加速康复外科理念下结直肠癌根治术后病人早期活动方案的构建及应用

Construction and application of early activity plan for patients undergoing colorectal carcinoma radical surgery under concept of enhanced recovery after surgery

目的:构建加速康复外科理念下结直肠癌根治术后病人早期活动方案,探讨其临床应用效果。方法:选择2019年10月—2020年9月在我科住院行腹腔镜下结直肠癌根治术的93例病人作为研究对象,采用随机数字表法将病人分为观察组(46例)和对照组(47例),对照组采用加速康复外科理念进行治疗、护理,观察组在对照组基础上通过检索数据库和2轮德尔菲专家函询,构建结直肠癌根治术后病人早期活动方案并实施。观察并记录病人术后首次下床活动时间、首次排气排便时间、术后24 h下床活动率、术后住院时间、活动不良事件发生率、病人活动步数、活动距离、睡眠时长、舒适状况、疼痛情况、情绪状态。结果:最终形成包括2项一级条目、7项二级条目、23项三级条目的结直肠癌根治术后病人早期活动方案。观察组病人首次下床活动时间、首次排气时间、首次排便时间、术后住院时间短于对照组(P<0.001),术后24 h下床活动率高于对照组(P<0.001)。病人术后不同时间活动步数、活动距离、睡眠时长、视觉模拟评分法(VAS)得分、Kolcaba舒适状况量表(GCQ)得分差异有统计学意义(P<0.001),两组病人活动步数、活动距离、睡眠时长、VAS得分、GCQ得分差异有统计学意义(P<0.001),两组病人不同时间活动步数、活动距离、睡眠时长、VAS得分、GCQ得分变化幅度不同(P<0.001)。干预后,两组病人焦虑自评量表(SAS)得分和抑郁自评量表(SDS)得分比较,差异有统计学意义(P<0.001)。两组病人活动不良事件发生率比较,差异无统计学意义(P=0.242)。结论:构建的结直肠癌根治术后病人早期活动方案有利于加快结直肠癌病人术后早期康复,提高病人活动依从性,促进病人安全、康复。

Objective:To construct early activity plan for patients undergoing colorectal cancer radical surgery under concept of enhanced recovery after surgery,and to explore its clinical application effects.Methods:There were 93 patients undergoing laparoscopic radical resection of colorectal carcinoma radical surgery in our department from October 2019 to September 2020,who were selected as research subjects.The patients were divided into observation group with 46 cases and control group with 47 cases by random number table method.The control group were treated and nursed under the guidance of concept of enhanced recovery after surgery,and the observation group carried out early activity plan for patients undergoing colorectal carcinoma radical surgery based on control group.The plan was constructed by retrieving database and conducting two rounds of Delphi expert correspondence.To observe and record the first time to get out of bed after operation,the first time to exhaust and defecate,the rate of getting out of bed in 24 hours after operation,the time to stay at hospital after operation,the incidence of adverse events,the number of patient steps,the distance of activity,the time of sleep,and comfort condition,pain and emotional state of patients.Results:The final early activity plan for patients undergoing colorectal carcinoma radical surgery included 2 first⁃level items,7 second⁃level items,23 third⁃level items.The first time to get out of bed,the first time to exhaust,the first time to defecation,and the time to stay at hospital after operation in observation group were shorter than those of control group(P<0.001),and the rate of getting out of bed 24 hours after operation of observation group was higher than that of control group(P<0.001).The number of patient steps,the distance of activity,the time of sleep,the scores of Visual Analogue Scale(VAS)and Kolcaba General Comfort Questionnaire(GCQ)were statistically significant among the patients at different times after operation(P<0.001).The variation ranges of number of patient steps,the distance of activity,the time of sleep,the scores of VAS and GCQ were statistically significant(P<0.001)between patients in two groups(P<0.001).The variation ranges of number of patient steps,the distance of activity,the time of sleep,the scores of VAS and GCQ were statistically significant between two groups at different times(P<0.001).After intervention,there were statistically significant differences in the scores of Self⁃Rating Anxiety Scale(SAS)and the Self⁃Rating Depression Scale(SDS)between two groups(P<0.001).The difference of incidence of adverse events was not statistically significant(P=0.242)between two groups.Conclusions:The constructed early activity plan for patients undergoing colorectal cancer radical surgery could be beneficial to speed up early recovery of patients undergoing colorectal cancer radical surgery,improve patient compliance with activities,and promote patient safety.