三联预康复护理策略在腹腔镜胃癌根治术患者中的应用效果

Application effect study of three mode pre-rehabilitation nursing strategy in laparoscopic radical gastrectomy for gastric cancer

目的探讨三联预康复策略在腹腔镜胃癌根治术患者围手术期的应用效果,及其对患者术后身体功能状态恢复及生命质量的影响。方法采用方便抽样法选取2019年1月至2020年9月在安徽医科大学第二附属医院96例择期行腹腔镜辅助胃癌根治术患者,采用随机数字表法分为对照组与观察组各48例,研究中对照组剔除2例。2组均接受胃癌腹腔镜手术常规围手术期管理,观察组在常规围手术期管理的基础上,在手术等待期启动为期6~8 d的三联预康复训练。比较2组围手术期指标、并发症发生情况,干预前后测量并比较2组的36项健康调查简表(SF-36)评分。结果观察组术后首次排气时间、首次下床活动时间、首次经口进食时间、住院时间分别为(61.49±6.71)h、(19.54±6.13)h、(71.23±6.79)d、(5.62±1.03)d,均低于对照组的(79.21±8.15)h、(22.95±7.19)h、(78.95±7.21)d、(6.64±1.17)d,差异有统计学意义(t值为2.48~11.53,均P<0.05)。观察组术后并发症发生率为6.25%(3/48),低于对照组的21.74%(10/46),差异有统计学意义(χ^(2)=8.72,P<0.05)。术前1 d、术后30 d,观察组SF-36评为(68.74±8.02)、(65.85±7.44)分,高于对照组的(60.73±7.43)、(61.04±6.85)分,差异有统计学意义(t=5.02、3.26,均P<0.05)。结论胃癌患者术前应用三联预康复策略有利于改善患者运动、营养及免疫功能状态,加速术后胃肠功能及整体康复,降低术后并发症发生率并提高患者的生命质量。

Objective To explore the application effect of three mode pre-rehabilitation strategy in gastric cancer patients after laparoscopic radical operation and its effect on the recovery of physical function and quality of life after operation.Methods Totally 96 patients undergoing elective laparoscopic-assisted radical gastric cancer surgery admitted in the Second Affiliated Hospital of Anhui Medical University from January 2019 to September 2020 were divided into control group(48 cases)and observation group(48 cases)by the random number table.Finally two cases in control group were excluded.The control group received gastric cancer regular preoperative health guidance,the observation group received trimodal pre-habilitation strategy for 6-8 days on the basis of the control group.The perioperative indicators and complications were compared between the two groups.The 36-item Health Survey Summary(SF-36)scores were measured before and after intervention.Results The first postoperative exhaust time,first out of bed time,first oral meal time,hospital stay in the observation group were(61.49±6.71)hours,(19.54±6.13)hours,(71.23±6.79)days,(5.62±1.03)days,which lower than(79.21±8.15)hours,(22.95±7.19)hours,(78.95±7.21)days,(6.64±1.17)days in the control group,and the differences were statistically significant between the two group(t values were 2.48-11.53,all P<0.05).The incidence of complications was 6.25%(3/48)in the observation group and 21.74%(10/46)in the control group,and the difference was statistically significant between the two groups(χ^(2)=8.72,P<0.05).At 1 d before operation and 30 d after operation,the average scores of SF-36 were(68.74±8.02),(65.85±7.44)points in the observation group and(60.73±7.43),(61.04±6.85)points in the control group,and the differences were statistically significant(t=5.02,3.26,both P<0.05).Conclusions Preoperative three mode pre-rehabilitation training for gastric cancer patients is beneficial to improving the state of exercise,nutrition and immune function,speeding up postoperative gastrointestinal function and overall rehabilitation,reducing the incidence of postoperative complications and improving the quality of life of patients.