作者：张颜，康春博，贺姗杉，高艳芳，李玲玲，武巧玲

单位：首都医科大学附属北京康复医院 胃肠康复中心，北京 100144

Authors:  Zhang Yan, Kang Chunbo, He Shanshan, Gao Yanfang, Li Lingling, Wu Qiaoling

Unit:  Gastrointestinal Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing 100144, China

摘要：

目的  研究基于5A 模式的分级干预对低位直肠癌结肠造口患者的作用影响。方法  选取首都医科大学附属北京康复医院2020年9月至2022年9月收治的100例低位直肠癌行结肠造口患者作为研究对象，按照随机数表法分为对照组（n=50）和研究组（n=50）。对照组给予常规造口护理干预及随访，研究组在对照组基础上增加基于5A 模式的分级干预，两组均随访至术后3个月。比较两组干预前后的造口接受度问卷（stoma acceptance questionnaire, SAQ）、自我护理能力测定量表（exercise of self-care agency scale, ESCA）、乐观主义-悲观主义量表（optimistic tendency-pessimism scale, OPS）和直肠癌特异性生活质量调查表29（quality of life questionnaire-colorectal 29, QLQ-CR29）评分，并统计两组术后3 个月内造口并发症的发生情况。结果  干预前，两组SAQ 评分、ESCA 各维度评分、QLQ-CR29 评分、OPS 乐观维度和OPS 悲观维度评分比较，差异均无统计学意义（均P>0.05）。干预后，两组SAQ 评分、ESCA 各维度评分、OPS 乐观主义评分高于干预前，QLQ-CR29 评分、OPS 悲观主义评分低于干预前，且研究组SAQ 评分、ESCA 各维度评分、OPS 乐观主义评分高于对照组，QLQ-CR29 评分、OPS 悲观主义评分低于对照组，差异有统计学意义（均P＜0.05）。术后3个月内，研究组造口并发症总发生率明显低于对照组，差异有统计学意义（P＜0.05）。结论  基于5A模式的分级干预有助于提高低位直肠癌结肠造口患者的造口接受度和自护能力，增强积极乐观心理，改善造口生活质量，降低造口并发症发生率。

关键词： 5A 模式；分级干预；低位直肠癌；结肠造口术；生活质量

Abstract：

Objective  To explore the effect of graded intervention based on 5A model on patients with low rectal cancer undergoing colostomy. Method  From September 2020 to September 2022, a total of 100 patients with low rectal cancer undergoing colostomy who admitted to our hospital were selected as the study subjects, and they were divided into control group (n=50) and research group (n=50) according to random number variation. The control group received routine ostomy nursing intervention and follow-up, while the research group received graded intervention based on 5A mode on top of the control group. Both groups were followed up until 3 months after surgery. The stoma acceptance questionnaire (SAQ), exercise of self-care agency scale (ESCA), optimistic tendency-pessimism scale (OPS) and quality of life questionnaire-colorectal 29 (QLQ-CR29) were compared between the two groups before and after intervention. And the incidence of stoma complications within 3 months after surgery was compared between the two groups. Result  Before intervention, there were no significant differences in SAQ score, each dimension score of ESCA, QLQ-CR29 score, optimistic dimension score of OPS and pessimistic dimension score of OPS between the two groups (all P>0.05). After intervention, the SAQ score, each dimension score of ESCA, optimistic dimension score of OPS of the two groups were higher than before intervention, and the QLQ-CR29 score, pessimistic dimension score of OPS were lower than before intervention, and the SAQ score, each dimension score of ESCA, optimistic dimension score of OPS in the research group were significantly higher than those in the control group, and the QLQ-CR29 score, pessimistic dimension score of OPS were lower than those in the control group, with statistically significant differences (all P <0.05). Within 3 months after surgery, the total incidence of stoma complications in the research group was significantly lower than that in the control group, with statistically significant difference (P<0.05). Conclusion  The graded intervention based on the 5A model can significantly improve the acceptance and self -care ability of patients with low rectal cancer undergoing colostomy, enhance positive psychology, reduce the incidence of colostomy complication, and improve the quality of life after colostomy.

Key Words:  5A mode; Graded intervention; Low rectal cancer; Colostomy; Quality of life