基于护理敏感质量指标的肠造口护理方案在新生儿造口管理中的应用

吕俊英; 李玲燕; 林小清; 王周洁; 陈芳芳

doi:10.16766/j.cnki.issn.1674-4152.003986

基于护理敏感质量指标的肠造口护理方案在新生儿造口管理中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003986

温州医科大学附属第二医院、育英儿童医院新生儿科，浙江温州 325027

基金项目:

浙江省医药卫生科技计划项目 2021KY800

详细信息

通讯作者:
陈芳芳，E-mail：cffchen@126.com

中图分类号: R473.72 R574.6 R574.8
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出版历程
- 收稿日期: 2025-01-14
- 网络出版日期: 2025-06-30

Application of intestinal stoma nursing plan based on nursing sensitive quality indicators in neonatal stoma management

Department of Neonatology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China

摘要

摘要: 目的构建基于护理敏感质量指标的肠造口护理方案，分析其对新生儿疼痛管理、造口并发症发生率、照顾者照护能力及护理满意度的影响。方法选取2020年6月—2024年5月温州医科大学附属第二医院、育英儿童医院收治的113例肠造口新生儿作为研究对象，2020年6月—2022年5月收治的56例新生儿为对照组，应用常规肠造口护理及传统护理质量评价标准，2022年6月—2024年5月收治的57例新生儿为观察组，构建护理敏感质量指标进行肠造口护理。比较2组新生儿疼痛程度、照顾者照护能力、造口并发症发生率及护理满意度。结果观察组新生儿造口袋更换过程中，操作时及操作后3 min新生儿疼痛/激惹及镇静评估(NPASS)量表评分均低于对照组(P＜0.05)。干预后，观察组新生儿照顾者照护能力量表各维度得分及总分均高于对照组(P＜0.05)。观察组新生儿造口并发症中造口周围皮肤粪水性皮炎、皮肤破损及造口周围皮肤过敏、皮疹发生率均低于对照组(P＜0.05)。观察组护理满意度为96.5%(55/57)，高于对照组[83.9%(47/56)，χ²=5.074，P=0.024]。结论基于护理敏感质量指标的肠造口护理方案有利于减轻新生儿造口护理中的不良刺激，降低疼痛及造口并发症发生，有效提高照顾者的照护能力。
- 新生儿 /
- 肠造口 /
- 护理敏感质量指标 /
- 造口管理
Abstract: Objective To construct an intestinal stoma nursing plan based on nursing sensitive quality indicators, analyze its impact on neonatal stoma management pain, incidence of stoma complications, caregiver care ability, and nursing satisfaction. Methods A total of 113 newborns with colostomy admitted to the Second Affiliated Hospital and Yuying Children ' s Hospital of Wenzhou Medical University from June 2020 to May 2024 were selected as the research subjects. Among them, 56 newborns admitted from June 2020 to May 2022 were selected as the control group, and routine colostomy nursing was applied. The remaining 57 newborns admitted from June 2022 to May 2024 were selected as the observation group, and nursing sensitive quality indicators were constructed for colostomy nursing. The pain situation, caregiver care ability, incidence of stoma complications, and nursing satisfaction of two teams of newborns were compared. Results During the process of replacing the ostomy bag in the observation group, the neonatal pain, agitation and sedation scale (NPASS) scores during and 3 minutes after the operation were lower than those in the control group (P < 0.05). After intervention, the scores and total scores of each dimension of the neonatal caregiver care ability scale in the observation group were higher than those in the control group (P < 0.05). The incidence of fecal dermatitis, skin damage, skin allergy, and rash around the stoma in the observation group of neonatal stoma complications was lower than that in the control group (P < 0.05). The nursing satisfaction rate of the observation group was 96.5% (55/57), which was higher than that of the control group [83.9% (47/56), χ²=5.074, P=0.024]. Conclusion A nursing plan for colostomy based on nursing sensitive quality indicators is beneficial in reducing adverse stimuli in neonatal colostomy care, reducing pain and complications, and effectively improving caregiver care capabilities.
- Newborn /
- Intestinal stoma /
- Nursing sensitive quality indicators /
- Ostomy management

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表 1 2组新生儿一般资料比较

Table 1. Comparison of general information between two groups of newborns

组别	例数	性别(例)		出生胎龄 (x±s，周)	出生体重 (x±s，kg)	造口类型(例)		造口位置(例)
组别	例数	男	女	出生胎龄 (x±s，周)	出生体重 (x±s，kg)	单腔	双腔	小肠	结肠
对照组	56	32	24	32.66±3.02	1.68±0.51	8	48	40	16
观察组	57	35	22	32.61±2.82	1.72±0.60	10	47	44	13
统计量		0.212^a		0.091^b	0.382^b	0.224^a		0.492^a
P值		0.645		0.928	0.704	0.636		0.483
注：^a为χ²值，^b为t值。

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表 2 2组照顾者一般资料比较

Table 2. Comparison of general information between two groups of caregivers

组别	例数	性别(例)		年龄 (x±s，岁)	文化程度(例)
组别	例数	男性	女性	年龄 (x±s，岁)	高中及以下	大专及以上
对照组	56	11	45	32.33±3.46	29	27
观察组	57	9	48	32.41±3.85	28	29
统计量		0.288^a		0.116^b	0.080^a
P值		0.592		0.908	0.777
注：^a为χ²值，^b为t值。

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表 3 2组新生儿疼痛程度比较(x±s，分)

Table 3. Comparison of pain levels between two groups of newborns (x±s, points)

组别	例数	操作前	操作时	操作后
对照组	56	3.18±0.53	6.07±0.75^a	5.23±0.70^a
观察组	57	3.21±0.49	5.36±0.64^a	4.01±0.66^a
F值		0.313	4.721	8.636
P值		0.755	＜0.001	＜0.001
注：与同组操作前比较，^aP < 0.05;F_时间=10.216，P＜0.001;F_组间=137.81，P＜0.001;F_交互=4.722，P＜0.001。

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表 4 2组新生儿照顾者照护能力比较(x±s，分)

Table 4. Comparison of care abilities between two groups of neonatal caregivers (x±s, points)

组别	例数	造口认知		造口护理基本技能		日常生活照护相关知识
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	56	5.71±1.22	13.66±2.58^b	8.18±1.43	20.02±4.17^b	22.80±4.94	40.73±6.99^b
观察组	57	5.48±1.07	17.30±2.61^b	7.96±1.25	23.75±3.92^b	23.17±5.28	50.25±4.76^b
统计量		1.066^a	5.931^c	0.871^a	3.719^c	0.385^a	8.140^c
P值		0.289	＜0.001	0.386	＜0.001	0.701	＜0.001

组别	例数	肠造口及周围并发症的识别与应对		照顾者执行力		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	56	12.62±2.77	20.71±4.23^b	5.02±1.41	8.46±2.04^b	50.62±5.20	103.67±10.21^b
观察组	57	12.41±2.39	26.55±3.06^b	4.89±1.33	11.72±2.49^b	49.73±4.92	131.45±8.74^b
统计量		0.472^a	6.792^c	0.504^a	6.033^c	0.935^a	13.571^c
P值		0.667	＜0.001	0.615	＜0.001	0.352	＜0.001
注：^a为t值，^b为F值; 与同组干预前比较，^bP < 0.05。

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表 5 2组新生儿造口并发症发生率比较[例(%)]

Table 5. Comparison of complication incidence in neonatal ostomy between two groups of newborns[cases (%)]

组别	例数	造口周围皮肤粪水性皮炎、皮肤破损	出血	造口脱垂	皮肤黏膜分离	造口周围皮肤过敏、皮疹
对照组	56	37(66.1)	2(3.6)	4(7.1)	3(5.4)	23(41.1)
观察组	57	8(14.0)	1(1.8)	2(3.5)	1(1.8)	5(8.8)
χ²值		31.917	0.361	0.742	1.074	15.429
P值		＜0.001	0.548	0.389	0.300	＜0.001

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表 6 2组护理满意度比较[例(%)]

Table 6. Comparison of nursing satisfaction between two groups[cases (%)]

组别	例数	非常满意	满意	一般	不满意	护理满意度
对照组	56	29(51.8)	18(32.1)	7(12.5)	2(3.6)	47(83.9)
观察组	57	43(75.4)	12(21.1)	2(3.5)	0	55(96.5)
注：2组护理满意度比较，χ²=5.074，P=0.024。

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