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

• 论著 · 临床研究 • 上一篇

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 E-mail:realltairui@163.com;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:realltairui@163.com;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

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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

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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

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