上腹部术后患者早期活动现状及影响因素分析  

Investigation on status and influencing factors of early mobilization in patients undergoing upper abdominal surgery

作　　者：沈波[1] 王建荣[2] 程艳爽[3] SHEN Bo;WANG Jianrong;CHENG Yanshuang(Department of Hepatobiliary and Pancreatic Medicine,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Nursing,Chinese PLA General Hospital,Beijing 100853,China;Department of Hepatobiliary and Pancreatic Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心肝胆胰学部,北京100853 [2]解放军总医院护理部,北京100853 [3]解放军总医院第一医学中心肝胆胰外科医学部,北京100853

出　　处：《解放军医学院学报》2021年第10期1053-1057,共5页Academic Journal of Chinese PLA Medical School

摘　　要：背景术后早期活动能促进患者康复,但临床实践中,上腹部术后患者受多种因素影响,早期活动水平较低,对康复不利。目的了解上腹部术后患者早期活动水平及其影响因素,为制定上腹部术后患者早期活动管理策略提供参考。方法采用一般资料及病情调查表、JH-HLM活动水平评分量表,对解放军总医院第一医学中心2019年10月-2020年5月195例上腹部手术患者术后第1天活动水平进行调查,并分析性别、年龄、诊断、是否合并慢性病、体质量指数(body mass index,BMI)、美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)评分、手术部位、手术时间、术中出血量、是否留置胃管、腹部引流管个数、血红蛋白、白蛋白、白细胞、静息疼痛情况、活动疼痛情况、早期疲乏情况、恶心呕吐情况这18个可能的相关因素。结果上腹部手术患者术后第1天约翰霍普金斯最高活动水平评分(Johns Hopkins Highest Level of Mobility,JH-HLM)中位数为3分,52.3%患者以床上活动为主。多元线性回归分析显示,年龄[B=-0.025 (Sx-=0.008);P=0.002]、是否留置胃管[B=0.746 (Sx-=0.209);P<0.001]、活动疼痛评分[B=-0.590 (Sx-=0.067);P<0.001]、早期疲乏评分[B=-0.211 (Sx-=0.052);P<0.001]、恶心呕吐分级[B=-0.735 (Sx-=0.147);P<0.001]与患者术后早期活动水平显著相关。结论上腹部手术患者术后第1天活动水平较低,临床医护人员为患者制定术后活动计划时需对患者进行个性化评估和干预,注重减轻患者伤口疼痛、疲乏、恶心呕吐等不适感,促进患者康复。Backgroud Early mobilization after surgery can promte recovery,however,in clinical practice,early mobility level of patients after upper abdominal surgery is low,which is affected by a variety of factors and is detrimental to the recovery of patients.Objective To evaluate the early mobility level among patients after upper abdominal surgery and investigate the releated factors,and provide evidence for making early mobilization program.Methods A total of 195 patients undergoing upper abdominal surgery in the First Medical Center of Chinese PLA General Hospital from October 2019 to May 2020 were investigated on the mobility level on the first day after surgery with general and disease information questionnaire,JH-HLM mobility level questionnaire,and the 18 influencing factors including gender,age,diagnosis,concomitant disease,BMI,ECOG score,operation time,operation site,blood loss,whether gastric tube was indwailed,the number of abdominal drainage tubes,hemoglobin,albumin,white blood cells,resting pain,activity pain,early fatigue,nausea and vomiting were analyzed.Results The median JH-HLM score of patients on the first day after upper abdominal surgery was 3,52.3% patients were confined to bed activity,which was defined as low level.Age(B=-0.025[ Sx= 0.008];P=0.002),whether to indwelling gastric tube(B=0.746[ Sx= 0.209];P< 0.001),activity pain level(B=-0.590[ Sx=0.067];P< 0.001),early fatigue level(B=-0.211[ Sx= 0.052];P< 0.001),nausea and vomiting level(B=-0.735[ Sx=0.147];P<0.001) were significantly associated with early mobilization.Conclusion Patients receiving upper abdominal surgery have low level of early mobility.Medical staff need to conduct individualized assessment and intervention on patients when making postoperative activity programmes,and attention should be paid to relieving discomforts of pain,fatigue,nausea and vomiting in order to accelerate recovery of patients.

关 键 词：上腹部手术 早期下床 活动水平 加速康复外科 约翰霍普金斯最高活动水平评分 

分 类 号：R686.3[医药卫生—骨科学]