癌症预康复在胰腺癌手术患者中的临床应用:一项单中心历史对照类试验研究

Clinical application of cancer prehabilitation program in pancreatic cancer patients undergoing surgery:A single-center historical control,quasi-experimental study

背景 癌症预康复是在癌症诊断至治疗开始阶段之间对患者实施包括营养、运动和心理措施在内的术前干预,可以改善术后结果。目的 探讨癌症预康复在胰腺癌手术患者中的应用效果。方法 招募2022年7月-2023年2月入院的胰腺癌手术患者为研究对象,其中2022年7-10月就诊患者纳入对照组,2022年11月-2023年2月就诊患者纳入预康复组。对照组接受常规术前干预,预康复组在对照组的基础上接受癌症预康复,包括营养支持、运动干预和心理护理。比较两组患者术前1 d的6 min步行距离(6-minute walking distance,6MWD)、营养风险筛查2002 (Nutrition Risk Screening 2002,NRS2002)量表得分、体质量指数(body mass index,BMI)、住院患者焦虑抑郁量表(the Hospital Anxiety and Depression Scale,HADS)评分和术后早期恢复指标。结果 共纳入47例患者,对照组23例,预康复组24例。两组患者年龄、性别等一般资料差异无统计学意义(P>0.05)。预康复组术前1 d的6MWD [(508.75±56.57) m vs (464.35±60.78) m]、NRS2002 (2.50±0.78 vs 3.13±1.22)、BMI [(24.53±1.43) kg/m^(2) vs (22.35±3.05) kg/m^(2)]、HADS-A (3.13±1.99 vs 5.35±1.85)、HADS-D (2.96±2.49 vs 4.70±1.96)均优于对照组,差异有统计学意义(P<0.05)。术后首次下床时间[(38.29±2.46) h vs (40.39±2.76) h]、首次排气时间[(59.13±3.66) h vs (61.74±3.44) h]、排便时间[(71.00±4.74) h vs (74.87±3.70) h]均较对照组有所改善,差异均有统计学意义(P<0.05)。两组患者术后住院时间的差异无统计学意义(P>0.05)。所有患者均未出现跌倒、心跳呼吸骤停等不良事件。结论 癌症预康复对改善胰腺癌患者运动功能、营养状况和心理状态,促进术后恢复具有一定效果。

Background Cancer prehabilitation is a preoperative intervention involving nutrition,exercise,and psychological measures from diagnosis to the beginning of treatment,which can improve postoperative outcomes.Objective To explore the application effect of cancer prehabilitation in pancreatic cancer patients undergoing surgery.Methods Patients undergoing pancreatic cancer surgery admitted to hospital from July 2022 to February 2023 were recruited as the study objects,among which patients admitted from July to October 2022 were included in the control group,and patients admitted from November 2022 to February 2023 were included in the prehabilitation group.The control group received routine preoperative intervention,and the prehabilitation group received cancer prehabilitation on the basis of the control group,including nutritional support,exercise inter-vention and psychological nursing.The 6-minute walking test(6MWT),Nutrition Risk Screening 2002(NRS2002),body mass index(BMI),the Hospital Anxiety and Depression Scale(HADS)at 1 day before surgery and early postoperative recovery indicators were compared between the two groups.Results A total of 47 patients were included,including 23 cases in the control group and 24 cases in the prehabilitation group.There was no significant difference in baseline general information such as age and gender between the two groups(P>0.05).In the prehabilitation group,the 6MWD([508.75±56.57]m vs[464.35±60.78]m),NRS2002(2.50±0.78 vs 3.13±1.22),BMI([24.53±1.43]kg/m^(2) vs[22.35±3.05]kg/m^(2)),HADS-A(3.13±1.99 vs 5.35±1.85),HADS-D(2.96±2.49 vs 4.70±1.96)at 1 day before surgery were superior to control group,the differences were statistically significant(P<0.05).The off-bed time([38.29±2.46]h vs[40.39±2.76]h),the first time to exhaust([59.13±3.66]h vs[61.74±3.44]h),the time to defecate([71.00±4.74]h vs[74.87±3.70]h)were improved compared with the control group,and the differences were statistically significant(P<0.05).There was no significant difference in postoperative hospital stay between the two groups(P>0.05).None of the patients had any adverse events such as fall or cardiac and respiratory arrest.Conclusion Cancer prehabilitation is effective in improving motor function,nutritional status and psychological state of pancreatic cancer patients and promoting postoperative recovery.