永久性肠造口患者造口适应水平影响因素分析

doi:10.3969/j.issn.1674-8115.2023.11.010

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (11): 1423-1429.doi: 10.3969/j.issn.1674-8115.2023.11.010

永久性肠造口患者造口适应水平影响因素分析

台瑞(), 方芳(), 毛晶珏, 周霞

上海交通大学医学院附属第一人民医院护理部，上海 200080

收稿日期:2023-06-26 接受日期:2023-10-12 出版日期:2023-11-28 发布日期:2023-11-28
通讯作者: 方　芳，电子信箱：fang_fang0604@163.com。
作者简介:台　瑞（1993—），女，护师，硕士；电子信箱：realltairui@163.com。
基金资助:
上海市卫生健康委员会科研项目(202150049);上海交通大学医学院护理学科建设项目(SJTUHLXK2022);上海市第一人民医院特色研究项目(CTCCR-2021C08)

Analysis of influencing factors of adaptation level in patients with permanent enterostomy

TAI Rui(), FANG Fang(), MAO Jingjue, ZHOU Xia

Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China

Received:2023-06-26 Accepted:2023-10-12 Online:2023-11-28 Published:2023-11-28
Contact: FANG Fang, E-mail: fang_fang0604@163.com.
Supported by:
Research Project of Shanghai Municipal Health Commission(202150049);Shanghai Jiao Tong University School of Medicine: Nursing Development Program(SJTUHLXK2022);Clinical Research Innovation Plan of Shanghai General Hospital(CTCCR-2021C08)

摘要/Abstract

摘要：

目的·调查永久性肠造口患者的造口适应水平并分析其影响因素。方法·通过方便抽样法选取2022年1月—12月上海交通大学医学院附属第一人民医院虹口北院和松江南院的260名行永久性肠造口手术的患者。采用一般资料调查表、中文版造口社会心理适应量表、医院焦虑抑郁量表、造口患者自我效能量表、中文简体版身体意象量表、修订版婚姻调适量表，调查患者的造口适应水平及其影响因素。经Shapiro-Wilk正态性检验后，满足正态分布的定量资料使用x±s进行统计描述；定性资料使用n（%）进行统计描述。采用t检验、方差分析进行单因素分析，采用Spearman相关分析对连续变量进行相关性分析，采用多元线性回归分析探索永久性肠造口患者造口适应水平的影响因素。结果·永久性肠造口患者的适应水平总分为42.28±11.47，处于中低水平的适应情况。单因素分析发现，居住地区（P=0.001）、收入情况（P=0.000）和造口相关并发症（P=0.000）对适应水平的影响具有统计学意义；相关性分析得出焦虑抑郁和身体意象与适应水平呈负相关（r=-0.391，P=0.000；r=-0.523，P=0.000），造口自我效能和婚姻调适与适应水平呈正相关（r=0.713，P=0.000；r=0.645，P=0.000）；经多元回归分析后，造口相关并发症、焦虑、造口照护自我效能和婚姻满意度共计4个变量进入回归方程，可共同解释总变量的59.8%（P=0.000）。结论·大多数永久性肠造口患者的适应水平较低，造口相关并发症、焦虑情绪、造口照护自我效能和婚姻满意度是影响适应水平的主要因素。

关键词: 结直肠癌, 肠造口术, 造口适应, 婚姻关系, 影响因素分析, 回归分析

Abstract:

Objective ·To investigate the level of stoma adaptation in patients with permanent enterostomy and its influencing factors. Methods ·In this cross-sectional study, 260 patients with permanent enterostomy from North Campus in Hongkou and South Campus in Songjiang of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine were recruited by convenience sampling approach from January to December, 2022. The level and the influencing factors of stoma adaptation were investigated by general information questionnaire, Chinese version of Ostomy Adjustment Inventory-20 (OAI-20), Hospital Anxiety and Depression Scale, Stoma Self-Efficacy Scale, Body Image Scale, and The Revised Dyadic Adjustment Scale. Statistical description used mean and standard deviation, frequency and percentage. T test, ANOVA, Spearman correlation and multiple linear regression analyses were preformed to explore the influencing factors of the level of stoma adaptation. Results ·The mean score of OAI-20 was (42.28±11.47). One-way ANOVA results showed the effects of registered residence (P=0.001), monthly income (P=0.000) and the ostomy-related complications (P=0.000) on the OAI-20 score were statistically significant. Spearman correlation analysis results showed that the OAI-20 score was positively correlated with stoma self-efficacy and marital adjustment score (r=0.713, P=0.000; r=0.645, P=0.000), but negatively correlated with anxiety and depression and body image score (r=-0.391, P=0.000; r=-0.523, P=0.000). Four of the eleven variables, ostomy-related complications, anxiety, self-efficacy of ostomy caring and marital satisfaction, were selected by the multiple linear stepwise regression analysis, and could explain 59.8% of total variance (P=0.000). Conclusion ·Most patients with permanent enterostomy have a low level of adaptation. Ostomy-related complications, anxiety, self-efficacy of ostomy caring and marital satisfaction are the main influencing factors of the level of stoma adaptation.

Key words: colorectal cancer, enterostomy, ostomy adaptation, marital relationship, regression analysis

中图分类号:

R473.6

台瑞, 方芳, 毛晶珏, 周霞. 永久性肠造口患者造口适应水平影响因素分析[J]. 上海交通大学学报（医学版）, 2023, 43(11): 1423-1429.

TAI Rui, FANG Fang, MAO Jingjue, ZHOU Xia. Analysis of influencing factors of adaptation level in patients with permanent enterostomy[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(11): 1423-1429.

图/表 4

参考文献 31

1	SIEGEL R L, MILLER K D, GODING SAUER A, et al. Colorectal cancer statistics, 2020[J]. CA Cancer J Clin, 2020, 70(3): 145-164.
2	顾晋, 汪建平.中国结直肠癌诊疗规范(2023版)[J].中国实用外科杂志, 2023, 43(6): 602-630.
	GU J, WANG J P. Chinese protocol of diagnosis and treatment of colorectal cancer of the National Health Commission (2023 edition)[J]. Chinese Journal of Practical Surgery, 2023, 43(6): 602-630.
3	CHEN W Q, ZHENG R S, BAADE P D, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132.
4	GARG P K, GOEL A, SHARMA S, et al. Protective diversion stoma in low anterior resection for rectal cancer: a meta-analysis of randomized controlled trials[J]. Visc Med, 2019, 35(3): 156-160.
5	SZPILEWSKA K, JUZWISZYN J, BOLANOWSKA Z, et al. Acceptance of disease and the quality of life in patients with enteric stoma[J]. Pol Przegl Chir, 2018, 90(1): 13-17.
6	ZHANG Y, XIAN H T, YANG Y, et al. Relationship between psychosocial adaptation and health-related quality of life of patients with stoma: a descriptive, cross-sectional study[J]. J Clin Nurs, 2019, 28(15/16): 2880-2888.
7	XIAN H T, ZHANG Y, YANG Y, et al. A descriptive, cross-sectional study among Chinese patients to identify factors that affect psychosocial adjustment to an enterostomy[J]. Ostomy Wound Manage, 2018, 64(7): 8-17.
8	VERWEIJ N M, BONHOF C S, SCHIPHORST A W, et al. Quality of life in elderly patients with an ostomy: a study from the population-based PROFILES registry[J]. Colorectal Dis, 2018, 20(4): O92-O102.
9	袁理, 冯红, 丁淑贞. 肠造口患者造口适应的研究进展[J]. 护理研究, 2019, 33(22): 3922-3926.
	YUAN L, FENG H, DING S Z. Research progress on stoma adaptation in patients with enterostomy[J]. Chinese Nursing Research, 2019, 33(22): 3922-3926.
10	SHARMA A, SANEHA C, PHLIGBUA W. Effects of dyadic interventions on quality of life among cancer patients: an integrative review[J]. Asia Pac J Oncol Nurs, 2021, 8(2): 115-131.
11	陈伟, 秦楠, 李辉. 癌症患者及其配偶二元应对的相关研究进展[J]. 护理学报, 2022, 29(11): 31-35.
	CHEN W, QIN N, LI H. Research progress on binary coping of cancer patients and their spouses[J]. Journal of Nursing, 2022, 29(11):31-35.
12	许勤, 程芳, 戴晓冬. 中文版造口者社会心理适应量表的修订及信效度评价[J]. 江苏医药, 2010, 36(14): 1647-1649.
	XU Q, CHENG F, DAI X D. Evaluation of reliability and validity of the revised Chinese version of Ostomates Adjustment Inventory-23[J]. Jiangsu Medical Journal, 2010, 36(14): 1647-1649.
13	SIMMONS K L, SMITH J A, MAEKAWA A. Development and psychometric evaluation of the Ostomy Adjustment Inventory-23[J]. J Wound Ostomy Continence Nurs, 2009, 36(1): 69-76.
14	ZIGMOND A S, SNAITH R P. The Hospital Anxiety and Depression Scale[J]. Acta Psychiatr Scand, 1983, 67(6): 361-370.
15	汪向东, 王希林, 马弘. 心理卫生评定量表手册[M]. 增订版. 北京: 中国心理卫生杂志社, 1999.
	WANG X D, WANG X L, MA H. Handbook of mental health assessment scales[M]. Updated ed.Beijing: Chinese Mental Health Journal Publisher, 1999.
16	阮卉, 尤黎明. 直肠癌永久性结肠造口患者自我效能及影响因素的调查[J]. 护士进修杂志, 2010, 25(11): 1055-1057.
	RUAN H, YOU L M. Self-efficacy and its influencing factors in patients with permanent rectal cancer colostomy[J]. Journal of Nurses Training, 2010, 25(11): 1055-1057.
17	BEKKERS M J, van KNIPPENBERG F C, van DULMEN A M, et al. Survival and psychosocial adjustment to stoma surgery and nonstoma bowel resection: a 4-year follow-up[J]. J Psychosom Res, 1997, 42(3): 235-244.
18	宋丽莉, 李磊, 孙婷婷, 等. 体象量表中文简体版在直肠癌患者中的适用性[J]. 中国心理卫生杂志, 2019, 33(3): 192-197.
	SONG L L, LI L, SUN T T, et al. Applicability of the simplified Chinese version of the Body Image Scale in patients with rectal cancer[J]. Chinese Mental Health Journal, 2019, 33(3): 192-197.
19	BUSBY D M, CHRISTENSEN C, CRANE D R, et al. A revision of the dyadic adjustment scale for use with distressed and nondistressed couples: construct hierarchy and multidimensional scales[J]. J Marital Fam Ther, 1995, 21(3): 289-308.
20	SPANIER G B. Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads[J]. J Marriage Fam, 1976, 38(1): 15-38.
21	刘华云, 李旭英, 谌永毅, 等. 结直肠癌造口术后患者社会心理适应现状及影响因素分析[J]. 上海护理, 2021, 21(11): 20-23.
	LIU H Y, LI X Y, SHEN Y Y, et al. Analysis on status quo and influencing factors of psychosocial adaptation in patients with colorectal cancer after colostomy[J]. Shanghai Nursing, 2021, 21(11):20-23.
22	BAHRAMI M, MASOUMY M, SADEGHI A, et al. The needs of colorectal cancer patients/survivors: a narrative review[J]. J Educ Health Promot, 2022, 7(11): 227-233.
23	韩杉, 张海邻, 唐瑾, 等. 肠造口患者及家属焦虑抑郁状况及对患者造口自护能力的影响[J]. 护理学杂志, 2019, 34(13): 79-82.
	HAN B, ZHANG H L, TANG J, et al. Impact of anxiety and depression levels among colostomy patients and their families on patient selfcare ability[J]. Journal of Nursing Science, 2019, 34(13): 79-82.
24	MOSHER C E, WINGER J G, GIVEN B A, et al. A systematic review of psychosocial interventions for colorectal cancer patients[J]. Support Care Cancer, 2017, 25(7): 2349-2362.
25	GÖTZE H, FRIEDRICH M, TAUBENHEIM S, et al. Depression and anxiety in long-term survivors 5 and 10 years after cancer diagnosis[J]. Support Care Cancer, 2020, 28(1): 211-220.
26	叶显辉, 汪秀云. 直肠癌永久性结肠造口患者适应状况及影响因素分析[J]. 解放军预防医学杂志, 2019, 37(5): 103-104.
	YE X H, WANG X Y. Analysis of adaptation and influencing factors in patients with permanent rectal cancer colostomy[J]. Journal of Preventive Medicine of Chinese People′s Liberation Army, 2019, 37(5): 103-104.
27	RATLIFF C R, GOLDBERG M, JASZAROWSKI K, et al. Peristomal skin health: a WOCN society consensus conference[J]. J Wound Ostomy Continence Nurs, 2021, 48(3): 219-231.
28	PAUL J C, ZIMNICKI K, PIEPER B A. Encountering ostomies in acute care: peristomal skin changes[J]. Adv Skin Wound Care, 2023,36(1): 54-55.
29	DU X X, WANG D Y, DU H Y, et al. The correlation between intimate relationship, self-disclosure, and adaptability among colorectal cancer enterostomy patients[J]. Medicine, 2021, 100(19): e25904.
30	CHEN M Z, GONG J L, CAO Q, et al. A literature review of the relationship between dyadic coping and dyadic outcomes in cancer couples[J]. Eur J Oncol Nurs, 2021, 54: 102035.
31	HASSON-OHAYON I, GOLDZWEIG G, BRAUN M, et al. Beyond being open about it: a systematic review on cancer related communication within couples[J]. Clin Psychol Rev, 2022, 96: 102176.

Characteristic variable	Sample size/n (%)	OAI-20/point	Statistical value	P value
Age/year			0.038	0.845
<60	68 (26.2)	42.51±11.78
≥60	192 (73.8)	42.20±11.39
Gender			0.113	0.737
Male	164 (63.1)	42.10±11.27
Female	96 (36.9)	42.59±11.85
Registered residence			14.803	0.001
City	141 (54.2)	45.38±10.94
Town	59 (22.7)	40.78±11.11
Country	60 (23.1)	36.47±10.61
Education			1.318	0.270
Junior high school and below	142 (54.6)	41.33±11.26
Technical secondary school/senior high school	95 (36.5)	41.05±10.83
Junior college and above	23 (8.9)	42.87±11.88
Marital status			1.585	0.209
Married	245 (94.2)	42.50±11.51
Single and others	15 (5.8)	38.67±10.41
Children			0.210	0.647
Yes	251 (96.5)	42.34±11.56
No	9 (3.5)	40.56±8.75
Work			0.281	0.839
In service	5 (1.9)	42.40±7.27
Sick leave	92 (35.4)	42.26±11.90
Jobless	73 (28.1)	41.37±10.94
Retired	90 (34.6)	43.03±11.72
Family monthly income/yuan			19.090	0.000
<10 000	110 (42.3)	38.77±11.23
≥10 000	150 (57.7)	44.85±10.98
Payment			1.436	0.232
URBMI	174 (66.9)	42.88±12.44
NCMS	86 (33.1)	41.07±9.13
Ostomy-related complications			47.045	0.000
No	239 (91.9)	43.93±10.40
Yes	31 (8.1)	30.06±11.74

Characteristic variable	Sample size/n (%)	OAI-20/point	Statistical value	P value
Age/year			0.038	0.845
<60	68 (26.2)	42.51±11.78
≥60	192 (73.8)	42.20±11.39
Gender			0.113	0.737
Male	164 (63.1)	42.10±11.27
Female	96 (36.9)	42.59±11.85
Registered residence			14.803	0.001
City	141 (54.2)	45.38±10.94
Town	59 (22.7)	40.78±11.11
Country	60 (23.1)	36.47±10.61
Education			1.318	0.270
Junior high school and below	142 (54.6)	41.33±11.26
Technical secondary school/senior high school	95 (36.5)	41.05±10.83
Junior college and above	23 (8.9)	42.87±11.88
Marital status			1.585	0.209
Married	245 (94.2)	42.50±11.51
Single and others	15 (5.8)	38.67±10.41
Children			0.210	0.647
Yes	251 (96.5)	42.34±11.56
No	9 (3.5)	40.56±8.75
Work			0.281	0.839
In service	5 (1.9)	42.40±7.27
Sick leave	92 (35.4)	42.26±11.90
Jobless	73 (28.1)	41.37±10.94
Retired	90 (34.6)	43.03±11.72
Family monthly income/yuan			19.090	0.000
<10 000	110 (42.3)	38.77±11.23
≥10 000	150 (57.7)	44.85±10.98
Payment			1.436	0.232
URBMI	174 (66.9)	42.88±12.44
NCMS	86 (33.1)	41.07±9.13
Ostomy-related complications			47.045	0.000
No	239 (91.9)	43.93±10.40
Yes	31 (8.1)	30.06±11.74

Variable OAI-20	Acceptance		Anxious preoccupation		Social life attitude		Total
Variable OAI-20	r	P	r	P	r	P	r	P
HADS	-0.421	0.000	-0.363	0.000	-0.333	0.000	-0.391	0.000
Factor1: Anxiety	-0.431	0.000	-0.379	0.000	-0.355	0.000	-0.409	0.000
Factor2: Depression	-0.351	0.000	-0.302	0.000	-0.269	0.000	-0.324	0.000
SSS	0.690	0.000	0.661	0.000	0.645	0.000	0.713	0.000
Factor1: Stoma care self-efficacy	0.691	0.000	0.661	0.000	0.631	0.000	0.705	0.000
Factor2: Social functional self-efficacy	0.662	0.000	0.363	0.000	0.637	0.000	0.696	0.000
BIS	-0.548	0.000	-0.541	0.000	-0.523	0.000	-0.523	0.000
RDAS	0.658	0.000	0.565	0.000	0.576	0.000	0.645	0.000
Factor1: Marital consistency	0.620	0.000	0.528	0.000	0.539	0.000	0.605	0.000
Factor2: Marital satisfaction	0.631	0.000	0.569	0.000	0.573	0.000	0.635	0.000
Factor3: Marital cohesion	0.548	0.000	0.438	0.000	0.466	0.000	0.524	0.000

Variable OAI-20	Acceptance		Anxious preoccupation		Social life attitude		Total
Variable OAI-20	r	P	r	P	r	P	r	P
HADS	-0.421	0.000	-0.363	0.000	-0.333	0.000	-0.391	0.000
Factor1: Anxiety	-0.431	0.000	-0.379	0.000	-0.355	0.000	-0.409	0.000
Factor2: Depression	-0.351	0.000	-0.302	0.000	-0.269	0.000	-0.324	0.000
SSS	0.690	0.000	0.661	0.000	0.645	0.000	0.713	0.000
Factor1: Stoma care self-efficacy	0.691	0.000	0.661	0.000	0.631	0.000	0.705	0.000
Factor2: Social functional self-efficacy	0.662	0.000	0.363	0.000	0.637	0.000	0.696	0.000
BIS	-0.548	0.000	-0.541	0.000	-0.523	0.000	-0.523	0.000
RDAS	0.658	0.000	0.565	0.000	0.576	0.000	0.645	0.000
Factor1: Marital consistency	0.620	0.000	0.528	0.000	0.539	0.000	0.605	0.000
Factor2: Marital satisfaction	0.631	0.000	0.569	0.000	0.573	0.000	0.635	0.000
Factor3: Marital cohesion	0.548	0.000	0.438	0.000	0.466	0.000	0.524	0.000

Independent variable	Assignment
Registered residence	City=1, Town=2, Country=3
Family monthly income	<10 000 yuan=0, ≥10 000 yuan=1
Ostomy-related complications	No=0, Yes=1

永久性肠造口患者造口适应水平影响因素分析

Analysis of influencing factors of adaptation level in patients with permanent enterostomy

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 31

相关文章 15

编辑推荐

Metrics

Variable	Partial regression coefficient	Standard error	Standardized regression coefficient	t value	P value
Constant	10.090	3.135	‒	3.219	0.001
Ostomy-related complications	-4.902	1.522	-0.139	-3.220	0.001
Anxiety	-0.392	0.148	-0.116	-2.644	0.009
Stoma care self-efficacy	0.546	0.063	0.421	8.701	0.000
Marital satisfaction	1.157	0.159	0.344	7.280	0.000

[1]	江怡, 黄晨浩, 李祉良, 吴珺玮, 赵任, 张弢. 1例KRAS突变的结直肠癌患者术前接受化疗联合免疫治疗的效果报道[J]. 上海交通大学学报（医学版）, 2025, 45(9): 1256-1260.
[2]	陈佳莹, 褚以忞, 彭海霞. 结直肠癌无进展生存时间预测模型及影响因素研究[J]. 上海交通大学学报（医学版）, 2025, 45(3): 324-334.
[3]	梁乐斌, 陈慧芳, 赖淑静, 顾靓, 苏冰. 基于空间ATAC-seq技术的Apc^min/+小鼠结肠肿瘤表观特征分析[J]. 上海交通大学学报（医学版）, 2025, 45(10): 1261-1270.
[4]	钱立恒, 温凯玲, 廖颖娜, 李书鑫, 聂惠贞. 分选链接蛋白1抑制结直肠癌细胞增殖和迁移的作用和机制研究[J]. 上海交通大学学报（医学版）, 2024, 44(9): 1124-1135.
[5]	冯昫皎, 刘健悦, 戚炀炀, 孙晶, 沈蕾. 结直肠癌中自然杀伤细胞表型及功能初探[J]. 上海交通大学学报（医学版）, 2024, 44(6): 713-722.
[6]	俞洋, 孟丹, 仇奕文, 袁见, 朱莹杰. 两样本孟德尔随机化法分析1型糖尿病对结直肠癌的影响[J]. 上海交通大学学报（医学版）, 2024, 44(6): 755-761.
[7]	罗晨, 沈玲, 王传伟, 顾佳妮, 王瑾, 赵黎, 黄帅. 腹腔镜结直肠癌根治术后患者早期下床活动现状及影响因素[J]. 上海交通大学学报（医学版）, 2023, 43(9): 1201-1210.
[8]	彭恬, 徐雷鸣. 表观遗传修饰与环状RNA在结直肠癌中相互作用的研究进展[J]. 上海交通大学学报（医学版）, 2023, 43(2): 237-243.
[9]	涂娟娟, 金志明. 免疫检查点抑制剂治疗转移性结直肠癌的研究进展[J]. 上海交通大学学报（医学版）, 2023, 43(2): 250-255.
[10]	胡慕妮, 季林华, 张昕雨, 沈超琴, 洪洁, 陈豪燕. 结直肠癌组织T细胞受体组库多样性与患者临床特征和具核梭形杆菌丰度的关联分析[J]. 上海交通大学学报（医学版）, 2022, 42(8): 1045-1052.
[11]	邱佳辉, 蔡谦谦, 杨彦, 程非池, 裘正军, 黄陈. 神经脉管浸润联合肿瘤间质比对结直肠癌预后的预测价值[J]. 上海交通大学学报（医学版）, 2022, 42(8): 1070-1080.
[12]	赵敏, 褚以忞, 彭海霞. 结直肠癌和结直肠腺瘤筛查方式的研究进展[J]. 上海交通大学学报（医学版）, 2022, 42(5): 673-679.
[13]	龚其雨, 陈磊. 多组学数据解析循环及浸润性B细胞在结直肠癌免疫微环境中的作用[J]. 上海交通大学学报（医学版）, 2022, 42(4): 472-481.
[14]	徐莹, 褚以忞, 杨大明, 李吉, 张海芹, 彭海霞. 基于差异表达基因组合构建高度微卫星不稳定结直肠癌转移预测模型[J]. 上海交通大学学报(医学版), 2021, 41(9): 1197-1206.
[15]	程盛, 赵益, 王永琛, 黄平. BRAF基因突变对肝切除后的结直肠癌肝转移患者预后影响的meta分析[J]. 上海交通大学学报(医学版), 2021, 41(6): 786-792.