RESUMO
BACKGROUND: Interleukin-10 (IL10) signalling pathway deficiency results in severe very early onset inflammatory bowel disease (VEOIBD), and enterostomy is often inevitable. However, studies in these surgical populations are lacking. This study aims to determine the enterostomy characteristics, postoperative complications and related risk factors in enterostomy patients. METHODS: From March 1, 2015, to December 31, 2018, patients with IL10R-mutation who underwent enterostomy were recruited for analysis. We collected data on the patients' clinical characteristics, enterostomy characteristics, postoperative complications and related risk factors. RESULTS: Twelve patients required emergency enterostomy, and 10 patients underwent elective enterostomy. Twelve patients experienced postoperative complications, including wound infection (27.3%), wound dehiscence (18.2%), reoperation (18.2%), etc. Compared with the pre-enterostomy values, there was a decrease in C-reactive protein (CRP) (P = 0.001), an increase in albumin (P = 0.001) and an improvement in the weight-for-age (P = 0.029) and body mass index (BMI) Z-scores (P = 0.004) after enterostomy. There was a significant difference between the pre-operation and postoperation medicine expenses (P = 0.002). Univariate binary logistic regression analysis revealed a statistically significant influence of CRP (OR: 1.43, 95% CI: 1.07-1.91, P = 0.016) and a tendency towards a significant influence of intestinal perforation, albumin level, BMI Z-score and weighted paediatric Crohn's disease activity index (wPCDAI). Multivariate logistic regression analysis showed that CRP (OR: 1.40), wPCDAI (OR: 2.88) and perforation (OR: 1.72) showed a tendency to behave as independent risk factors for postoperative complications, but the results were not significant (all P > 0.05). CONCLUSIONS: Surgery and enterostomy showed benefits for VEOIBD with IL-10 signalling deficiency. The timing of intervention, potential postoperative complications, economic burden and other related problems should be considered.
Assuntos
Enterostomia/efeitos adversos , Doenças Inflamatórias Intestinais/cirurgia , Complicações Pós-Operatórias/genética , Receptores de Interleucina-10/deficiência , Transdução de Sinais/genética , Adolescente , Adulto , Idade de Início , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Enterostomia/economia , Feminino , Humanos , Doenças Inflamatórias Intestinais/economia , Doenças Inflamatórias Intestinais/genética , Interleucina-10/genética , Modelos Logísticos , Masculino , Mutação , Complicações Pós-Operatórias/economia , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
This article reviews early postoperative complications in adults undergoing ostomy surgery. Whether the ostomy is the result of an emergent or elective procedure, the WOC nurse and staff nurses are responsible for monitoring and ensuring quality healthcare for the patient. Nevertheless, many patients undergoing ostomy surgery experience a complication during the early postoperative period. Early postoperative complications not only influence immediate postoperative care but may also impact quality of life for the person living with an ostomy. Keen assessment skills, early recognition of signs and symptoms of a complication, and prompt interventions are crucial to maintaining a viable stoma and a successful surgical outcome.
Assuntos
Enterostomia , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/terapia , Higiene da Pele , Derivação Urinária , Competência Clínica , Constrição Patológica/etiologia , Efeitos Psicossociais da Doença , Diagnóstico Precoce , Enterostomia/efeitos adversos , Enterostomia/enfermagem , Humanos , Enteropatias/etiologia , Necrose , Avaliação em Enfermagem , Planejamento de Assistência ao Paciente , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/enfermagem , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prolapso , Qualidade de Vida , Fatores de Risco , Higiene da Pele/métodos , Higiene da Pele/enfermagem , Deiscência da Ferida Operatória/etiologia , Derivação Urinária/efeitos adversos , Derivação Urinária/enfermagemRESUMO
Obesity has become the number one health problem in the United States. The patients who is obese and undergoing a surgical procedure that results in the formation of fecal or urinary diversion requires advanced skills of a multidisciplinary healthcare team. Patients who are obese carry a high risk of wound and cardiopulmonary complications and often present a serious challenge in terms of stoma creation and management. The purpose of this article is to examine the risk factors that face the patient who is obese and undergoing stoma surgery, the challenges of stoma creation, and the resultant stoma management problems.
Assuntos
Enterostomia/enfermagem , Obesidade/complicações , Assistência Perioperatória/métodos , Higiene da Pele/métodos , Derivação Urinária/enfermagem , Constrição Patológica , Enterostomia/efeitos adversos , Necessidades e Demandas de Serviços de Saúde , Humanos , Necrose , Enfermeiros Clínicos , Avaliação em Enfermagem , Equipe de Assistência ao Paciente/organização & administração , Seleção de Pacientes , Assistência Perioperatória/enfermagem , Fatores de Risco , Sepse/etiologia , Sepse/prevenção & controle , Higiene da Pele/enfermagem , Derivação Urinária/efeitos adversosRESUMO
Home healthcare nurses have tremendous impact on how a patient adapts to a new ostomy. This article increases the nurse's knowledge regarding basic ostomy management by reviewing common ostomy surgical procedures, assessment of the stoma, ostomy supplies, and appliance application and by providing helpful hints for helping the patient incorporate the ostomy into everyday life.
