基于HAPA的饮食、运动行为干预在结直肠癌手术患者中的应用

Application of HAPA-based diet and exercise behavior intervention in patients undergoing colorectal cancer surgery

目的探讨基于健康行动过程取向理论(HAPA)的饮食、运动行为干预在结直肠癌(CRC)手术患者中的应用效果,以期为临床决策提供参考。方法选取2021年10月—2022年3月南华大学附属邵阳医院胃肠外科收治的230例CRC患者作为研究对象。采用随机数字表法,将研究对象分为对照组和干预组,每组115例。对照组患者给予常规饮食、运动指导,干预组患者在对照组基础上给予基于HAPA的饮食、运动行为干预,比较2组患者术后康复情况、并发症发生情况及早期生活质量等。结果干预组患者术后首次下床活动时间、首次肛门排气时间、术后住院时间均短于对照组(P<0.05)。干预组患者术后并发症总发生率为6.1%,明显低于对照组的27.8%(P<0.05)。干预前,2组患者Kamofsky功能状态(KPS)得分、营养状况分级、自我管理效能感量表各维度得分及总分、大肠癌生活质量量表(QLICP-CR)各维度得分及总分比较,差异均无统计学意义(P>0.05)。干预后,2组患者KPS得分均高于干预前,且干预组高于同期对照组(P<0.05);干预组患者的营养状况分级优于对照组(P<0.05);2组患者自我管理效能感量表各维度得分及总分均高于干预前,且干预组高于同期对照组(P<0.05);2组患者QLICP-CR各维度得分(干预组心理功能维度除外)及总分均高于干预前,且干预组高于对照组(心理功能、社会功能维度除外)(P<0.05)。结论基于HAPA的饮食、运动行为干预可提升CRC患者的自我管理效能水平,改善患者的营养状况,减少其术后并发症的发生,提高患者的生活质量,值得临床推广应用。

Objective To investigate the effect of diet and exercise behavior intervention based on the Health Action Process Approach(HAPA)in patients undergoing colorectal cancer(CRC)surgery to provide evidence for clinical decision-making.Methods From October 2021 to March 2022,230 patients with CRC were enrolled in the Gastrointestinal Surgery Department of Shaoyang Hospital.Study participants were assigned to a control group and an intervention group using a random number table,with 115 cases in each group.Patients in the control group received conventional diet and exercise guidance and patients in the intervention group received HAPA-based diet and exercise behavior intervention based on the control group.The postoperative rehabilitation,complications and early quality of life were compared between the two groups.Results The time to first ambulation,time to first flatus,and the postoperative hospital stay in the intervention group were significantly shorter than those in the control group(P<0.05).The overall incidence rate of postoperative complications in the intervention group was 6.1%,which was significantly lower than that in the control group(27.8%)(P<0.05).Before the intervention,there was no significant difference in the Kamofsky Functional Status(KPS)scale score,nutritional status grade,subscale and total scores of the Self-Management Efficacy scale,and subscale and total scores of Quality of Life Instruments for Cancer Patients-Colorectal Cancer(QLICP-CR)between the two groups(P>0.05).After the intervention,the KPS scores of the two groups were higher than those before the intervention,and the intervention group was higher than the concurrent control group,with statistical significance(P<0.05).The nutritional status grade of the intervention group was superior to that of the control group(P<0.05);the subscale and total scores of the Self-Management Efficacy scale of the two groups were higher than those before the intervention,and the intervention group was higher than the concurrent control group,with statistical significance(P<0.05).The subscale and total scores of LICQP-CR in the two groups(except the psychological function dimension of the intervention group)were higher than those before the intervention,and the intervention group was higher than the control group(except the psychological function and social function dimension),with statistical significance(P<0.05).Conclusion The HAPA-based diet and exercise behavior intervention can improve self-management efficacy,increase nutritional status,reduce the incidence of postoperative complications,and raise the quality of life of patients with CRC.These benefits hold promise for a wider application of this technique clinically.