口腔癌游离皮瓣移植患者术后早期活动的研究

Study on the effect of early mobilization in oral cancer patients who have undergone free flap reconstruction

目的制订口腔癌游离皮瓣移植手术患者术后早期活动方案,并探讨此方案在临床中的应用效果。方法本研究为前瞻性随机对照研究,选取2018年12月至2021年12月就诊于北京大学口腔医学院·口腔医院口腔颌面外科二病区的游离皮瓣移植手术患者173例,采用整群随机分组的方法将患者随机分为对照组87例和干预组86例。对照组执行现有护理常规,术后头部制动4 d,第5天坐起、下床活动;干预组患者采取早期活动方案,术后第2天坐起,第3天下床活动。比较2组患者术后血管危象发生率、并发症发生率、术后前5 d睡眠时长及导管留置时间、住院时长及费用。结果干预组患者术后肺部感染发生率、术后前5 d平均每日睡眠时长及鼻胃管、气管套管和导尿管留置时间分别为7.0%(6/86)、(5.0±1.0)h/d及(11.8±7.3)、(6.1±3.2)、(3.6±0.6)d,均优于对照组的13.8%(12/87)、(4.4±1.3)h/d及(14.2±5.8)、(7.3±1.7)、(4.0±0.9)d,差异均有统计学意义(χ^(2)=3.89、t值为-3.57~-2.44,均P<0.05);2组患者术后血管危象发生率、住院时长及费用比较差异无统计学意义(均P>0.05)。结论口腔癌游离皮瓣移植手术患者,术后第2天坐起,第3天下床活动是安全的,可减少术后肺部感染并发症,改善患者睡眠情况,缩短导管留置时间。

Objective To explore an early mobilization plan for oral cancer patients after free flap reconstruction and evaluate the application effect of the plan.Methods This study was a prospective randomized controlled trial.A total of 173 patients undergoing free flap reconstruction surgery from December 2018 to December 2021 in the second ward of Peking University School and Hospital of Stomatology were selected.The patients were randomly divided into the control group(87 cases)and the intervention group(86 cases)by cluster randomized grouping.The control group received the routine nursing plan,that was,head immobilization for 4 days after surgery,and patients performed sat up and off-bed activity on the 5th day.The intervention group received the early mobilization plan,that was,patients sat up on the 2nd day after surgery and performed off-bed activity on the 3rd day.The incidence of vascular compromise,postoperative complications,sleep time in the first 5 days after surgery,catheter removal time,hospitalization duration and expenses were compared between the two groups.Results The incidence of postoperative pulmonary infection,the daily sleep time in the first 5 days after surgery,the time for removing nasogastric tube,trachea cannula,and urinary catheter were 7.0%(6/86),(5.0±1.0)h/d,(11.8±7.3)d,(6.1±3.2)d,(3.6±0.6)d in the intervention group,and 13.8%(12/87),(4.4±1.3)h/d,(14.2±5.8)d,(7.3±1.7)d,(4.0±0.9)d in the control group,all differences were statistically significant(χ^(2)=3.89,t values were-3.57--2.44,all P<0.05).There was no significant difference in the incidence of rascular compromise,hospitalization duration and expenses between the two groups(all P>0.05).Conclusions For patients undergoing free tissue flap reconstruction,it is safe to sit up on the 2nd day and get out of bed on the 3rd day,which can reduce the incidence of pulmonary infection,improve patient sleep,and shorten the indwelling time of nasogastric tube,trachea cannula and urinary catheter.