. Relevant departments should further strengthen the publicity of relevant contents of telecare, carry out practical operation training related to nursing information, improve the nursing information ability of nurses in county-level hospitals and strengthen the awareness of health management services, so as to promote the successful implementation of telecare services in rural areas.

Objective:To investigate the current situation of moisture-associated skin damage (MASD) in patients with permanent colostomy, and analyze its influencing factors.Methods:From January 2019 to January 2020, 115 patients received permanent colostomy in Henan Provincial People's Hospital were selected by convenience sampling method as the research objects. The patients were investigated by the self-designed General Information Questionnaire and Disease Factor Questionnaire.Results:Finally, 107 patients with permanent colostomy were included, and the incidence of MASD was 39.25% (42/107) . One-way analysis of variance showed that age, body mass index, stoma site, stoma height, excrement characteristics, defecation regularity, chassis leakage times were the influencing factors for the incidence of MASD in patients with permanent colostomy ( P<0.05) . Conclusions:The incidence of MASD in patients with permanent colostomy is high. Age, stoma site, stoma height, defecation and so on are the influencing factors of MASD in patients with permanent colostomy. Medical and nursing staff can formulate targeted preventive measures according to the influencing factors to reduce the incidence of MASD.

解读欧洲加速康复外科协会发布的《腰椎融合手术围术期护理的共识指南》,该指南针对腰椎融合手术提供21条加速康复外科(ERAS)建议,其中术前建议8项、术中建议7项、术后建议6项,内容涵盖术前病人教育、营养评估、术中麻醉、手术技术和术后多模式镇痛策略多个方面内容,旨在为腰椎融合手术提出ERAS建议,减少围术期不良事件发生率,减少并发症,缩短住院时间.

目的 探讨肠造口术后患者对腹部运动的体验及态度,为提高肠造口患者腹部运动积极性、降低造口旁疝(PSH)的发生率提供借鉴.方法 采用质性研究中的现象学研究方法,对12例肠造口患者进行半结构式访谈,采用Colaizzi七步分析法并运用NVivo 11软件对访谈资料进行整理与分析,提炼主题.结果 肠造口患者造口术后对腹部运动的体验可归纳为3个主题:参与腹部锻炼的态度、影响腹部运动的因素、寻求腹部运动专业指导.结论 肠造口患者腹部运动认知一般,腹部运动知识缺乏,对运动消极应对等;医护人员应该关注患者腹部运动相关需求,给予有效的指导与干预,提高患者的运动能力及生活质量.

Review question / Objective: To conduct a systematic review and meta-synthesis of qualitative research about sexuality and intimate relationships among patients with intestinal ostomy, to highlight and summarise the overarching dimensions of this clinical issue -to identify key elements, assess our qualitative knowledge on this topic to then identify implications for care and help define a future research agenda.Condition being studied: (a) Research theme was about sexuality and intimate relationship experience of people with Ostomies; (b) Qualitative methodology was used in studies, data needed to be collected via customary qualitative approaches (e.g., interview, focus group, open-ended survey questions) with sufficient data (i.e., patients' or partners' quotations) reported to support the study findings; (c) Primary study is mixed-methods Studies employing both qualitative and quantitative methods were eligible if qualitative data could be extracted for analysis; (d) Focusing on patients who were or more than 18 years old; (e)Published in Chinese and English.

目的 汉化护士压力性损伤管理自我效能感量表(Pressure Ulcer Management Self-Efficacy Scale for Nurses,PUM-SES),并检测该量表的信效度.方法 采用Brislin模式对PUM-SES量表进行翻译、回译及跨文化调适,形成中文版PUM-SES量表.请6名专家进行2轮内容效度评价.便利选取河南省4所三级甲等医院1190名临床护士,采用中文版PUM-SES量表进行调查,评价量表的信度和效度.结果 中文版PUM-SES量表内容效度指数为0.967,探索性因子分析得到4个公因子,与原量表结构相同,累计方差贡献率为74.93％,验证性因子分析x2/df=2.87、RMR=0.02、RMSEA=0.06、GFI=0.97、AGFI=0.95、TLI=0.93、IFI=0.91、CFI=0.97、PGFI=0.51,均达到适配(拟合)标准;中文版PUM-SES量表Cronbach'sα系数为0.948,重测信度为0.932.结论 中文版PUM-SES量表信效度较好,可以作为评估护士压力性损伤管理自我效能感的工具.

病例介绍 患者,女,63岁,体重71 kg.因"腹部切口二次裂开",为进一步治疗于2020年5月10日转入我院胃肠外科.患者于2020年4月14日在当地医院行结肠癌根治术+结肠造口术.2020年5月3日手术切口裂开,肠壁膨出,行结肠癌术后切口裂开缝合术,患者术后在当地医院由主管医生每日给予切口0.5％聚维酮碘溶液消毒,无菌纱布覆盖.2020年5月9日腹部切口再次裂开,粪水从腹部切口流出.

目的:研究快速康复外科(FTS)理念下腹腔镜结肠癌根治术对结肠癌术后患者免疫功能、应激反应及胃肠激素的影响.方法:选取2018年5月至2019年6月于我院就诊的结肠癌患者60例,按照随机数字表法分为对照组(30例)和研究组(30例).对照组行常规腹腔镜结肠癌根治术,研究组行FTS腹腔镜结肠癌根治术,观察两组患者胃肠功能康复情况、免疫功能、应激反应、胃肠激素.结果:研究组胃肠功能恢复时间均显著短于对照组(P<0.05);研究组术后CD4+、CD8+、CD4+/CD8+均显著高于对照组(P<0.05);两组患者术后Epi、Cor均显著升高,但研究组显著低于对照组(P<0.05);术后两组患GAS、GIP均显著升高,且显著高于对照组(P<0.05).结论:FTS理念下腹腔镜结肠癌根治术能够显著增强结肠癌术后患者的免疫功能,降低应激损伤,纠正胃肠激素紊乱,可临床推广.

总结1例急性肠系膜静脉血栓病人行近远端小肠造瘘术后间断给予肠内营养联合消化液回输的护理.强调术中经鼻腔给予留置鼻肠管,早期给予肠内营养液输注,通过改良两件式造口袋,回收小肠造口近端消化液,造口远端通过留置尿管再进行回输.采用Caprini评分量表及血栓弹力图检测进行静脉血栓栓塞症风险预测,密切观察造口血液循环,切口无出血及渗血.同时配合外科基础治疗和造口护理.经过14 d个性化和系统化的专业护理,病人病情好转出院.

目的 构建尿道下裂术后患儿健康教育移动平台,并探讨其在尿道下裂术后患儿中应用效果.方法 选取我院泌尿外科收治的尿道下裂术后患儿80例,通过构建和应用健康教育移动平台为术后出院患儿及其家长进行延续护理,包含患者、宣教课程、预约治疗、微信咨询及评价5个模块.结果 运用健康教育移动平台对尿道下裂术后80例患儿进行延续护理6个月,2例失访,78例患儿出院6个月内尿瘘4例,均在6个月后再次手术修复尿瘘而治愈,尿道狭窄4例,给予定期尿道扩张,患儿排尿困难的症状均得到改善.结论 健康教育移动平台应用于尿道下裂术后患儿延续护理中,可及时解决患儿居家护理中出现的问题,有利于保障患儿术后护理的延续性,可提高患儿家属的护理知识,降低患儿尿瘘及尿道狭窄等并发症的发生.

近年来,随着人们生活方式及饮食习惯的改变,结直肠癌的发病率逐年升高,肠造口术是治疗结直肠癌常用的手术方式之一,肠造口术对患者的生理、心理及社会功能带来较大改变[1].不同程度肠道功能改变及排便失控常导致患者体力活动依从性降低;而适当的活动锻炼在预防造口并发症,提高患者生活质量以及降低结直肠癌疾病复发率及死亡率等方面获益明显[2-3].国际造口护理临床实践指南强调造口患者恢复术前的活动水平具有重要意义[4].但国外研究[5]表明肠造口患者体力活动受多种因素影响,依从性有待提高.目前,国内针对此方面的研究相对较少,多数医护人员对造口患者运动锻炼的形式及其对患者的康复作用认识不够充分.因此,本文从体力活动的概念、造口患者体力活动的现状及其影响因素、造口患者参与体力活动的建议4方面进行论述,旨在引起国内医护人员对肠造口患者活动锻炼的重视,为医护人员的干预提供理论依据.

目的 探讨微信平台在肠造口患者居家延续护理中的应用效果.方法 选取2015年3月-2017年3月在本院行永久性肠造口术患者98例为研究对象,按照随机数字表法将其分为干预组和对照组各49例,对照组给予常规的出院指导及电话随访,干预组在常规出院指导及电话随访基础上实施微信平台居家延续护理.比较干预后6个月两组患者造口相关并发症发生率及患者的焦虑程度.结果 干预组造口相关并发症发生率为14.3％(7/49),低于对照组的67.3％(33/49),差异具有统计学意义(P<0.01);干预组1个月、3个月、6个月焦虑自评量表得分分别为(50.61±7.76)、(46.24±7.63)、(43.69±8.78)分,与对照组的(54.14±5.84)、(51.02±6.75)、(48.61±6.98)分比较差异具有统计学意义(P<0.05).结论 应用微信平台进行居家延续护理,可降低患者造口相关并发症发生率及焦虑程度.

[目的]探讨健康教育移动平台对尿道下裂术后患儿父母元担忧的影响.[方法]将2015年1月-2015年12月79例尿道下裂术后患儿及其父母设为对照组,2016年1月-2016年12月80例尿道下裂术后患儿及其父母设为观察组,对照组给予常规出院指导及随访,观察组在常规出院指导及随访基础上应用健康教育移动平台进行延续护理.采用中文版元担忧量表评价患儿父母元担忧情况,比较两组患儿尿瘘和尿道狭窄发生情况.[结果]观察组术后1个月、3个月、6个月患儿父母元担忧得分低于对照组(P＜0.05);观察组患儿尿瘘发生率低于对照组(P＜0.05).[结论]健康教育移动平台应用于尿道下裂患儿术后延续护理,可有效降低患儿父母元担忧水平及患儿尿瘘发生率.

目的 探讨结直肠癌患者及照顾者进行造口护理预警教育的方法 及效果.方法 将98例肠造口患者随机分为干预组和对照组各49例.对照组给予常规造口健康教育,干预组在此基础上对患者及照顾者实施预警教育.比较干预后3个月两组造口护理依从性,患者焦虑水平及造口并发症发生率.结果 干预后3个月后,干预组患者及照顾者造口依从性得分显著高于对照组(均P＜0.05);患者焦虑得分显著低于对照组,造口并发症(粪水性皮炎、造口黏膜出血及造口周围皮肤湿疹)发生率显著低于对照组(P＜0.05,P＜0.01).结论 预警教育可有效提高肠造口患者及照顾者造口护理依从性,降低患者焦虑水平及造口并发症发生率,提高患者的生活质量.