Haas U, Geng V, Evers G C M, Knecht H
Department in Nursing Science, Institute for Clinical Research, Swiss Paraplegic Center, Nottwil, Switzerland.
Spinal Cord. 2005 Dec;43(12):724-30. doi: 10.1038/sj.sc.3101795.
A descriptive, cross-sectional, multicentre design was used.
To analyse bowel management in patients with spinal cord injury (SCI) especially the occurrence of unplanned bowel evacuations and duration of planned bowel evacuation.
In total, 29 rehabilitation facilities for SCI patients in Austria, Germany, the Netherlands and Switzerland, with a total of 837 hospitalized SCI patients.
Data were collected by nurses within 1 week in November 2001 using a quantitative questionnaire containing 14 questions. For data analysis, a chi (2)-test was used for differences in the outcome of bowel evacuation procedures associated with different interventions. Stepwise multiple logistic regression was used to analyse the relationship between the outcome of bowel management and the interventions as well as intervening factors.
More unplanned bowel evacuations were associated with usage of oral laxatives (n=444, P<0.001) as well as bowel evacuation every day (n=270, P<0.05) or every second day (n=368, P<0.05). The outcome of less unplanned bowel evacuations was associated with manual removal of stool combined with digital stimulation (n=35, P<0.05) and spontaneous bowel evacuations (n=104, P<0.001). Short duration of bowel evacuation (<60 min) was associated with manual removal of stool (n=64, P<0.05), the sitting position at defecation (n=494, P<0.001) and low frequency of bowel evacuation (>or=3 days) (n=638, P<0.05). Duration >60 min was associated with the use of oral laxatives (n=444, P<0.001) and complete loss of sensory function (n=349, P<0.05). Stool of hard consistency was associated with the manual removal of stool (n=64, P<0.001), the manual removal of stool in combination with digital stimulation (n=53, P<0.001) and the sitting position at defecation (n=494, P<0.05). Stool of soft consistency (n=341) was associated with the complete motor lesion (n=443, P<0.05).
Manual removal of stool was combined with low risk of unplanned bowel evacuations and short duration of evacuation time. These results are useful to improve the outcomes of bowel management in SCI patients.
采用描述性横断面多中心设计。
分析脊髓损伤（SCI）患者的肠道管理情况，尤其是意外排便的发生率和计划性排便的持续时间。
奥地利、德国、荷兰和瑞士共有29家SCI患者康复机构，共有837名住院SCI患者。
2001年11月，护士在1周内使用一份包含14个问题的定量问卷收集数据。数据分析时，采用卡方检验分析不同干预措施相关的肠道排便程序结果差异。采用逐步多元逻辑回归分析肠道管理结果与干预措施及干预因素之间的关系。
意外排便较多与口服泻药的使用有关（n = 444，P < 0.001），以及每天排便（n = 270，P < 0.05）或每两天排便一次（n = 368，P < 0.05）。意外排便较少的结果与手动清除粪便并结合手指刺激有关（n = 35，P < 0.05）以及自主排便（n = 104，P < 0.001）。排便持续时间短（<60分钟）与手动清除粪便有关（n = 64，P < 0.05）、排便时的坐姿有关（n = 494，P < 0.001）以及排便频率低（≥3天）有关（n = 638，P < 0.05）。持续时间>60分钟与口服泻药的使用有关（n = 444，P < 0.001）以及感觉功能完全丧失有关（n = 349，P < 0.05）。硬便与手动清除粪便有关（n = 64，P < 0.001）、手动清除粪便并结合手指刺激有关（n = 53，P < 0.001）以及排便时的坐姿有关（n = 494，P < 0.05）。软便（n = 341）与完全运动损伤有关（n = 443，P < 0.05）。
手动清除粪便与意外排便风险低和排便时间短相关。这些结果有助于改善SCI患者的肠道管理效果。
