| Objectives1Explore a systematic management programs for restorative proctocolectomy, ileal pouch-anal anastomosis (IPAA) perioperative of Ulcerative colitis (UC).2To investigate the quality of life (QOL) and nutritional status of UC patients in different periods of operation, before and after the intervention of Systematic management programs.3To evaluate the effects of systematic management programs on postoperative QOL, nutriture, stool consistency, anal function and postoperative complications for UC patients.MethodsInvestigational study and intervention study were used in this research. From September2012to September2013,58patients with UC were selected who undergoing IPAA surgery by two stages, and divided into the control group (30cases) and the intervention group (28cases) by surgery chronologically. The control group received routine clinical treatment and care. In addition to the same treatment and care like control group, the intervention group also received a planned, purposeful, targeted systematic management program from admission which was administered by researchers.1The QoL of UC patients were calculated by field questionnaire survey at three different time points respectively--before the first stage of IPAA operation, before the second stage of ileostomy closured, and3months after ileostomy closured. During the same period,60cases of health examination population were randomly investigated as the norm of QOL.2We worked to collect UC patients’nutrition indicators before the first stage of IPAA operation, before the second stage of ileostomy closured, and3months after ileostomy closured, including body measurements and laboratory parameters:such as body mass index(BMI), hemoglobin(HB), serum albumin(ALB), prealbumin(PA), transferrin(TRF).3To compare the differences of two groups of patients in QOL, nutriture, stool consistency, anal function and postoperative complications before and after the intervention of systematic management programs.The above data was analysed using SAS9.2statistical software. General data was described by frequency, percentage, mean and deviation. Count data were analyzed using chi-square test or Fisher’s exact probability method. Measurement data were analyzed by two independent samples t-test or Wilcoxon rank test method in two independent samples. Single factor repeated measures design ANOVA method was used to compare the of QOL scores in different surgical period. P<0.05was considered statistically significant.Results1Before surgical treatment, UC patients had a long course of disease, mostly in the severe and activity, the condition was more complex compared with the patients in medical therapy and often associated with intestinal manifestations in different parts. In this study, the overall QOL scores of58UC patients before surgery were only43.2±9.4, far below the level of QOL norm (85.8±4.0), and the levels of bowel symptoms, systemic symptoms, emotional competence, social competence were also significantly lower than the norm, the difference was statistically significant (P<0.05); Before the second stage of ileostomy closured, scores of intestinal symptoms, systemic symptoms and emotional aspects were comparable to that of the norm, except the overall QOL and social competence, the difference was statistically significant (P<0.05). The overall QoL and four domains scores were as high as the norm values at3months after ileostomy closured, the difference was not statistically significant (P>0.05). Through the comparison of different QOL dimensions at three operation period showed that, the trends of the overall QoL and four domains were diverse in different surgical periods.2With BMI, HB, ALB, PA and TRF as malnutrition assessment indicators, the malnutrition rates of UC patients before the first stage of surgery were40.63%, 0.00%respectively before the second stage of surgery; the incidences were20.31%,7.81%,0.00%,6.25%,0.00%at3months after the second stage of surgery.3After the intervention of systematic management program, the values of total QOL and four dimension(bowel symptoms, systemic symptoms, emotional competence, social competence) of intervention group were higher than the control group, before and3months after the second stage surgery, the difference was statistically significant (P<0.05).4After the intervention of systematic management program, the average values of BMI, HB, ALB, PA and TRF of intervention group were higher than the the control group, before and3months after the second stage surgery, the difference was statistically significant (P<0.05).5After the intervention of systematic management program, the stool score (6points) of intervention group was better than the control group (6.5points) before the second stage surgery; the score (5points) of intervention group was better than the control group (6points) at3months after the second stage surgery, the difference was statistically significant (P<0.05).6Taking24h stool frequency, stool frequency at night, set pad, Wexner score as evaluation parameters, the anal function of intervention group was better than the control group at3months after the second stage surgery after the intervention of systematic management program; the difference was statistically significant (P <0.05).7After the intervention of systematic management program, the incidence rates of wound infection, urinary tract infection/stones and stoma complication in the intervention group were lower than the control group after the first stage operation; the incidence rates of wound infection, urinary tract infection/stones in the intervention group were lower than the control group after the second stage operation; the difference was statistically significant (P<0.05).Conclusion1UC patients had serious illness and poor QOL before surgical treatment; IPAA surgery can significantly improve the QOL of patients, and the levels of QOL had closed to the norm3months after the second operation.2The nutritional status of UC patients was poor before surgical treatment, with a very high incidence of malnutrition; nutriture of UC patients improved gradually after IPAA surgery, which had tended to be normal3months after the second stage operation.3Systematic management programs during IPAA perioperative is an effective care methods, which can improve the postoperative QOL, nutriture, stool consistency, anal function, reduce the incidence of postoperative complications, and shoud be applied to clinical practice.4Based on the results of this study, nursing staffs should pay attention to IPAA perioperative care of UC patients; nurse managers should formulate a systematic nursing specification as soon as possible to improve the rehabilitation of patients with IPAA surgery. |
PDF Full Text Request