三联预康复策略对腹腔镜肝部分切除术患者功能状态及生活质量的影响  

The impact of trimodal prehabilitation strategy on functional capability and short-term quality of life for patients undergoing laparoscopic partial hepatectomy

作　　者：刘慧敏 颜壹敏 冯斌[1] 郑铭陟 任芳沅 LIU Huimin;YAN Yimin;FENG Bin;ZHENG Mingzhi;REN Fangyuan(The Affiliated Zhuzhou Hospital of Xiangya Medical College,Central South University,Zhuzhou 412007,China)

机构地区：[1]中南大学湘雅医学院附属株洲医院,株洲412007

出　　处：《湖南师范大学学报（医学版）》2024年第4期81-86,共6页Journal of Hunan Normal University(Medical Sciences)

基　　金：湖南省医学会医学科研基金资助课题“亚临床剂量艾司氯胺酮在老年患者无痛纤支镜中的临床应用”(HNA202101013)。

摘　　要：目的:探讨三联预康复策略对行腹腔镜肝部分切除手术的患者围术期功能状态及生活质量的影响。方法:选取2022年4月—2023年11月我院100例择期行腹腔镜肝部分切除术的患者为研究对象,按照随机数字表法将患者分为对照组和预康复组,每组各50例。对照组接受常规腹腔镜手术术前准备,预康复组术前2~4周接受三联预康复干预策略,随访时间为出院后30 d。分别于基线值、术前1 d、术后7 d及术后30 d对两组患者围术期功能状态(运动功能、心理状况、营养状况)进行效果评价,其中围术期运动功能以6 min步行距离(6MWD)进行评价,心理状况采用医院焦虑抑郁量表(HADS)进行评价,营养状况采用前白蛋白、白蛋白和总蛋白客观营养指标进行评价;短期生活质量采用SF-36健康调查简表(SF-36)进行评价;比较两组患者手术时间、术中出血量、住院时间、腹腔引流情况、术后并发症、出院后30 d内再入院情况等结局指标的差异。结果:两组患者手术时间、术中出血量比较差异无统计学意义;预康复组患者术后第1d腹腔引流量少于对照组;预康复组住院时间较对照组明显缩短;基线时,两组患者6MWD、HADS焦虑评分、HADS抑郁评分、前白蛋白、白蛋白、总蛋白及SF-36各维度评分比较无明显差异;术前1 d、术后7 d及术后30 d,预康复组6MWD、前白蛋白、白蛋白、总蛋白均高于对照组;术前1天及术后7天,预康复组HADS焦虑评分、HADS抑郁评分较基线下降,且均优于对照组;术后30 d,两组患者HADS焦虑评分、HADS抑郁评分比较差异无统计学意义;术后30 d,预康复组患者SF-36的BP、GH、MH、PF、RP、SF、VT评分均高于对照组,两组患者RE评分比较差异无统计学意义;预康复组患者术后并发症发生率低于对照组,两组均无出院后30 d内再入院病例。结论:三联预康复策略能有效改善腹腔镜肝部分切除术患者的围术期功能状态�Objective To investigate the impact of trimodal prehabilitation strategy on perioperative functional capability and short-term quality of life for patients undergoing laparoscopic partial hepatectomy.Methods 100 cases of patients undergoing elective laparoscopic partial hepatectomy in our hospital from April 2022 to November 2023 were randomly divided into control group and prehabilitation group,each were 50 cases.The control group received conventional preparation for laparoscopic surgery,while the prehabilitation group received trimodal prehabilitation intervention strategy before surgery,about 2-4 weeks.All patients were followed up 30 days after discharge.The perioperative (at the baseline,1 day before surgery,7 days after surgery and 30 days after surgery) functional capability included:the validated six-minute walking distance (6MWD) was used to evaluate motor function,the hospital anxiety and depression scale (HADS) was used to evaluate the psychological status,and the nutritional indicators of prealbumin,albumin and total protein was used to evaluate the nutritional status.Short-term quality of life measured using SF-36 Health Survey Form (SF-36).The operation time,intraoperative blood loss,hospitalization time,abdominal drainage,postoperative complications and readmission within 30 days after discharge of two groups were compared.Results The operation time and intraoperative blood loss of two groups had no significant difference.Prehabilitation group had a significant reduction in abdominal drainage on the first day after surgery than control group.The hospitalization time of prehabilitation group was shorted than control group.At baseline,there was no statistically difference in 6MWD,HADS anxiety score,HADS depression score,prealbumin,albumin,total protein and SF-36 score between two groups.1 day before surgery,7 days after surgery and 30 days after surgery,6MWD,prealbumin,albumin and total protein of prehabilitation group were higher than control group.1 day before surgery and 7 days after surgery,HADS

关 键 词：三联预康复策略 腹腔镜肝切除 功能能力 生活质量 

分 类 号：R614[医药卫生—麻醉学] R493[医药卫生—外科学]