加速康复外科模式下结直肠癌患者术后早期下床活动现状及影响因素分析

Analysis of associated factors of early mobilization in colorectal cancer patients who underwent enhanced recovery after surgery pathway

目的了解加速康复外科(ERAS)模式下结直肠癌患者术后早期(术后24 h内)下床活动的现状并探讨其影响因素。方法便利取样,选取2020年2月至2021年6月期间四川大学华西医院胃肠外科收治的ERAS下结直肠癌手术患者为研究对象。通过问卷调研、查阅医院信息系统的方法收集患者的一般资料及围术期资料,通过床旁询问方式了解患者术后24 h下床活动情况。采用logistic回归方法分析ERAS下结直肠癌患者术后早期下床活动的影响因素。结果本研究共选取300例ERAS下结直肠癌手术患者,术后24 h内有47例患者下床活动,早期下床活动率为15.7%。logistic回归分析结果显示,术前无合并症(OR=2.726,P=0.019)、术前不存在营养风险(OR=3.621,P=0.013)及手术时间<3 h(OR=2.246,P=0.032)的患者增加其早期下床活动的几率,术前低白蛋白降低其早期下床活动的几率(OR=0.364,P=0.007)。结论 ERAS模式下结直肠癌患者术后早期下床活动率偏低,术前合并症、术前白蛋白水平、术前NRS2002评分以及手术时间是其重要影响因素。通过积极治疗术前合并症,改善患者术前营养状况,使患者以更好的身体状态承受后续的手术应激过程,有助于促进患者实现早期下床活动。

Objective To investigate the prevalence of early mobilization and it’s influencing factors in colorectal cancer patients who underwent enhanced recovery after surgery(ERAS) pathway. Methods The geneal data and perioperative data were collected through questionnaire survey and accessing to the hospital information system. The situation of early mobilization was investigated by bedside inquiry. Logistic regression was used to analyze the influencing factors of early mobilization in the patients with colorectal cancer. Results In this study, 300 patients with colorectal cancer underwent ERAS were selected. Within 24 h after operation, 47 patients got out of bed, the early mobilization rate was 15.7%. Logistic regression results showed that the patients without preoperative complications(OR=2.726, P=0.019)and without preoperative nutritional risk(OR=3.621, P=0.013), and with operation time <3 h(OR=2.246, P=0.032)increased the probability of early mobilization, and preoperative low albumin decreased the probability of early mobilization(OR=0.364, P=0.007). Conclusions Early mobilization rate of patients with colorectal cancer in ERAS mode is low. Preoperative complications, preoperative albumin level, preoperative NRS2002 score, and operation time were important influencing factors. Active treatment of preoperative complications and improvement of preoperative nutritional status could make patients bear follow-up stress process with better physical condition, which helps to promote early mobilization.