术后早期活动在胃肠道肿瘤切除患者加速康复中的应用

The role of early ambulation in enhanced recovery after surgery protocol for gastrointestinal cancer patients

目的探讨术后早期活动在胃肠道肿瘤患者加速康复中的应用效果。方法选取济南军区总医院普外科2016年1月至2016年7月行腹腔镜胃肠道肿瘤切除患者48例,采用随机数表法随机分为试验组和对照组各24例。两组患者性别、年龄、文化程度、肿瘤类型、手术方式差异无统计学意义。对照组实施常规术后活动护理方案,试验组采用术后早期活动护理计划,比较两组患者首次排气时间、开始进食时间、术后住院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。结果试验组患者首次排气时间为(2.25±0.86)天、开始进食时间为(2.05±0.45)天、术后住院时间为(6.30±1.22)天,均短于对照组,差异有统计学意义(P<0.05);两组患者术后并发症的发生率差异无统计学意义(P>0.05);试验组患者日常生活活动能力(activities of daily living, ADL)评分高于对照组,差异有统计学意义(P<0.05)。结论术后早期活动在实施了加速康复外科围术期处理方案的胃肠道手术患者中安全有效,有利于肠蠕动的恢复,加快恢复经口进食,有助于患者自理能力的恢复,使其能早日回归家庭,减少住院天数。

Objective To evaluate the role of early ambulation in the enhanced recovery after surgery（ERAS） protocol for gastrointestinal cancer patients. Methods Forty-eight patients with gastric cancer or colorectal cancer who received laparoscopic surgery in our department were enrolled. They were divided into the experimental group and control group randomly（n=24）.There was no significant difference between the two groups in terms of gender,age,education level,tumor type and surgical method. ERAS protocol was performed in both groups. In the experimental group, early ambulation was emphasized under the guidance and supervision by nurse. Measures included the time of first postoperative flatus, the time of oral feeding, the length of stay, and postoperative complications. The ability of daily activity of patient was evaluated by the Activities of Daily Living （ADL） scale. Results The average time of first flatus,the time of beginning oral feeding and the average length of stay of the experimental group were （2.25 0.86）d, （2.05 0.45） d, （6.30 1.22） d respectively. All these three indices were less than those of the control group significantly. There is not any difference for the postoperative complication. The patients of experimental group possessed higher ADL score postoperatively （P〈0.05）. Conclusion Early postoperative ambulation is effectively in promoting the recovery of gastrointestinal cancer patients.