運用造口貼袋改善一位結腸癌病人傷造口潮溼性皮膚炎與惡臭之經驗

Experience of Using the Application of Stoma Bag to Improve One Colon Ostmate's Peristomal Skin of Moisture-Associated Dermatitis and Odor Problems

10.6537/TJHPC.202103_25(2).06

吳美鳳(Mei-Feng Wu)；王虹(Hung Wang)

結腸癌 ； 潮溼性相關皮膚損傷 ； 腸造口 ； 惡臭 ； 傷口照護 ； colon cancer ； moisture-associated skin damage(MASD) ； stoma ； malodor ； wound care

安寧療護雜誌

25卷2期（2021 / 03 / 01）

173 - 187

繁體中文

臨床中面對病人傷口造口大量異味滲液，若無法有效控管，易導致潮溼性相關皮膚損傷，不僅護理人員疲於奔命更換傷口、造口敷料，同時也影響病人的生活品質，讓醫護人員倍感挑戰。本文描述一位結腸癌末期病人，複雜性傷口與空腸排泄造口大量臭味滲液，造成腹部皮膚廣泛性糜爛，同時遭受傷口及空腸排泄造口困難貼袋，住院過程護、病皆心力交瘁。筆者經由跨團隊討論，統整國內外文獻及臨床經驗，掌握敷料與造口袋特色，採取漢堡式堆疊貼袋技巧，改變傳統傷口、造口護理模式，有效收集傷口、造口滲液，控管惡臭味，進而恢復其皮膚完整性，提升護理品質與病人生活品質，最終讓亡者無憾，生者無怨。

In the clinic, if we cannot effectively control a large amount of peculiar odor exudate from the wound of the patient's stoma, it will lead to moisture-associated skin damage (MASD) easily. Once skin damage occurs, the nursing staff must be exhausted to change the wound and stoma dressing, also reduce the quality of life of patients, so it does make the medical staff felt challenging. This article describes one advanced colon cancer patient who had complicated wounds and a large amount of odorous exudate from the jejunum excretion stoma, which caused extensive erosion of the abdominal skin. At the same time, she suffered from the difficult ostomy bag change to the wound and jejunum excretion stoma, medical staff and patients were exhausted during the hospitalization. The author through inter-professional collaborative discussion, the integrated domestic and foreign literatures, and clinical experiences to master the characteristics of dressings and ostomy bags in adopting the Hamburg- stacking patch ostomy bag technique, changed the traditional wound and stoma care model, effectively collected wounds and stoma exudate, also reduced malodor, and then recovered the integrity of the skin. Improving the quality of care and the quality of life of patients, thus the dying patient, families and friends will have no regrets.

1. 吳唯萱,潘采玟,游馥蓮(2020)。乳癌個案面臨身體心像改變之護理經驗。彰化護理，27(1)，107-118。
   連結：
2. Ambe, PC,Kurz, NR,Nitschke, C,Odeh, SF,Möslein, G,Zirngibl, H(2018).Intestinal ostomy: classification, indications, ostomy care and complication management.Dtsch Arztebl Int,115(11),182-187.
3. Colwell, JC,McNichol, L,Boarini, J.(2017).North America wound, ostomy, and continence and enterostomal therapy nurses current ostomy care practice related to peristomal skin issues.JWOCN,44(3),257-261.
4. David, V.(2019).Prevention and management of moisture-associated skin damage.Nurs Stand,34(2),77-82.
5. Dozois, EJ,Boardman, LA,Suwanthanma, W(2008).Young-onset colorectal cancer in patients with no known genetic predisposition: can we increase early recognition and improve outcome?.Medicine,87(5),259-263.
6. Harries, Rhiannon L,Bosanquet, David C,Harding, Keith G.(2016).Wound bed preparation: TIME for an update.Int Wound J,13(3),8-14.
7. Hendren, S,Hammond, K,Glasgow, SC(2015).Clinical practice guidelines for ostomy surgery.Dis Colon Rectum,58(4),375-387.
8. Ladabaum, U,Mannalithara, A,Meester, RG,Gupta, S,Schoen, RE(2019).Cost-effectiveness and national effects of initiating colorectal cancer screening for average-risk persons at age 45 years instead of 50 years.Gastroenterology,157(1),137-148.
9. Miyazaki, Y,Asano, M,Uchino, T(2019).Development of a Breathable Protective Ointment for Moisture-associated Skin Damage.Yakugaku zasshi: JPSJ,139(10),1281-1284.
10. Novak-Bilić, G,Vučić, M,Japundžić, I,Meštrović-Štefekov, J,Stanić-Duktaj, S,Lugović-Mihić, L(2018).Irritant and allergic contact dermatitis–skin lesion characteristics.Acta Clin Croat,57(4),713-719.
11. Park, S,Lee, YJ,Oh, DN,Kim, J(2011).Comparison of standardized peristomal skin care and crusting technique in prevention of peristomal skin problems in ostomy patients.JKAN,41(6),814-820.
12. Qaseem, A,Crandall, CJ,Mustafa, RA,Hicks, LA,Wilt, TJ(2019).Screening for colorectal cancer in asymptomatic average-risk adults: a guidance statement from the American College of Physicians.Ann Intern Med,171(9),643-654.
13. Samala, RV,Davis, MP(2015).Comprehensive wound malodor management: Win the RACE.Cleve Clin J Med,82(8),535-543.
14. Suwanabol, PA,Hardiman, KM(2018).Prevention and Management of Colostomy Complications: Retraction and Stenosis.Dis Colon Rectum,61(12),1344-1347.
15. Woo, KY,Beeckman, D,Chakravarthy, D(2017).Management of moisture-associated skin damage: a scoping review.Adv Skin Wound Care,30(11),494-501.
16. Woodward, S.(2019).Moisture-associated skin damage: use of a skin protectant containing manuka honey.Br J Nurs,28(6),329-335.
17. World Cancer Research Fund International. Colorectal cancer statistics. Available at: https://www.wcrf.org/dietandcancer/cancer-trends/worldwide-cancer-data. Accessed September 21, 2020.
18. 李豔麗(2019)。“TIME＂原則應用於腹部感染傷口護理的臨床效果分析。世界最新醫學資訊文摘，41，202。
19. 衛生福利部國民健康署。中華民國 106 年癌症登記報告。2020 年 8 月 25 日，取自https://dep.mohw.gov.tw/DOS/np-1714-113.html 發布日：2020/6/2

1. 高廷瑜,邱婉婷(2023)。透過臨床護理教學經驗－照護一位卵巢癌合併腹壁轉移之病人。安寧療護雜誌，27(2)，167-180。