老年结直肠癌衰弱患者围手术期运动方案的构建及应用研究

Construction and preliminary application of a Perioperative Exercise Program for Frail Elderly Patients with Colorectal Cancer based on the goal-directed therapy

目的构建老年结直肠癌衰弱患者围手术期运动方案并验证初步应用效果。方法以目标导向理论为理论基础,在文献回顾的基础上,经专家函询后构建老年结直肠癌衰弱患者围手术期运动方案。采用便利抽样法,选取2022年7月—12月在苏州市某三级甲等医院普外科住院的老年结直肠癌衰弱患者为研究对象,进行初步应用。以病区为单位分为试验组和对照组,试验组在接受常规围手术期护理的基础上应用老年结直肠癌衰弱患者围手术期运动方案,对照组接受常规围手术期护理。评价方案的安全性、可行性及干预效果。结果15名专家进行2轮德尔菲专家函询,权威系数为0.880,变异系数均<0.250,肯德尔和谐系数分别为0.167和0.224(均P<0.001)。最终方案包括术前运动、术后卧床运动、术后坐位运动和术后站立位运动4个阶段。初步应用结果显示,30例患者完成试验。广义估计方程结果显示,两组中文版15项恢复质量量表在交互效应上无统计学差异(P=0.752);在干预效应和时间效应上得分均有统计学意义(P<0.05)。出院时,两组计时起立行走测试和巴氏指数得分差异均有统计学意义(P<0.05)。试验组2例感到轻微疼痛,未发生其他不良事件。结论该研究基于目标导向理论构建的老年结直肠癌衰弱患者围手术期运动方案具有科学性且安全、可行。在改善患者术后躯体功能、日常生活活动能力和术后早期恢复质量方面得到初步验证。

Objective To construct a perioperative exercise program for older frail patients with colorectal cancer,and to verify its effect.Methods Based on Goal-directed Theory and literature review,expert consultation was carried out to establish the perioperative exercise program for older frail patients with colorectal cancer.Then,from July to December 2022,the perioperative exercise program was established for older frail patients with colorectal cancer hospitalized in the General Surgery Department of a tertiary A hospital in Suzhou by convenience sampling method for preliminary application.It was divided in to the intervention group and the control group by the ward.The intervention group was applied with the constructed perioperative exercise program on the basis of routine perioperative nursing.The safety,feasibility and intervention effect of the program were evaluated.Results 15 experts were included for 2 rounds of expert consultations.The authority coefficient was 0.880;the coefficient of variation was<0.250;the Kendall concordance coefficient was 0.167 and 0.224,respectively.The final program contained 4 stages:preoperative exercise,postoperative bed rest,sitting and standing exercise.In the end,54 specific interventions were constructed.During the preliminary application,all the patients completed the program.Generalized estimation equation showed that,on the interaction effect,there was no statistical difference(P=0.752);there were significant differences on the intervention effect and the time effect(P<0.05).At discharge,there were significant differences in timed up and go test and Barthel Index between the 2 groups(P<0.05).Only 2 patients experienced mild pain in the intervention group,and no other adverse events occurred.Conclusion The perioperative exercise program for older frail patients with colorectal cancer,based on Goal-directed Theory,is scientific,reliable and safe.It has been preliminarily verified in improving postoperative physical function,activities of daily living and early postoperative recovery of elderly frail patients with colorectal cancer.