结直肠癌患者术后造口并发症的危险因素分析及针对性护理干预效果研究OA

Objective We aimed to identify independent risk factors associated with postoperative stoma complications in patients with colorectal cancer,construct a risk prediction model,and evaluate the impact of stratified,individualized nursing interven-tions on complication incidence and patient outcomes.Methods A prospective study was conducted in two stages.In the first stage,124 patients with colorectal cancer who underwent curative resection with stoma creation at our institution between February 2022 and June 2023 were enrolled.Patients were categorized into a complication group(n=42)and a non-complication group(n=82)based on the occurrence of stoma-related complications within 30 days postoperatively.Demographic characteristics,preoperative nutritional status,and surgery-related variables were collected.Variables with P<0.10 in univariate analysis were entered into a multi-variable logistic regression model to obtain the linear risk score,which was subsequently transformed into the predicted probability(P)through the logistic function.The model's discriminatory performance was evaluated using a receiver operating characteristic(ROC)curve based on the predicted probability.In the second stage,between July 2023 and May 2024,using the optimal cutoff value of P=0.60,a total of 45 high-risk patients were identified and randomly assigned to an individualized intervention group(n=22)or a rou-tine care group(n=23).The intervention group received a risk-stratified nursing pathway comprising preoperative stoma site marking and education,daily postoperative stoma assessment,targeted peristomal skin management,and structured remote follow-up after dis-charge.The control group received standard education and routine nursing care.Differences in 30-day postoperative stoma complica-tion rates,nursing satisfaction,and quality-of-life scores were compared between the two groups.Results The overall incidence of stoma-related complications within 30 days was 33.87%(42/124),with peristomal dermatitis being the most common(45.24%),fol-lowed by stoma retraction(26.19%)and stenosis(11.90%).Univariate analysis indicated significant associations between complica-tion occurrence and age,body mass index(BMI),preoperative albumin level,diabetes,absence of preoperative stoma site marking,time to first stoma bag change,and lack of follow-up by stoma care specialists(P<0.05).Multivariate logistic regression identified BMI≥27.5 kg/m²(OR=3.047),preoperative albumin<34.0 g/L(OR=2.674),lack of preoperative stoma site marking(OR=3.198),and delayed first bag change(>3 days)(OR=2.529)as independent risk factors for stoma-related complications in patients with colorectal cancer.The prediction model demonstrated good discriminatory power,with an AUC of 0.825(95%CI:0.743～0.907),a sensitivity of 73.8%,and a specificity of 78.0%.Among high-risk patients,the complication rate was significantly lower in the intervention group compared to the control group(13.64%vs.39.13%,P=0.042).Furthermore,the intervention group reported significantly higher nursing satisfaction scores(89.27±6.15 vs.82.13±7.04)and quality-of-life scores(84.91±5.36 vs.78.48±6.12),with all differences reaching statistical significance(P<0.05).Conclusion The development of postoperative stoma complica-tions in colorectal cancer patients is influenced by multiple factors.Elevated BMI,hypoalbuminemia,absence of preoperative stoma site marking,and delayed postoperative stoma care are key independent predictors.The risk prediction model shows high clinical appli-cability,and targeted nursing interventions based on risk stratification significantly reduce complication rates and improve patient satis-faction and quality of life.