老年直肠癌术前新辅助放化疗期间实施多模式预康复的研究

A study of multimodal prehabilitation program during neoadjuvant chemoradiotherapy for elderly patients with rectal cancer

目的:探讨预康复在老年直肠癌术前新辅助放化疗(nCRT)期间的应用效果。方法:采取同一纳入及排除标准,2016年1月至2018年12月n CRT后限期手术者作为对照组(n=50),2019年1月至2021年7月nCRT联合预康复后限期手术者作为实验组(n=48),比较围手术期指标。结果:两组手术时间、术中出血比较,差异无统计学意义(t=1.04,0.88,P> 0.05);与对照组相比,实验组术后下床、肛门排气、开始进食、拔除引流管时间提前,术后输液时间、住院时间及总费用降低(P <0.05);入院时两组运动、肺功能、白蛋白、PNI、心理评分无差异(P>0.05),但术前1d,术后30d,实验组运动、肺功能、白蛋白、PNI相较对照组,差异有统计学意义(P <0.05);术前1d及术后30d两组心理评分较入院好转,但组间差异无统计学意义(P> 0.05);实验组术后总并发症发生率低于对照组,多因素分析:术前低白蛋白、低FVC、高NRS 2002评分是术后并发症独立危险因素;术前营养支持,运动锻炼是并发症保护因素。结论:预康复改善病人功能状态,降低术后并发症,远期疗效尚需进一步观察。

Objective: To explore the potential effects of prehabilitation during neoadjuvant chemoradiotherapy(nCRT) for elderly patients with rectal cancer. Methods: According to the treatment method, 50 patients who underwent radical surgery after nCRT from January 2016 to December 2018 were selected as the control group, and a total of 48 consecutive patients undergoing radical surgery after nCRT combined with prehabilitation from January 2019to July 2021 were selected as the experimental group. The perioperative indicators were compared. Results: No statistically differences in operation time and intraoperative blood loss between two groups(t = 1.04, 0.88, P > 0.05);Compared with the control group, the experimental group had earlier times to get out of bed, pass flatus, start eating, and remove drainage tubes after surgery, and had reduced postoperative infusion time, hospital stay, and total costs(P <0.05). There was no difference in exercise, lung function, albumin, PNI, and psychological scores between the two groups at admission(P > 0.05), but on postoperative day 1 and day 30, the experimental group showed statistically significant improvements in exercise, lung function, albumin, and PNI compared to the control group(P < 0.05). The psychological scores of both group improved on day 1 before operation and day 30 after operation compared to admission, but there was no statistically significant difference between the groups(P > 0.05);The total incidence of postoperative complications in experimental group were lower than that in control group(P < 0.05). Multivariate analysis showed that low preoperative albumin, low FVC, and high NRS 2002 scores were independent risk factors for postoperative complications, while preoperative nutritional support and exercise were protective factors. Conclusion:Multimodal prehabilitation program seemed to have positive effects on improved exercise capacity, postoperative functional recovery. However, further observation is necessary to assess the long-term efficacy of this approach.