ERAS理念下个体化生物反馈训练对老年低位直肠癌保肛术后患者康复的影响

Effect of individualized biofeedback training under the ERAS concept on the rehabilitation in elderly patients with low rectal cancer after anus-preserving surgery

目的探讨加速康复外科(ERAS)理念下个体化生物反馈训练对老年低位直肠癌保肛术后患者肛门括约肌功能及排便功能的影响。方法回顾性分析方法将河南省人民医院消化内科2017年8月至2020年8月期间149例保肛术后老年低位直肠癌患者为研究对象,按照组间基线资料匹配原则分为对照组(74例)和观察组(75例)。对照组男44例、女30例,年龄(65.28±2.63)岁,给予围术期常规传统护理干预;观察组男46例、女29例,年龄(65.31±3.01)岁,给予ERAS理念下的个体化生物反馈训练。观察两组术后恢复情况、肛门括约肌功能、肛门排便功能及并发症情况。计数资料采用χ^(2)检验,等级资料采用秩和检验,计量资料采用t检验。结果观察组术后首次肛门排气时间、进食时间、下床活动时间和住院时间分别为(2.23±0.65)d、(4.03±1.01)d、(2.62±0.24)d、(8.26±2.01)d,均短于对照组(3.32±1.02)d、(6.01±1.26)d、(3.69±0.35)d、(12.25±3.24)d,差异均有统计学意义(t=7.757、10.575、21.736、9.019,均P<0.05)。干预后,观察组肛门最大收缩压、静息压、肛门收缩向量容积、肛门静息向量容积分别为(145.96±29.35)mmHg(1 mmHg=0.133 kPa)、(60.69±8.68)mmHg、(62531.26±1112.24)cm×mmHg^(2)、(563.69±35.68)cm×mmHg^(2),均大于对照组(131.01±28.01)mmHg、(55.23±9.86)mmHg、(58632.14±655.32)cm×mmHg^(2)、(459.69±32.62)cm×mmHg^(2),差异均有统计学意义(t=3.181、3.586、26.112、18.573,均P<0.05)。观察组肛门排便功能优于对照组(Z=2.365,P<0.05)。观察组并发症发生率为2.67%(2/75),低于对照组12.16%(9/74),差异有统计学意义(χ^(2)=4.912,P=0.027)。结论ERAS理念下个体化生物反馈训练可通过调节老年低位直肠癌保肛术后患者肛门括约肌功能,改善排便功能,降低术后并发症,促使术后快速康复。

Objective To investigate the effect of individualized biofeedback training under the concept of enhanced recovery after surgery(ERAS)on the anal sphincter function and defecation function in elderly patients with low rectal cancer after anus-preserving surgery.Methods According to the matching principle of baseline data between groups,149 elderly patients with low rectal cancer who underwent anus-preserving surgery in Department of Gastroenterology,Henan Provincial People's Hospital from August 2017 to August 2020 were divided into two groups.There were 44 males and 30 females in the control group,aged(65.28±2.63)years;there were 46 males and 29 females in the observation group,aged(65.31±3.01)years.The control group was given routine perioperative nursing intervention,and the observation group was given individualized biofeedback training under the ERAS concept.The postoperative recovery,anal sphincter function,anal defecation function,and complications were observed in the two groups.χ^(2)test was used for the count data,rank sum test was used for the grade data,and t test was used for the measurement data.Results The time of first anal exhaust,feeding time,time of out-of-bed ambulation,and hospital stay in the observation group were(2.23±0.65)d,(4.03±1.01)d,(2.62±0.24)d,and(8.26±2.01)d,respectively,which were all shorter than those in the control group[(3.32±1.02)d,(6.01±1.26)d,(3.69±0.35)d,and(12.25±3.24)d],with statistically significant differences(t=7.757,10.575,21.736,and 9.019;all P<0.05).After the intervention,the maximum anal systolic pressure,resting pressure,anal contraction vector volume,and anal resting vector volume of the observation group were(145.96±29.35)mmHg(1 mmHg=0.133 kPa),(60.69±8.68)mmHg,(62531.26±1112.24)cm×mmHg^(2),and(563.69±35.68)cm×mmHg^(2),which were all higher than those of the control group[(131.01±28.01)mmHg,(55.23±9.86)mmHg,(58632.14±655.32)cm×mmHg^(2),and(459.69±32.62)cm×mmHg^(2)],with statistically significant differences(t=3.181,3.586,26.112,and 18.573;all P<0.05).The anal defecation function of the observation group was better than that of the control group(Z=2.365,P<0.05).The incidence of complications in the observation group was 2.67%(2/75),which was lower than that in the control group[12.16%(9/74)],with a statistically significant difference(χ^(2)=4.912,P=0.027).Conclusion Individualized biofeedback training under the ERAS concept can adjust the anal sphincter function in elderly patients with low rectal cancer after anus-preserving surgery,improve the defecation function,reduce the postoperative complications,and promote the rapid postoperative recovery.