摘要
背景：造口旁疝或膨出是一种长期公认的造口并发症。约有一半的患者会出现造口旁膨出，多达 75% 的患者会出现症状。只有少数患者可接受手术治疗；因此，大多数患者可自行或通过造口护理护士提供的干预措施来处理隆起：目的：确定并介绍有关护理干预治疗造口旁膨出症状的现有信息：方法：本范围综述遵循乔安娜-布里格斯研究所（Joanna Briggs Institute）的框架，在 11 个数据库中进行检索，并通过造口组织进行检索。纳入了有关造口旁膨出护理管理的文献。两位作者独立筛选研究，其中一位作者绘制数据图表，另一位作者进行核实。PAGER 框架描述了证据的状况，PRISMA-ScR 检查表则指导了整个过程：在筛选出的 8361 篇文献中，44 篇被纳入。对腹股沟旁膨出及相关症状的处理在以下八种护理干预措施中有所描述：器具、支撑衣、大便冲洗和调节、绞窄、伪装和亲密接触、体育活动、支持和教育、记录保存、随访和转诊。大多数证据基于专家意见，只有 ⅓ 的论文采用了研究设计，如横断面、定性、回顾、前后研究、德尔菲和 RCT：本范围综述强调了对腹膜旁膨出进行护理干预的复杂性。它表明，一种干预措施可以处理多种症状，并可能同时处理多种症状，而处理一种症状可能需要多种干预措施。因此，必须根据问题的根本原因来决定干预措施。由于有关护理干预效果的研究数量有限，今后需要进行更严格的研究：研究结果可作为临床实践的启发性指导。Background: Parastomal hernia or bulging is a long-recognised complication in relation to a stoma. Around half of patients develop a parastomal bulge and up to 75% experience symptoms. Only a minority is offered surgical treatment; thus, most patients manage the bulge on their own or by interventions provided by stoma care nurses.
Aims and objectives: To identify and present the available information on nursing interventions for the management of symptoms caused by the parastomal bulge.
Methods: This scoping review followed the framework by the Joanna Briggs Institute, conducting searches in 11 databases and through stoma organisations. Literature on nursing management of parastomal bulges was included. Two authors independently screened and selected the studies, with data-charting performed by one author and verified by another. The PAGER framework depicted the state of the evidence and the PRISMA-ScR checklist guided the process.
Results: Of 8361 screened publications, 44 were included. Management of the parastomal bulge and related symptoms were described in eight nursing interventions: appliances, support garments, irrigation and regulation of stool, strangulation, disguise and intimacy, physical activity, support and education, record keeping, follow-up and referral. Most evidence was based on expert opinion with only ⅓ of papers using study designs, such as cross-sectional, qualitative, review, before and after study, Delphi and RCT.
Conclusion: This scoping review highlights the complexity of providing nursing interventions for parastomal bulging. It shows that one intervention can manage multiple symptoms and potentially several symptoms simultaneously, whereas several interventions may be needed to address a single symptom. Therefore, decisions on interventions must be based on the underlying cause of the problem. Due to the limited number of studies on the effects of nursing interventions, more rigorous research is needed in the future.
Relevance to clinical practice: The results can be used as an inspirational guide for clinical practice.
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