术后早期活动在肝癌肝叶切除患者术后加速康复中的应用

Application of early postoperative activity on postoperative rehabilitation of patients with liver cancer undergoing liver resection

目的 探讨术后早期活动在肝癌肝叶切除患者术后加速康复中的应用效果.方法 选取2015年1月-2016年5月湖南省人民医院收治的行肝癌肝叶切除术的患者100例,采用随机数表法随机分为观察组52例和对照组48例.对照组实施常规术后活动方案,观察组采用术后早期活动方案,比较两组患者术后肠鸣音恢复时间、下床活动时间、首次排气排便时间及术后并发症的情况,并采用ADL评估比较两组患者手术前后日常生活自理能力.结果 观察组患者术后肠鸣音恢复时间为（55.26±2.63）h、下床活动时间为（64.43±3.37）h、首次排气时间为（73.78±3.10）h、首次排便时间为（123.43±6.46）h,均短于对照组,差异有统计学意义（t值分别为4.81、3.16、3.57、2.59,P〈0.05）;两组患者术后并发症的发生率差异无统计学意义（χ^2=2.53,P〉0.05）;重复测量方差分析结果显示,干预前后不同时间患者ADL评分差异有统计学意义（F时间=1598.85,P〈0.05）,观察组与对照组ADL评分差异有统计学意义（F组间=40.01,P〈0.05）,测量前后与干预之间存在交互作用（F交互=21.62,P〈0.05）.结论 肝癌肝叶切除患者术后加速康复过程中进行早期活动安全有效,能够加速患者胃肠道功能的恢复,提高其日常生活自理能力.

Objective To investigate the application effect of early postoperative activity on postoperative rehabilitation of patients with liver cancer undergoing liver resection.Methods A total of 100 liver cancer patients, having undergone liver resection in Hunan Provincial People＇s Hospital from January 2015 to May 2016, were divided according to random number table into observation group, with 52 cases and control group, with 48 cases. Patients in the control group were treated by conventional postoperative activity program, while patients in the observation group received early postoperative activity program. Recovery time of bowel sound, time to get out of bed, the first time of flatus, of defecation, and postoperative complications of the two groups were compared. The activity of daily living scale （ADL） was used to compare self-care ability of patients in the two groups.Results In the observation group, recovery time of bowel sound was （55.26±2.63） h, time to get out of bed was （64.43±3.37） h, the first time of flatus was （73.78±3.10） h, and the first time of defecation was （123.43±6.46） h, all shorter than that in the control group （t=4.81, 3.16, 3.57, 2.59;P〈0.05）; there was no significant difference in incidence of postoperative complications between the two groups （χ^2=2.53, P〉0.05）; it was shown in variance analysis of repeated measures that before and after the intervention, at different time points, ADL differences of all the patients were statistically significant （FTime=1598.85,P〈0.05）, ADL differences between the two groups were statistically significant （FInter-group=40.01,P〈0.05）, and interaction existed among measurement and intervention （FInteraction=21.62,P〈0.05）.Conclusions Early postoperative activity was safe and effective to patients having undergone open hepatic resection, which can accelerate recovery of gastrointestinal function and help patients recover their self-care ability.