床上渐进康复运动训练促进直肠癌术后患者胃肠功能及营养状况改善的效果观察

Effect of gradual rehabilitation exercise on gastrointestinal function and nutritional status in patients with rectal cancer after surgery

目的观察开展床上渐进康复运动促进直肠癌保肛术后患者胃肠功能恢复及营养状态改善的效果。方法前期入组2016年1月至2017年12月于本院接受保肛手术的82例直肠癌患者为研究对象,随机分为观察组(n=41)和对照组(n=41),部分病例中途因故被剔除,两组最终纳入分析病例分别为38例、39例。对照组术后予常规护理,观察组在此基础上接受床上渐进康复运动训练。比较两组术后胃肠功能恢复情况、手术前后营养指标及免疫功能指标变化情况,及术后并发症发生情况。结果观察组术后首次肛门排气时间与排便时间、开始进食流质时间、术后平均住院时间均短于对照组,差异均有统计学意义(均P <0.05)。术前1 d,两组患者血红蛋白(Hb)、白蛋白(ALB)、前白蛋白(PRE)、转铁蛋白(TRF)、C反应蛋白(CRP)、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)水平比较,差异均无统计学意义(均P> 0.05)。出院前1 d,观察组Hb、ALB、PRE、TRF、IgG、IgM水平均高于对照组,CRP水平低于对照组,差异均有统计学意义(均P <0.05)。结论直肠癌保肛术后患者进行床上渐进康复运动有助于促进患者术后胃肠功能恢复,改善机体营养及免疫状态,对患者术后早期康复有益。

Objectives To investigate the effect of gradual rehabilitation exercise in bed on gastrointestinal function and nutritional status in patients with rectal cancer who underwent sphincter-preserving surgery. Methods In our previous work, there were 82 patients with rectal cancer treated in our hospital between January 2016 and December 2017 were recruited as study subjects and randomly divided into treatment group (n = 39) and control group (n = 39). Some cases were excluded due to some reasons and the final cases included in the analysis of the two groups were 38 cases and 39 cases, respectively. Patients in the control group received routine nursing, and patients in the treatment group received, in addition to routine nursing, gradual rehabilitation exercise in bed. We compared between the two groups recovery of gastrointestinal function, nutritional status before and after surgery, changes of indices of immune function, as well as incidence of complications. Results Time to first anal exhaust, time to first defecation, time to liquid intake, and duration of postoperative hospitalization were all significantly shorter in treatment group than in control group (P < 0.05). There was no significantly difference between the two groups in levels of hemoglobin (HB), albumin (ALB), prealbumin (PRE), transferrin (TRF), C-reactive protein (CRP), immunoglobulins M (IgM) and immunoglobulins G (IgG) 1 day before surgery (P > 0.05). Levels of HB, ALB, PRE, TRF, IgG, and IgM 1 day before discharge were all significantly higher and CRP level significantly lower in treatment group than in control group (P < 0.05). Conclusion Gradual rehabilitation exercise in bed could effectively promote recovery of gastrointestinal function, and improve nutritional status and immune function in patients who receive sphincter-preserving surgery for rectal cancer. It was beneficial for patients early recovery.