摘要
目的 探讨以家庭管理为中心的换药模式在低位单纯性肛瘘切除术后患者创面愈合中的价值.方法 纳入2022年6月至2022年12月在中山大学附属第六医院肛肠外科行肛瘘切除术的64例低位单纯性肛瘘患者作为研究对象.入组患者术后在院期间每日常规换药,出院后患者自行选择换药模式.根据患者出院后换药模式,将入组患者分为来院换药组(n=32)、居家换药组(n=32).通过病历回顾及调查问卷采集患者相关资料,包含3个部分.第1部分为患者的一般情况,包括性别、年龄、文化程度、吸烟史、饮酒史.第2部分为疾病相关情况,包括肛瘘内口位置、病程、创面面积、瘘管类型(括约肌间型、经括约肌型).第3部分为出院后创面换药情况及术后情况,包括换药模式(居家换药、来院换药)、频率,创面愈合时间,换药及复查相关费用情况,复发情况,术后2周创面疼痛情况,术后2周焦虑情况,以及创面完全愈合后的患者满意度情况.结果 两组均无饮酒病例.两组性别、年龄、文化程度、吸烟情况比较差异无统计学意义(P＞0.05).两组肛瘘内口位置、病程、创面面积、瘘管类型比较差异无统计学意义(P＞0.05).居家换药组的换药及复查相关费用更少,视觉模拟疼痛评分更低,差异有统计学意义(P＜0.05);两组创面愈合时间、复发情况、广泛性焦虑量表评分及患者满意度评分比较差异无统计学意义(P＞0.05).结论 以家庭管理为中心的换药模式在低位单纯性肛瘘切除术后创面愈合中具有一定的价值,在不影响创面愈合时间的同时,可减少患者经济支出,节约医疗资源,减轻患者的创面疼痛程度.
Abstract
Objectives To investigate the value of home-centered dressing change model in wound healing after low simple anal fistulectomy.Methods Total of the sixty-four patients with low simple anal fistula who underwent fistulec-tomy at the Department of Anorectal Surgery,The Sixth Affiliated Hospital of Sun Yat-sen University from June 2022 to December 2022 were included as the study subjects.Patients were given routine daily dressing changes during hospital-ization after surgery,and patients were allowed to choose their own dressing change model after discharge.Based on the dressing change model after discharge,patients were divided into the hospital dressing change group(n=32)and the home dressing change group(n=32).Relevant patient data were collected through medical record review and ques-tionnaires,including three parts.The first part was patients'general conditions,including gender,age,education level,smoking history,and alcohol consumption history.The second part was disease-related conditions,including the location of the internal opening of the anal fistula,disease duration,wound area,and fistula type(intersphincteric or transsphinc-teric).The third part was post-discharge wound dressing change and post-operative conditions,including dressing change model(home dressing change or hospital dressing change)and frequency,wound healing time,costs related to dressing changes and follow-up,recurrence,wound pain at 2 weeks post-operation,anxiety at 2 weeks post-operation,and patient satisfaction after complete wound healing.Results There were no alcohol consumption cases in either group.There were no significant differences in gender,age,education level,and smoking status between the two groups(P＞0.05).There were no significant differences in the location of the internal opening of the anal fistula,disease duration,wound area,and fistula type between the two groups(P＞0.05).The home dressing change group had lower costs related to dressing changes and follow-up and lower visual analogue scale pain scores,with statistically significant differences(P＜0.05).There were no significant differences in wound healing time,recurrence,generalized anxiety disorder-7 scale scores,and patient satisfaction scores between the two groups(P＞0.05).Conclusion The home-centered dressing change model has certain value in wound healing after low simple anal fistulectomy.It can reduce patients'economic ex-penditure,save medical resources,and alleviate wound pain without affecting wound healing time.
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