早期肢体主动活动对肺癌患者术后肺栓塞发生的效果分析  

Effect of early limb active exercise on incidence of pulmonary embolism among patients received lung cancer surgery

作　　者：潘琼 田娅媛 童斐 Pan Qiong;Tian Yayuan;Tong Fei(Department of Nursing,Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200011,China;Department of Nursing,Zhabei District Central Hospital in Jing’an District,Shanghai 200435,China)

机构地区：[1]上海交通大学医学院附属第九人民医院护理部,上海200011 [2]上海市静安区闸北中心医院护理部,上海200435

出　　处：《结核与肺部疾病杂志》2024年第3期212-218,共7页Journal of Tuberculosis and Lung Disease

基　　金：国家自然科学基金(71904144)。

摘　　要：目的:分析早期肢体主动活动对降低肺癌患者术后肺栓塞的效果。方法:采用回顾性研究方法,按照入组标准选取2019年1—12月上海交通大学医学院附属第九人民医院收治的187例肺癌手术治疗患者为对照组(采用常规方法护理),2020年1—12月收治的194例肺癌手术治疗患者为观察组(采用在对照组护理基础上联合早期肢体主动活动方案),比较两组患者术后第1日和第7日血小板指标[包括血小板(PLT)计数、血小板分布宽度(PDW)及血小板平均容积(MPV)]和血液纤溶指标[包括溶酶原激活物特异性抑制物(PAI-1)、组织型纤溶酶原激活物(tPA)、D-二聚体]水平、术后第1日和7日内肺栓塞发生率,以及术后7 d内、1个月、6个月、1年、3年期患者生存情况。结果:观察组术后第1日和第7日的MPV[分别为(7.29±0.51)fl和(7.22±0.82)fl]、PLT[(173.13±21.56)×10^(9)/L和(169.11±19.64)×10^(9)/L]、PAI-1[(6.61±0.80)AU/ml和(6.53±1.21)AU/ml]、tPA水平[(0.81±0.21)IU/ml和(0.82±0.11)IU/ml],以及术后第1日的D-二聚体水平[(0.31±0.11)mg/L]和第7日的肺栓塞发生率[2.58%(5/194)]均低于对照组[分别为(8.23±0.69)fl和(8.11±1.13)fl、(184.56±23.71)×10^(9)/L和(181.61±21.78)×10^(9)/L、(7.41±1.22)AU/ml和(7.32±1.11)AU/ml、(0.92±0.21)IU/ml和(0.91±0.41)IU/ml、(0.41±0.11)mg/L、9.63%(18/187)],而术后1年期和3年期的生存率[分别为85.57%(166/194)和63.40%(123/194)]均明显高于对照组[分别为70.05%(131/187)和51.87%(97/187)],差异均有统计学意义(t=18.294,P=0.043;t=15.011,P=0.039;t=20.415,P=0.048;t=19.669,P=0.046;t=18.214,P=0.028;t=19.015,P=0.032;t=17.141,P=0.033;t=18.011,P=0.039;t=15.326,P=0.049;χ^(2)=8.195,P=0.019;χ^(2)=5.148,P=0.031;χ^(2)=7.047,P=0.007)。两组患者术后第1日无患者发生肺栓塞,7 d内和1个月内均无死亡病例。结论:早期肢体主动活动能降低肺癌患者术后肺栓塞发生率,改善患者预后,延长生存期,值得推广应用。Objective:To analyze the effect of early active limb movement in reducing postoperative pulmonary embolism(PE)in lung cancer patients.Methods:Using retrospective research method,according to enrolment criteria,187 patients who had received surgical treatment of lung cancer in Shanghai Ninth People’s Hospital affiliated to Shanghai Jiaotong University School of Medicine from January to December 2019 were selected as control group,and 194 patients treated from January to December 2020 were selected as observation group.The control group was given routine nursing,while the observation group took early active limb activity on top of routine nursing.We compared the levels of platelet indicators(PLT,PDW,MPV)and fibrinolytic indicators(PAI-1,tPA,D-dimer)between the two groups of patients on postoperative day 1 and 7,as well as the incidence of PE within 1 and 7 days,the survival of patients in 7-day,1-month,6-month,1-year,and 3-year periods after surgery.Results:The incidence of MPV((7.29±0.51)fl and(7.22±0.82)fl),PLT((173.13±21.56)×10^(9)/L and(169.11±19.64)×10^(9)/L),PAI-1((6.61±0.80)AU/ml and(6.53±1.21)AU/ml),tPA((0.81±0.21)IU/ml and(0.82±0.11)IU/ml)on day 1 and day 7,and D-dimer((0.31±0.11)mg/L)on day 1,as well as the incidence of PE(2.58%(5/194))on day 7 were lower in the observation group than in the control group((8.23±0.69)fl and(8.11±1.13)fl,(184.56±23.71)×10^(9)/L and(181.61±21.78)×10^(9)/L,(7.41±1.22)AU/ml and(7.32±1.11)AU/ml,(0.92±0.21)IU/ml and(0.91±0.41)IU/ml,(0.41±0.11)mg/L,and 9.63%(18/187)),whereas the survival rates(85.57%(166/194)and 63.40%(123/194))at 1 and 3 years after surgery were significantly higher than those of the control group(70.05%(131/187)and 51.87%(97/187)),and the differences were statistically significant in all cases(t=18.294,P=0.043;t=15.011,P=0.039;t=20.415,P=0.048;t=19.669,P=0.046;t=18.214,P=0.028;t=19.015,P=0.032;t=17.141,P=0.033;t=18.011,P=0.039;t=15.326,P=0.049;χ^(2)=8.195,P=0.019;χ^(2)=5.148,P=0.031;χ^(2)=7.047,P=0.007).No patient developed PE on post

关 键 词：肺肿瘤 肺外科手术 肺栓塞 围手术期护理 行为疗法 护理评价研究 

分 类 号：R734.2[医药卫生—肿瘤] R563.5[医药卫生—临床医学] R473