痔疮术后换药与护理优化策略临床实施效果研究

Study on the Clinical Implementation Effect of Dressing Change and Nursing Optimization Strategies after Hemorrhoid Surgery

摘要: 目的：通过文献回顾与临床研究，对我科痔疮术后患者实施换药与护理优化策略并探讨其临床效果。方法：本研究采用随机抽样法，选取2024年1月-2025年4月入住洛川县医院外科行痔切除术的患者作为研究对象。观察组实施换药与护理优化策略，对照组实施常规实施换药与护理，对比不同干预措施的临床效果：痔疮术后患者创面愈合时间、术后1、2、4周水肿发生率及排便时疼痛评分、随访术后4周患者满意度。采用SPSS 23.0软件统计分析，计数资料描述采用频数与构成比((n) %)，两组痔疮术后患者组间比较采用χ²检验；计量资料符合正态分布采用($\overline{X}\pm s$ )或M (P₂₅, P₇₅)描述，两组患者组间比较采用t检验或非参数检验；不同换药与护理方案的痔疮术后患者各时间节点疼痛评分比较采用重复测量方差分析；以P < 0.05为差异具有统计学意义。结果：本研究共纳入82例痔疮术后患者，对照组回顾性的收集了41例2024年1月~2024年8月在我院外科住院行痔疮手术的患者，其采用常规换药与护理措施；2024年9月~2025年4月在我院外科住院行痔疮手术的患者，作为观察组，实施换药与护理优化策略，纳入41例患者。实施换药与护理优化策略组的痔疮术后患者创面愈合时间平均为(15.69 ± 3.28)天，实施常规换药与护理的痔疮术后患者创面愈合时间平均为8 (17.21 ± 3.29)天，观察组患者创面愈合时间少于对照组(t = 2.151)，差异具有统计学意义(P < 0.05)。重复测量方差分析结果显示，实施换药与护理优化策略组的痔疮术后患者在术后1、2、3周排便时疼痛评分较换药与护理常规组低，差异具有统计学意义(P < 0.05)，不同换药与护理方案的痔疮术后患者术后2、3周水肿发生率较低，差异具有统计学意义(P < 0.05)，术后3周患者满意度提升。结论：实施痔疮术后换药与护理优化策略，可降低患者术后局部水肿发生率，减轻患者排便时疼痛。优化的换药与护理策略通过规范的清创操作、合理应用抗炎敷料，减少局部刺激，且优化策略中镇痛方案和患者教育模块(如呼吸放松训练、心理疏导)可能通过多维度调控疼痛感知，提高了患者的疼痛耐受性，以及结合术后科学护理(如坐浴、饮食管理)及生活习惯改善，以提升愈后效果，帮助患者恢复正常的肛门功能与生活质量，验证了优化策略在促进术后康复中的积极作用。

Abstract: Objective: Through literature review and clinical research, to implement dressing change and nursing optimization strategies for patients after hemorrhoid surgery in our department and explore their clinical effects. Method: This study adopted the random sampling method and selected patients who underwent hemorrhoidectomy in the surgical department of Luochuan County Hospital from January 2024 to April 2025 as the research subjects. The observation group implemented the dressing change and nursing optimization strategy, while the control group implemented the conventional dressing change and nursing. The clinical effects of different intervention measures were compared: the wound healing time of patients after hemorrhoid surgery, the incidence of edema at 1, 2, and 4 weeks after surgery, the pain score during defecation, and the satisfaction of patients at 4 weeks after follow-up. SPSS 23.0 software was used for statistical analysis. Frequency and composition ratio ((n) %) were used for description of count data. χ² test was used for comparison between the two groups of patients after hemorrhoid surgery. Measurement data conforming to the normal distribution were described as ($\overline{X}\pm s$ )or M (P₂₅, P₇₅), and t-tests or non-parametric tests were used for comparison between the two groups of patients. Repeated measures analysis of variance was used to compare the pain scores of patients after hemorrhoid surgery with different dressing changes and nursing regimens at each time point. P < 0.05 was considered statistically significant. Results: A total of 82 patients after hemorrhoid surgery were included in this study. The control group retrospectively collected 41 patients who were hospitalized in the surgery department of our hospital and underwent hemorrhoid surgery from January 2024 to August 2024. They received conventional dressing changes and nursing measures. From September 2024 to April 2025, patients who were hospitalized in the surgery department of our hospital and underwent hemorrhoid surgery were taken as the observation group. Strategies of dressing change and nursing optimization were implemented, and 41 patients were included. The average wound healing time of patients after hemorrhoid surgery in the group implementing the dressing change and nursing optimization strategy was (15.69 ± 3.28) days, and that of patients after hemorrhoid surgery implementing the conventional dressing change and nursing was 8 (17.21 ± 3.29) days. The wound healing time of patients in the observation group was less than that in the control group (t = 2.151). The difference was statistically significant (P < 0.05). The results of repeated measures analysis of variance showed that the pain scores of patients after hemorrhoid surgery in the group implementing dressing change and nursing optimization strategies during defecation at 1, 2, and 3 weeks after surgery were lower than those in the group implementing dressing change and conventional nursing, and the difference was statistically significant (P < 0.05). The incidence of edema at 2 and 3 weeks after surgery was lower in patients after hemorrhoid surgery with different dressing changes and nursing plans. The difference was statistically significant (P < 0.05), and the patient satisfaction improved 3 weeks after the operation. Conclusion: The implementation of dressing change and nursing optimization strategies after hemorrhoid surgery can reduce the incidence of local edema in patients after surgery and alleviate the pain during defecation. The optimized dressing change and nursing strategies reduce local irritation through standardized debridement operations and rational application of anti-inflammatory dressings. Moreover, the analgesia program and patient education modules (such as breathing relaxation training and psychological counseling) in the optimized strategies may improve patients' pain tolerance by multi-dimensionally regulating pain perception. Combined with postoperative scientific care (such as sitz baths and diet management) and improvement of living habits to enhance the prognosis, help patients restore normal anal function and quality of life, the positive role of the optimization strategy in promoting postoperative recovery has been verified.