关键词: 结核, 脊柱/外科学, 腰椎, 排便, 围手术期护理

Abstract: Objective To compare the effects of two nursing methods of defecation by using the disposable plastic bag and the ordinary bedpan respectively among the patients with lumbar tuberculosis (TB) during the perioperative period. Methods From January 2012 to June 2013, a total of 160 patients with lumbar TB and received internal fixation operation were recruited in the study. Those patients were randomly divided into two groups according to the odd number and even number with the patients’ ID number and the two different nursing cares of de-fecation were respectively used for the patients in each group: disposable plastic bag was used for 80 patients in one group and ordinary bedpan was used for another 80 patients in the other group. The following variables were evaluated and compared between the two groups byχ² test: degree of comfort, taking care independently, exposure of pe-rineum, clothing contamination and convenience of disposal. The degree of the low back pain was graded on a scale of 10 based on the NPRS: 0=no pain, 1-3=little pain; 4-6=moderate pain, 7-10=painful. The degree of skin damage was graded by 3 levels: normal, reddening and bruising. The Wilcoxon rank-sum test was used to compare the degree of the low back pain and the skin damage between the two groups. A P-value of <0.05 was regarded as statistically significant difference.  Results The rates of patients who felt comfortable, could manage independently and conveniently were 72.50% (174/240), 44.17% (106/240) and 95.00% (228/240) respectively in the disposable plastic bag group, which were much higher than the rates in the bedpan group (14.47% (33/228), 18.42% (42/228) and 8.33% (19/228)). The difference had statistic significant (χ²=159.60, 35.84 and 352.38, P<0.001). The rates of perineum exposure and clothing contamination were 29.58% (71/240) and 12.08% (29/240) respectively in the disposable plastic bag group, which were lower than that in the bedpan group (81.14% (185/228) and 26.32% (60/228)). The difference had statistic significant (χ²=125.43 and 15.38, P<0.001). In the disposable plastic bag group, the number of patients who did not feel lower back pain was 138 person-times, which was significantly higher than that in the bedpan group (33 person-times only; Z=-9.16, P<0.001). The number of patients without buttock skin damage after defecation was 227 person-times in the disposable plastic bag group, which was significantly higher than that in the bedpan group (156 person-times; Z=-8.10, P<0.001).  Conclusion The nursing of defecation by using the disposable plastic bag can reduce the low back pain and buttock skin damage of the patients with lumbar TB during the perioperative period; it also makes the patients to feel more comfortable and dignified, to improve the patient’s self-management capacity and reduce the workload of paramedic. It is a good perioperative nursing method for the patients with lumbar TB.

Key words: Tuberculosis, spinal/surgery, Lumbar vertebrae, Defecation, Perioperative nursing