Stomal Therapy Nursing, Stomal Therapy Department, Prince of Wales Hospital, Sydney, New South Wales, Australia.
J Wound Ostomy Continence Nurs. 2012 Sep-Oct;39(5):524-8. doi: 10.1097/WON.0b013e3182648cc9.
We compared a standardized postoperative laxative protocol to laxatives provided on an ad hoc basis by the surgical team.
Forty-five patients who underwent colostomy surgery participated in the study. The research setting was 2 acute care facilities in south-eastern Sydney, New South Wales, Australia.
A randomized controlled trial was conducted. The intervention group (n 5 19) received a standardized laxative protocol postsurgery. Two types of laxatives were selected for first-line treatment: sterculia and frangula bark (Normacol Plus), a bulking agent and stimulant; and liquid paraffin (Agarol), a stool softener. An iso-osmotic polyethylene glycol macrogel (Movicol) was chosen as second-line treatment. The comparison group (n = 26) received laxative intervention(s) as preferred by the surgical team. Constipation, measured as fecal loading on plain abdominal film, stomal therapy nurse activity, patient comfort, and length of hospital stay were compared between intervention and control groups.
The presence of fecal loading favored the intervention group (1 episode in the treatment group vs 7 episodes in the comparison group; χ5 = 3.8; P = .05). This finding suggests that the laxative protocol given to the treatment group was more likely to prevent fecal loading/constipation when compared to the ad hoc laxative group. Stomal therapy nurse activity in terms of the number of empty bag changes was significantly higher in the comparison group (F 5 4.8; P 5 .03).
The findings of this study support the benefits of a standardized laxative protocol for prevention of constipation. Data collection was discontinued after 3 years due to a contamination effect developing, because our surgeons observed the utility of the laxative protocol and incorporated it into their routine practice. Further experimental research is needed to explore the best constipation prevention approaches for postcolostomy surgery patients.
我们比较了标准化术后通便方案与手术团队按需提供的通便剂。
45 名接受结肠造口术的患者参与了这项研究。研究地点是澳大利亚新南威尔士州东南部悉尼的 2 个急性护理机构。
进行了一项随机对照试验。干预组（n=19）术后接受标准化通便方案。选择了两种类型的通便剂作为一线治疗：洋槐树胶和鼠李皮（Normacol Plus），一种膨松剂和刺激剂；以及液体石蜡（Agarol），一种大便软化剂。选择等渗聚乙二醇大凝胶（Movicol）作为二线治疗。对照组（n=26）接受手术团队首选的通便干预措施。比较干预组和对照组之间的便秘情况（通过腹部平片上的粪便负荷来衡量）、造口治疗护士的活动、患者舒适度和住院时间。
粪便负荷情况有利于干预组（治疗组 1 例，对照组 7 例；χ5=3.8；P=0.05）。这一发现表明，与按需使用通便剂的对照组相比，给予治疗组的通便方案更有可能预防粪便负荷/便秘。对照组造口治疗护士更换空袋的次数明显更高（F5=4.8；P=0.03）。
这项研究的结果支持使用标准化通便方案预防便秘的益处。由于我们的外科医生观察到通便方案的实用性并将其纳入常规实践，因此在 3 年后因出现污染效应而停止了数据收集。需要进一步的实验研究来探索预防结肠造口术后患者便秘的最佳方法。
