目的 探讨基于“替代搜寻”的延续护理模式的应用效果，以期为改善农村老年肠造口患者家庭护理质量提供健康管理模式。 方法 采用便利抽样选取2021年10-12月某院收治的结直肠癌行永久性造口术的患者40例患者为对照组，同法选择2022年1-3月收治的同类患者40例及其1名主要照顾家属为观察组。分别给予常规延续护理和基于“替代搜寻”的延续护理。比较两组患者出院前及出院后3个月的生存质量、自我护理能力、焦虑状态， 并比较出院3个月后两组患者造口并发症的发生情况以及观察组替代者（家属）电子健康素养情况。 结果 出院3个月后，两组患者总体健康状况、自护能力及焦虑情况均优于出院前，差异均有统计学意义（均P＜0.05）；且观察组的总体健康状况、自我护理能力得分均高于对照组[(65.68±7.52）分 vs. (61.43±7.00）分；（117.55±9.07）分 vs. （98.45±9.40）分] ，焦虑评分及造口并发症的发生低于对照组[（46.50±5.94）分 vs. （54.85±6.89）分；7.5% vs. 25.0%]，差异均有统计学意义（均P＜0.05）；替代者电子健康素养评分有明显提升[（24.20±4.09）分 vs. (18.90±4.62）分]，与出院前相比，差异亦有统计学意义（P＜0.05）。 结论 基于“替代搜寻”的延续护理模式可提高出院指导质量，改善患者生存质量和心理状态，提升患者自我护理能力，降低肠造口并发症发生率。

Objective To explore the application effect of continuing care model based on “proxy search”,and to provide a health management model for improving the quality of family care for the elderly patients with enterostomy in rural areas. Methods A total of 40 colorectal cancer patients with permanent enterostomy admitted to a hospital from October to December 2021 were selected into the control group by convenience sampling,and 40 patients of the same type admitted from January to March 2022 and one of their main caregivers were selected into the observation group.Conventional continuing care and continuing care based on “proxy search” were given to the 2 groups,respectively.The quality of life, self-care ability and anxiety before and 3 months after discharge were compared between the two groups.The incidence of ostomy complications between the two groups and the electronic health literacy of substitutes (family members) in the observation group were compared after 3 months of discharge. Results Three months after discharge, the overall health status, self-care ability and anxiety of the two groups were better than before discharge, the differences were statistically significant (all P＜0.05).The overall health status and self-care ability scores of the observation group were higher than those of the control group[(65.68±7.52) points vs. (61.43±7.00) points;(117.55±9.07) points vs. (98.45±9.40) points].The anxiety score and the incidence of ostomy complications were lower than those in the control group[(46.50±5.94) points vs. (54.85±6.89) points;7.5% vs. 25%].The differences were statistically significant(all P＜0.05).The electronic health literacy score of the substitute was significantly improved[(24.20±4.09) points vs. (18.90±4.62) points].The difference was also statistically significant compared with before discharge(P＜0.05). Conclusions The continuing care model based on “proxy search” can improve the quality of discharge guidance,improve the quality of life and psychological state of patients,enhance patients’ self-care ability,and reduce the incidence of enterostomy complications.

R473.2；R473.73

国家社科基金一般项目（20BKS009）