Porrett T R, Lunniss P J
Surgical Nurse Specialist Department, Homerton Hospital, London, UK.
Colorectal Dis. 2001 Jul;3(4):227-31. doi: 10.1046/j.1463-1318.2001.00239.x.
To determine whether nurse practitioner (NP)-led advice in relation to bowel and defecatory habits in hemorrhoidal disease is as effective as local invasive treatment (sclerotherapy) in the management of patients with symptomatic 1st and 2nd degree haemorrhoids, with respect to both alleviation of presenting symptoms and relapse rate, and patients' understanding of their condition.
In a prospective randomized trial, 25 patients with bleeding haemorrhoids were allocated to receive either standard medical injection sclerotherapy (Group 1, n=13) or NP-led advice, information and bowel habit retraining (Group 2, n=12). Bulking agents were offered, when deemed appropriate, to patients in both groups. Treatment was administered by two clinicians only. Patients were assessed at 8 weeks, 4 months and finally at 6 months post treatment and any symptoms present were graded.
At 6 months, symptomatic improvement was similar in both groups (mean range 3 points) with a patient expected to get better with a good degree of confidence (C.I: 2-4 points). However those patients in Group 2 would be expected to have a slightly better minimum level of improvement (GP 1 P=0.004 GP 2 P=0.0005). At six months, there was no statistical difference between the two groups with regard to the patient's perception of the amount of information given, the clarity of the explanation, and the ability of the patient to understand and discuss their problem. In relation to understanding the cause of their problem patients in Group 2 felt they had a higher level of understanding of the cause of their problem (U=13, NA=7, NB=10, P=0.05) and felt more able to prevent their problem returning (U=12, NA=7, NB=10, P=0.05).
A bulking agent and Nurse led education, advice and bowel habit retraining is as effective in reducing the incidence of bleeding from 1st and 2nd degree haemorrhoids as injection sclerotherapy. Patients who consult a NP with symptomatic 1st and 2nd degree haemorrhoids feel more empowered in the long term. Non-invasive bowel retraining methods should be offered as an alternative to more traditional, invasive treatments for patients with symptomatic early hemorrhoidal disease.
确定在缓解症状和复发率以及患者对自身病情的理解方面，执业护士（NP）针对痔病患者的肠道和排便习惯提供的建议，是否与局部侵入性治疗（硬化疗法）在治疗有症状的Ⅰ度和Ⅱ度痔患者时同样有效。
在一项前瞻性随机试验中，25例出血性痔患者被分配接受标准的医学注射硬化疗法（第1组，n = 13）或由NP提供的建议、信息及排便习惯再训练（第2组，n = 12）。两组患者在认为适当时均给予容积性泻剂。治疗仅由两名临床医生进行。在治疗后8周、4个月及最后6个月对患者进行评估，并对出现的任何症状进行分级。
在6个月时，两组症状改善情况相似（平均范围为3分），患者预期会有较好程度的好转（置信区间：2 - 4分）。然而，预计第2组患者的最低改善水平会稍好一些（第1组P = 0.004，第2组P = 0.0005）。在6个月时，两组在患者对所提供信息量的感知、解释的清晰度以及患者理解和讨论自身问题的能力方面无统计学差异。关于对自身问题原因的理解，第2组患者觉得他们对自身问题原因的理解程度更高（U = 13，NA = 7，NB = 10，P = 0.05），并且觉得更有能力防止问题复发（U = 12，NA = 7，NB = 10，P = 0.05）。
容积性泻剂以及由护士主导的教育、建议和排便习惯再训练在降低Ⅰ度和Ⅱ度痔出血发生率方面与注射硬化疗法同样有效。患有症状性Ⅰ度和Ⅱ度痔并咨询NP的患者从长远来看会感觉更有能力应对。对于有症状的早期痔病患者，应提供非侵入性的排便习惯再训练方法作为更传统侵入性治疗的替代方案。
