以质量求发展，以服务铸品牌

护理学报 ›› 2023, Vol. 30 ›› Issue (1): 41-46.doi: 10.16460/j.issn1008-9969.2023.01.041

• 循证护理 • 上一篇    下一篇

肠造口患者造口周围潮湿相关性皮肤损伤预防及护理的最佳证据总结

李牧玲a, 甄莉b, 朱木兰b, 白雪洁b, 温海飞b, 周宏珍c   

  1. 南方医科大学南方医院 a.眼科; b.普通外科; c.护理部,广东 广州 510515
  • 收稿日期:2022-09-14 出版日期:2023-01-10 发布日期:2023-02-22
  • 通讯作者: 周宏珍（1965-）,女,江苏扬州人,博士,主任护师。E-mail：Zhouhz2005@126.com
  • 作者简介:李牧玲（1994-）,女,湖南常德人,硕士,护师。
  • 基金资助:
    2021年度南方医院护理创优-循证护理项目（2021EBNc005）

Best evidence summary for prevention and nursing of peristomal moisture-associated skin damage in patients with enterostomy

LI Mu-linga, ZHEN LIb, ZHU Mu-lanb,bai Xue-jieb, WEN Hai-feib, ZHOU Hong-zhenc   

  1. a. Dept. of Ophthalmology; b. Dept. of General Surgery; c. Dept. of Nursing Administration, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
  • Received:2022-09-14 Online:2023-01-10 Published:2023-02-22

PDF (PC)

388

赞

摘要： 目的 总结肠造口患者造口周围潮湿相关性皮肤损伤预防及护理的相关证据,为临床实践管理提供依据。方法 检索Up To Date、BMJ、JBI、RNAO、GIN、NICE、NGC、SIGN、WOCN、PubMed、Web of Science、医脉通、The Cochrane Library、CINAHL、Embase、SinoMed、CNKI、维普和万方数据库关于肠造口患者造口周围潮湿相关性皮肤损伤预防及护理的相关证据。结果 共纳入16篇文献,其中6篇指南、3篇系统评价、3篇专家共识1篇临床决策、3篇证据总结,最后汇总9个方面,共21条证据。结论 肠造口患者造口周围潮湿相关性皮肤损伤的预防及护理的最佳证据总结可为临床应用提供循证依据,在证据转化过程中应结合临床实际,提高护理质量。

关键词: 肠造口, 造口周围潮湿相关性皮肤损伤, 证据总结

Abstract: Objective To summarize the best evidence for the prevention and care of peristomal moisture-associated skin damage in patients with enterostomy and to provide reference for clinical management. Methods We searched Up To Date, BMJ, JBI, RNAO, GIN, NICE, NGC, SIGN, WOCN, PubMed, Web of Science, Medlive, The Cochrane Library, CINAHL, Embase, SinoMed, CNKI, VIP and Wanfang for eligible literature. Results Sixteen articles were collected, including 6 guidelines, 3 systematic reviews, 3 expert consensuses/position statement, 1 clinical decision and 3 evidence summaries. Twenty-one pieces of best evidence was summarized into 9 themes. Conclusion Best evidence summary of the prevention and care of peristomal moisture-associated skin damage in patients with enterostomy provides evidence-based reference for clinical application. Clinical practice should be considered during the transition of the evidence so as to improve nursing quality.

Key words: colostomy, peristomal moisture-associated skin damage, evidence summary

中图分类号: 

  • R473.6
[1] Colwell JC, Ratliff CR, Goldberg M, et al.MASD part 3: peristomal moisture-associated dermatitis and periwound moisture-associated dermatitis: a consensus[J]. J Wound Ostomy Continence Nurs, 2011,38(5):541-553.DOI:10.1097/WON.0b013e31822acd95.
[2] Gray M, Bliss DZ, McNichol L, et al. Moisture-associated skin damage: a historic step forward[J]. J Wound Ostomy Continence Nurs, 2021, 48(6):581-583. DOI:10.1097/WON.0000000000000827.
[3] 刘莺歌, 吴燕, 曹秋君, 等. 肠造口患者造口周围潮湿相关性皮肤损伤的影响因素分析[J]. 中华护理教育, 2021, 18(8):749-754. DOI:10.3761/j.issn.1672-9234.2021.08.016.
[4] 董珊,袁玲,陈秋菊,等. 肠造口周围潮湿相关性皮肤损伤预防与管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(2): 223-230. DOI:10.3761/j.issn.0254-1769.2022.02.017.
[5] 朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017,32(21):1991-1994.DOI:10.16821/j.cnki.hsjx.2017.21.025.
[6] Brouwers MC, Kho ME, Browman GP, et al.AGREE II: advancing guideline development, reporting, and evaluation in health care[J]. Prev Med, 2010, 51(5):421-424. DOI:10.1016/j.ypmed.2010.08.005.
[7] 顾莺,张慧文,周英凤,等. JBI循证卫生保健中心关于不同类型研究的质量评价工具——系统评价的方法学质量评价[J]. 护士进修杂志, 2018, 33(8):701-703. DOI:10.16821/j.cnki.hsjx.2018.08.008.
[8] 王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
[9] 王雨彤,刘韦辰,陶静怡,等. 慢性非特异性腰背痛患者疼痛评估与管理的最佳证据总结[J]. 护理学报, 2022, 29(6): 55-59. DOI:10.16460/j.issn1008-9969.2022.06.055.
[10] Roveron G, Barbierato M, Rizzo G, et al.Italian guidelines for the nursing management of enteral and urinary stomas in adults: an executive summary[J]. J Wound Ostomy Continence Nurs, 2021,48(2):137-147. DOI:10.1097/WON.0000000000000745.
[11] Chabal LO, Prentice JL, Ayello EA.Practice implications from the WCET international ostomy guideline 2020[J]. Adv Skin Wound Care, 2021,34(6):1.DOI:10.1097/01.ASW.0000742888.02025.d6.
[12] Registered Nurses’ Association of Ontario. Supporting adults who anticipate or live with an ostomy:second edition[EB/OL].[2021-11-16]. https://rnao.ca/bpg/guidelines/ostomy.
[13] Ferrara F, Parini D, Bondurri A, et al.Italian guidelines for the surgical management of enteral stomas in adults[J]. Tech Coloproctol, 2019, 23(11):1037-1056. DOI:10.1007/s10151-019-02099-3.
[14] Wound, Ostomy and Continence Nurses Society, Guideline Development Task Force. WOCN society clinical guideline: management of the adult patient with a fecal or urinary ostomy-an executive summary[J]. J Wound Ostomy Continence Nurs,2018, 45(1):50-58.DOI:10.1097/WON.0000000000000396.
[15] Miller D, Pearsall E, Johnston D, et al.Executive summary: enhanced recovery after surgery: best practice guideline for care of patients with a fecal diversion[J]. J Wound Ostomy Continence Nurs, 2017, 44(1):74-77. DOI:10.1097/WON.0000000000000297.
[16] Ambe PC, Kugler CM, Breuing J, et al. The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy-a systematic review and meta-analysis[J].Colorectal Dis, 2022, 2022 Mar 17. DOI:10.1111/codi.16118.
[17] Heerschap C, Duff V.The value of nurses specialized in wound, ostomy, and continence: a systematic review[J]. Adv Skin Wound Care, 2021,34(10):551-559.DOI:10.1097/01.ASW.0000790468.10881.90.
[18] Banharak S, Panpanit L, Subindee S, et al.Prevention and care for incontinence-associated dermatitis among older adults: a systematic review[J].J Multidiscip Healthc, 2021, 14: 2983-3004. DOI:10.2147/JMDH.S329672.
[19] Prinz A, Colwell JC, Cross HH, et al.Discharge planning for a patient with a new ostomy: best practice for clinicians[J]. J Wound Ostomy Continence Nurs, 2015, 42(1):79-82. DOI:10.1097/WON.0000000000000094.
[20] Salvadalena G,Hendren S,McKenna L, et al. WOCN society and ASCRS position statement on preoperative stoma site marking for patients undergoing colostomy or ileostomy surgery[J]. J Wound Ostomy Continence Nurs, 2015, 42(3): 249-252. DOI:10.1097/WON.0000000000000119.
[21] Landmann RG, Cashman AL. Ileostomy or colostomy care and complications[EB/OL].(2020-06-09)[2022-04-12]. https://www.uptodate.com/contents/zh-Hans/ileostomy-or-colostomy-care-and-complications?search=%E9%80%A0%E5%8F%A3&source=search_result&selectedTitle=1~118&usage_type=default&dis-play_rank=1.
[22] Minooee S.Stoma Care: Post-operatively discharge and follow-up[J]. The JBI EBP Database,2021.
[23] 司龙妹,刘飞,张佩英,等.造口患者围手术期健康教育的最佳证据总结[J]. 中华护理杂志, 2021, 56(3):452-457. DOI:10.3761/j.issn.0254-1769.2021.03.024.
[24] Dissemond J, Assenheimer B, Gerber V, et al.Moisture-associated skin damage (MASD): a best practice recommendation from Wund-D.A.CH[J]. J Dtsch Dermatol Ges, 2021, 19(6):815-825. DOI:10.1111/ddg.14388.
[25] Parnham A, Copson D, Loban T.Moisture-associated skin damage: causes and an overview of assessment, classification and management[J]. Br J Nurs, 2020, 29(12):S30-S37. DOI:10.12968/bjon.2020.29.12.S30.
[26] 中华护理学会.成人肠造口护理[EB/OL].(2020-01-03)[2022-04-12].http://www.zhhlxh.org.cn/cnaWebcn/article/2127.
[27] 朱夏雪. 肠造口周围潮湿相关性皮肤损伤风险预测模型的构建与验证[D].广州: 南方医科大学, 2021.
[28] Recalla S, English K, Nazarali R,et al.Ostomy care and management: a systematic review[J]. J Wound Ostomy Continence Nurs, 2013,40(5):489-500. DOI:10.1097/WON.0b013e3182a219a1.
[29] Shao L, Lv L, Zheng MC,et al.Adaptation and psychometric evaluation of the stoma-QOL questionnaire among Chinese rectal cancer patients with colostomy[J]. Int J Nurs Pract, 2022, 5(10): e13045. DOI:10.1111/ijn.13045.
[30] Yuan JM, Zhang JE, Zheng MC,et al.Stigma and its influencing factors among Chinese patients with stoma[J]. Psychooncology, 2018, 27(6):1565-1571. DOI:10.1002/pon.4695.
[31] Zelga P, Kluska P, Zelga M, et al.Patient-related factors associated with stoma and peristomal complications following fecal ostomy surgery:a scoping review[J]. J Wound Ostomy Continence Nurs, 2021, 48(5):415-430. DOI:10.1097/WON.0000000000000796.
[32] Mitchell A, Hill B.Moisture-associated skin damage: an overview of its diagnosis and management[J]. Br J Community Nurs, 2020,25(3):S12-S18.DOI:10.12968/bjcn.2020.25.Sup3.S12.
[33] Rat P, Robert N, Fernandes I,et al.Evaluation of a one-piece soft convex ostomy appliance: a prospective, multicentre, open-label pilot study[J]. Br J Nurs, 2018, 27(16):S20-S28. DOI:10.12968/bjon.2018.27.16.S20.
[34] Hughes M.Total barrier protection: protecting skin and budgets using a structured moisture damage treatment strategy[J]. Wounds UK, 2016, 12(4):96-101.
[35] 崔天娇,屈清荣,高娅鑫,等. 肠造口患者重返工作适应性现状及其影响因素分析[J]. 解放军护理杂志,2022,39(3):5-8. DOI:10.3969/j.issn.1008-9993.2022.03.002.
[1] 张静, 彭焕椽, 陈佳, 鲁永锦, 刘克玄, 侯晓敏. 成人体外循环心脏手术患者预防手术部位感染的最佳证据总结[J]. 护理学报, 2025, 32(4): 41-47.
[2] 李若雨, 刘鑫, 林萍, 陈丹, 林桦. 出院患者用药安全管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 50-55.
[3] 毕雅昕, 端烨, 何丽君, 徐秒, 龚荣花. 减重代谢术后骨质疏松症预防与管理的最佳证据总结[J]. 护理学报, 2025, 32(1): 44-49.
[4] 王灵, 秦芳, 高钰琳, 甄莉, 冯日宣, 刘兵, 马正文, 许笑宇, 李国新. 经皮穴位电刺激治疗术后疼痛的最佳证据总结[J]. 护理学报, 2024, 31(6): 51-55.
[5] 杨建国, 何细飞, 鄢建军, 张梦, 杨纯子, 徐蓉, 王艳芳. 局部枸橼酸抗凝在连续性肾脏替代治疗中的应用及管理的最佳证据总结[J]. 护理学报, 2024, 31(4): 48-53.
[6] 刘璇, 蓝玉清, 李梦如, 王小惠, 钟雪梅, 周文. 住院老年性痴呆患者跌倒预防的最佳证据总结[J]. 护理学报, 2024, 31(4): 54-59.
[7] 祁水林, 林桦, 邓锐颖, 李荣杰, 李若雨, 王凤廷. 老年皮肤瘙痒症患者非药物管理的最佳证据总结[J]. 护理学报, 2024, 31(3): 46-50.
[8] 林梅燕, 张星星, 李瑞华, 陶思琪, 甄莉. 肠造口患者居家睡眠质量特点及影响因素研究进展[J]. 护理学报, 2024, 31(24): 27-32.
[9] 戴倩, 刘翔宇, 朱小妹, 王佳丽, 黄远思. 结直肠癌造口患者自我同情现状及影响因素研究[J]. 护理学报, 2024, 31(23): 13-17.
[10] 张星星, 李瑞华, 朱木兰, 林梅燕, 李雅男, 龚立红, 曾海婷, 甄莉. 成人肠造口患者高排量预防与管理的最佳证据总结[J]. 护理学报, 2024, 31(23): 73-78.
[11] 张倩君, 毛小英, 张莉, 刘俏玲, 向霞, 冯结兰, 冼顺英, 张璠, 邓伟英, 白志宝. 218名肠造口患者家庭照顾者的心理脱离现状及影响因素分析[J]. 护理学报, 2024, 31(22): 7-11.
[12] 刘肖蓉, 李思思, 罗家成, 王丽芳. 阿尔茨海默病患者音乐治疗的最佳证据总结[J]. 护理学报, 2024, 31(20): 39-44.
[13] 卢歌玲, 罗伟香, 欧静, 郑春娆. 甲状腺术后颈部出血预防及管理的最佳证据总结[J]. 护理学报, 2024, 31(2): 59-64.
[14] 刘佩玉, 李雪云, 牟童, 芮琳, 安晓燕. 全身麻醉手术患者恶性高热管理的最佳证据总结[J]. 护理学报, 2024, 31(18): 45-49.
[15] 蔡岩秀, 李静, 毕刘娜, 王琳琳, 韩静. 肝癌术后患者疲乏症状非药物管理策略的最佳证据总结[J]. 护理学报, 2024, 31(17): 35-39.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!