腸造口病人之造口相關合併症及預測因子

The Incidence and Predicting Factors of Ostomy-Related Complications among Enterostomy Patients

徐小惠(Hsiao‐Hui Hsu) ； 許美玉(Mei‐Yu Hsu) ； 章淑娟(Shu‐Shang Chang) ； 呂基燕(Ji‐Yan Lyu) ； 王淑貞(Shu‐Chen Wang) ； 鍾惠君(Hui‐Chun Chung)

《護理暨健康照護研究》 10卷3期 (2014/09) Pp. 220-228

https://doi.org/10.6225/JNHR.10.3.220

摘要

背景：造口相關合併症是病人接受腸造口手術後普遍存在的問題，實證研究顯示發生率12-72%之間。目的：探討腸造口病人在術後不同時間點之造口合併症發生率及預測因子。方法：採回溯性研究，選取某醫院2010年1月至2013年10月期間，登錄在造口個案管理資料庫之腸造口病人為研究對象。由一位造口護理師收集病人屬性、相關危險因子、造口特性、造口及造口周圍合併症等變項。結果：共264位腸造口病人符合收案條件。早期合併症發生率為34.5%；晚期發生率為12.7%。手術後1個月發生率最高18.2%，手術後10天內以回縮、剝離、壞死等合併症居多；造口周圍皮膚問題常見於手術後第1及3個月。造口部位、大小直徑及高度與早期合併症發生具有顯著相關（p＜.05）。邏輯斯迴歸分析結果發現，造口大小直徑（OR=3.12, p＜.05）及高度（OR=4.17, p=.00）可預測早期合併症之發生。結論／實務應用：本研究顯示，造口合併症於術後一個月內發生率最高，且與手術因素相關。建議未來針對造口相關合併症可建立追蹤計畫及預防介入措施，以降低造口合併症的發生。

關鍵字

腸造口病人 ； 造口相關合併症 ； 發生率 ； 預測因子

並列摘要

Background: Ostomy‐related complications are a prevalent postoperative problem for patients who receive an enterostomy. A previous study reported a 12% to 70% incidence rate for stoma‐related complications. Purpose: This study aims to determine the incidence and predicting factors of ostomy‐related complications in enterostomy patients at various time points after stoma creation. Methods: A retrospective chart review was conducted at a single institution. The participants in this study comprised patients entered in an ostomy case‐management database who underwent enterostomy from January 2010 to October 2013. The patient demographics, revelant risk factors, stoma characteristics, and stomal and peristomal complications were documented by a wound ostomy and continence nurse. Results: A total of 264 patients were enrolled in this study (175 men and 89 women). The mean age of participants was 62.8 years. The incidence rate was 34.5% for early complications and 12.7% for late complications. Most stomal complications occurred within 1 month after surgery (48 of 264; 18.2%). The most common stomal complications that occurred within 10 days postoperative were: retraction, separation, and necrosis. Peristomal skin problems most frequently occurred within the first and the third postoperative months. Risk factors significantly associated with early complications were: stoma location, diameter, height, and peristomal skin condition (p ＜ .05). A logistic regression analysis proved that stoma diameter (odds ratio [OR] = 3.12, p ＜ .05) and height (OR = 4.17, p = .00) were effective in predicting the incidence of early complications. Conclusions/Implications for Practice: This research supports that the highest rate of stoma complications occurs within the first postoperative month and that stoma complications are associated with surgical factors. In the future, postoperative follow‐up programs and preventive intervention may be implemented to decrease the occurrence of stoma complications.

並列關鍵字

enterostomy patients ； ostomy‐related complications ； incidence ； predicting factors