行开腹手术的肝癌患者术后早期下床活动的最佳方案探讨

Investigation on preferred regimen of early postoperative off-bed activity in patients with liver cancer undergoing open surgery

目的探讨行开腹手术的肝癌患者术后首次下床活动的最佳时间及早期活动水平。方法将152例行开腹手术的肝癌患者分为4组:A1组(n=36)患者于术后第2天开始下床并进行低水平活动,第3天进行中水平活动;A2组(n=40)患者于术后第2天开始下床并进行中水平活动;B1组(n=39)患者于术后第1天开始下床并进行低水平活动,第2、3天进行低中水平活动;B2组(n=37)患者于术后第1天开始下床并进行低水平活动,第2天开始进行中水平活动。比较4组患者术后肠功能恢复情况、术后住院时间及40项恢复质量调查问卷(QoR-40)评分。结果4组患者术后肠鸣音恢复时间、术后住院时间差异无统计学意义(P>0.05);A1组患者的术后肛门排气时间长于其他3组,腹胀程度重于B1、B2组(P<0.05)。A2组、B2组患者的身体舒适度维度、情绪状态维度、疼痛维度、自理能力维度得分及QoR-40总分高于A1、B1组,且B1组患者的自理能力维度评分高于A1组(P<0.05)。结论对于行开腹手术的肝癌患者,在病情允许的情况下,术后第1天开始下床活动或术后第2天下床活动达中水平均有利于其术后恢复。

Objective To investigate the optimal time and early activity level of first postoperative off-bed activity in patients with liver cancer undergoing open surgery.Methods A total of 152 liver cancer patients undergoing open surgery were divided into four groups:group Al(n=36),patients got out of bed and carried out activity with low level on the second day after operation,and carried out activity with medium level on the third day;group A2(n=40),patients got out of bed and carried out activity with medium level on the second day after operation;group B1(n=39),patients got out of bed and carried out activity with low level on the first day after operation,and carried out activity with low to medium level on the second and third day;in addition,group B2(n=37),patients got out of bed and carried out activity with low level on the first day after operation,and carried out activity with medium level on the second day.Postoperative intestinal function recovery,length of hospital stay,and Quality of Recovery.40 Questionnaire(QoR-40)score were compared between patients of the four groups.Results There was no statistically significant difference in postoperative bowel sound recovery time and postoperative length of hospital stay between the four groups(P>0.05).Group A1 exhibited longer postoperative anal exhaust time as compared with the other 3 groups,and severe abdominal distension as compared with groups B1 and B2(P<0.05).Groups A2 and B2 interpreted higher scores of physical comfort dimension,emotional status dimension,pain dimension,and self-care ability dimension,as well as total score of QoR40 as compared with groups Al and B1,and group B1 yielded a higher score of self-care ability dimension as compared with group Al(P<0.05).Conclusion For patients with liver cancer undergoing open surgery,as long as the condition permits,carrying out off-bed activity on the first day after operation or carrying out off-bed activity reaching medium level on the second day after operation is beneficial to their postoperative recovery.