加速康复外科模式下胃癌患者术后早期下床活动现状及影响因素分析  

Analyses of status and influencing factors of early ambulation in patients with gastric cancer under enhanced recovery surgery mode

作　　者：熊方丽 贺育华 蒋晓莲[3] XIONG Fangli;HE Yuhua;JIANG Xiaolian(West China School of Nursing,Sichuan University/Center of Gerontology and Geriatrics,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Colorectal Cancer Center,West China Hospital,Sichuan University/West China School of Nursing,Sichuan University,Chengdu 610041,P.R.China;West China School of Nursing,Sichuan University/West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西护理学院/四川大学华西医院老年医学中心/干部医疗科,成都610041 [2]四川大学华西医院结直肠肿瘤中心/四川大学华西护理学院,成都610041 [3]四川大学华西护理学院/四川大学华西医院,成都610041

出　　处：《中国普外基础与临床杂志》2022年第12期1618-1622,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的调查加速康复外科(enhanced recovery after surgery,ERAS)管理模式下胃癌患者术后早期下床活动完成情况并分析其影响因素。方法选取2021年11月1日至2022年3月31日期间四川大学华西医院胃肠外科收治的符合本研究纳入标准的胃癌手术患者为调查对象,于术后48 h采用床旁询问患者和查看电子病历的方式收集患者一般资料、疾病相关资料、术后自觉症状资料以及患者早期下床活动时间,同时对早期下床活动的影响因素进行logistic回归分析。结果根据本研究的纳入和排除标准及结合样本量需求,共调查了符合条件的胃癌手术患者140例,有34例(24.3%)患者完成了早期下床活动。二元logistic回归多因素分析结果显示,术后48 h内留置尿管[OR=10.031,95%CI(1.037,97.061),P=0.046]和美国麻醉医生协会分级为Ⅲ级[OR=4.209,95%CI(1.792,9.886),P=0.001]降低胃癌患者术后早期下床活动完成概率。结论从本研究调查结果显示,ERAS模式下胃癌患者早期下床活动完成率较低,可通过减少尿管安置或缩短尿管留置时间来改善,并且针对术前存在机体功能衰退的美国麻醉医生协会分级Ⅲ级患者,术后需要医生或护士对其活动能力进行评估后在患者耐受范围内进行下床活动或辅助进行床上活动。Objective To investigate the completion of early ambulation in patients with gastric cancer under the enhanced recovery after surgery(ERAS)management mode in the West China Hospital of Sichuan University,and analyze the influencing factors.Methods From November 1,2021 to March 31,2022,the patients with gastric cancer who met the inclusion criteria of this study in the West China Hospital of Sichuan University were selected as the survey objects.At 48 h after the operation,the patients were enquired at the bedside and the electronic medical records were accessed to collect the general information,diseases information,etc.of the patients.The postoperative data were also investigated,and the time of early ambulation was investigated,and the influencing factors were analyzed by logistic regression.Results According to the inclusion and exclusion criteria of this study and the sample size requirements,140eligible patients with gastric cancer were investigated,34 of whom got out of bed early,and the rate of early ambulation was 24.3%.The results of binary logistic regression analysis showed that indwelling urinary catheter within 48 h after operation[OR=10.031,95%CI(1.037,97.061),P=0.046]and American Society of Anaesthesiologists(ASA)grade Ⅲ[OR=4.209,95%CI(1.792,9.886),P=0.001]decreased the probability of early ambulation after operation in patients with gastric cancer.Conclusions From the results of this survey,the completion rate of early ambulation in patients with gastric cancer under ERAS mode is lower,which may be improved by reducing the placement of the urinary catheter or shortening the indwelling time of the urinary catheter.For patients with ASA grade Ⅲ having functional decline before surgery,doctor or nurse needs to evaluate their mobility after surgery and help them to finish early ambulation or exercise on hospital bed within their tolerances.

关 键 词：加速康复外科模式 胃癌 手术 早期下床活动 

分 类 号：R735.2[医药卫生—肿瘤]