中国实用外科杂志

中国实用外科杂志

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赋能干预对溃疡性结肠炎术后疗效影响研究

高森阳，张迎迎，李凯钰，胡    芳，刘    刚   

  1. 天津医科大学总医院普外科，天津300052
  • 出版日期:2016-11-01 发布日期:2016-10-27

  • Online:2016-11-01 Published:2016-10-27

摘要：

目的    探讨赋能干预对溃疡性结肠炎（UC）病人全结直肠切除回肠贮袋肛管吻合术（IPAA）后肛门功能及生活质量影响。方法    选取2010年1月至2014年9月天津医科大学总医院普外科收治的行IPAA的UC病人60例，采用随机数字表法将病人分为干预组（30例）和对照组（30例），分别接受赋能干预和传统健康指导。干预6个月后，以24 h和夜间便次及Kirwan分级评价术后肛门自制功能，Bristol粪便分类法评定粪便性状；于干预前及干预6个月后，采用血浆中血清总蛋白（TP）、前白蛋白（PA）、白蛋白（ALB）及转铁蛋白（TRF）的水平评估病人的营养状况，采用IBDQ问卷评估生活质量。结果    赋能6个月后，干预组病人24 h和夜间便次均优于对照组，差异有统计学意义［24 h：（4.3±1.5）次 vs. （5.9±2.4）次；夜间：（1.6±0.7）次 vs. （2.3±1.3）次，均P<0.05］。干预组Kirwan 分级Ⅰ级21例、Ⅱ级7例、Ⅲ级2例，对照组Ⅰ级14例、Ⅱ级12例、Ⅲ级4例，差异无统计学意义（χ2=3.380，P>0.05）。干预组病人Bristol大便分类4类20例、5类6例、6类4例，对照组4类11例、5类17例、6类2例，差异有统计学意义（χ2=8.540，P<0.05）。营养状况方面，干预组病人ALB水平高于对照组［（47.4±5.8）g/L vs. （43.3±6.5）g/L，P<0.05）］；IBDQ问卷得分方面，干预组在肠道症状、全身症状等维度均高于对照组，差异有统计学意义（均P<0.05）。结论    赋能干预可以改善UC病人IPAA后肛门功能及粪便性状，提高其生活质量。

关键词: 溃疡性结肠炎, 全结直肠切除回肠贮袋肛管吻合术, 赋能, 生活质量, 肛门功能

Abstract:

Effect of empowerment intervention on ulcerative colitis patients’ anal function and quality of life after ileal pouch-anal anastomosis        GAO Sen-yang，ZHANG Ying-ying，LI Kai-yu，et al. Department of General Surgery, Tianjin Medical University General Hospital，Tianjin 300052，China
Corresponding author：LIU Gang，E-mail：landmark1503@sina.com
Abstract Objective To investigate the effect of empowerment intervention on ulcerative colitis (UC) patients’ anal function and quality of life after ileal pouch-anal anastomosis (IPAA）and provide gist for clinical intervention. Methods Sixty patients with UC who underwent IPAA between January 2010 and September 2014 in Department of General Surgery, Tianjin Medical University General Hospital were invited as the intervention group and the control group randomly，which received empowerment intervention and traditional health education respectively. Six months after intervention， the patients’ anal function and stool form by the 24 hours and night defecation，Kirwan grade，Bristol stool form scale were evaluated. Before and after the intervention of 6 months，serum total protein (TP), prealbumin (PA), albumin (ALB) and transferrin (TRF) were usd to assess patients’ nutritional status, assess the patients’ quality of life by the Inflammation Bowel Disease Questionare (IBDQ). Results Six months after empowerment intervention，24 hours and night defecations of intervention group were better than those of control group ［24h:（4.3±1.5）vs. (5.9±2.4); night:（1.6±0.7）vs. (2.3±1.3)，all P<0.05］. The number of patients in intervention group were 21 in grade Ⅰ(Kirwan classification)，7 in gradeⅡ，2 in grade Ⅲ，and the control group were 14 in grade Ⅰ，12 in grade Ⅱ，4 in grade Ⅲ（χ2=3.380，P>0.05）. The number of patients in intervention group were 20 in type four (Bristol stool form scale)，6 in type five，4 in type six ，and the control group were 11 in type four，17 in type five，2 in type six （χ2=8.540，P<0.05）. In intervention group，ALB levels were elevated ［（47.4±5.8）g/L vs. （43.3±6.5）g/L，P<0.05）］. The IBDQ scores of intervention group are higher than those of control group (P<0.05). Conclusion Empowerment intervention may improve the anal function and stool form of UC patients after IPAA and enhance the quality of their life.

Key words: ulcerative colitis, ileal pouch-anal anastomosis, empowerment, quality of life, anal function