上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (9): 1201-1210.doi: 10.3969/j.issn.1674-8115.2023.09.015

• 临床护理专题 • 上一篇    下一篇

腹腔镜结直肠癌根治术后患者早期下床活动现状及影响因素

罗晨1,2(), 沈玲1(), 王传伟3, 顾佳妮4, 王瑾5, 赵黎1, 黄帅1   

  1. 1.上海交通大学医学院附属新华医院普外科，上海 200092
    2.上海交通大学护理学院，上海 200025
    3.上海理工大学能源与动力工程学院，上海 200093
    4.上海交通大学医学院附属新华医院护理部，上海 200092
    5.上海交通大学医学院附属新华医院肛肠外科，上海 200092
  • 收稿日期:2023-01-29 接受日期:2023-05-23 出版日期:2023-09-28 发布日期:2023-09-28
  • 通讯作者: 沈　玲，电子信箱：shenling@xinhuamed.com.cn。
  • 作者简介:罗　晨（1997—），女，护士，硕士生；电子信箱：Luo.CH@sjtu.edu.cn。
  • 基金资助:
    上海交通大学医学院附属新华医院护理学科骨干人才项目(xhlgg009)

Current status and influencing factors of early mobilization of patients undergoing laparoscopic radical resection of colorectal cancer

LUO Chen1,2(), SHEN Ling1(), WANG Chuanwei3, GU Jiani4, WANG Jin5, ZHAO Li1, HUANG Shuai1   

  1. 1.Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
    2.Shanghai Jiao Tong University School of Nursing, Shanghai 200025, China
    3.School of Energy and Power Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
    4.Department of Nursing, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
    5.Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
  • Received:2023-01-29 Accepted:2023-05-23 Online:2023-09-28 Published:2023-09-28
  • Contact: SHEN Ling, E-mail: shenling@xinhuamed.com.cn.
  • Supported by:
    Key Nursing Talents Project of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine(xhlgg009)

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摘要：

目的·了解腹腔镜结直肠癌（colorectal cancer，CRC）根治术后患者早期下床活动现状及其影响因素。方法·采用方便抽样法，选取2022年1月—12月入住上海交通大学医学院附属新华医院肛肠外科和普外科的腹腔镜CRC根治术后患者作为研究对象，于术后24 h、48 h、72 h采用床旁询问患者和查看电子病历系统的方式收集患者的一般资料，疾病、手术、术后相关资料以及术后下床活动情况。采用单因素分析和二元Logistic回归进行影响因素分析。结果·共纳入277例患者，术后24 h内有47例患者下床活动，早期下床活动率仅为16.97%；这47例患者术后24 h内的步行距离为55.46（18.28，145.60）m，最小距离2.60 m，最大距离803.68 m。术后24 h内、>24~48 h、>48~72 h的Brown平均下床活动评分分别为2（0，4）分、8（0，10）分、8（8，10）分，分别属于低活动水平、中等活动水平、中等活动水平。早期下床组与未早期下床组患者的年龄、术前血红蛋白水平、麻醉时长、留置导管数目的差异有统计学意义（均P<0.05）。与未早期下床组相比，早期下床组患者首次排气时间、首次排便时间、术后住院时间均较短，差异具有统计学意义（均P<0.05）。早期下床组术后未发生并发症，未早期下床组术后有11例患者发生并发症，并发症发生率为4.78%。二元Logistic回归分析显示，年龄≥70岁、术前血红蛋白水平低、麻醉时长长是患者术后早期下床活动的独立危险因素（均P<0.05）。结论·腹腔镜CRC根治术后患者早期下床活动可显著加快术后康复，但患者早期下床活动现况有待改善。年龄、术前血红蛋白水平、麻醉时长是患者术后早期下床活动的影响因素。

关键词: 早期下床活动, 结直肠癌, 腹腔镜手术, 加速康复外科, 影响因素

Abstract:

Objective ·To investigate the status of early mobilization and influencing factors of the patients undergoing laparoscopic radical resection of colorectal cancer (CRC). Methods ·The convenience sampling method was used to select patients undergoing laparoscopic radical resection of CRC in the Department of Colorectal Surgery and Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from January to December, 2022. The patients′ general information, disease-, surgery- and postoperation-related information, and the situation of postoperative early mobilization were collected by bedside interview and electronic medical record system at 24 h, 48 h and 72 h after surgery. The influencing factors were analyzed by univariate analyses and binary Logistic regression. Results ·A total of 277 patients were included. Within 24 h after surgery, 47 patients got out of bed with the early mobilization rate of 16.97%. The walking distance of these patients was 55.46 (18.28, 145.60) m within 24 h after surgery, with a minimum of 2.60 m and a maximum of 803.68 m. The average scores of Brown rating of mobility within 24 h, >24－48 h, and >48－72 h after surgery were 2 (0, 4) points, 8 (0, 10) points, and 8 (8, 10) points, which respectively belonged to the low level, moderate level, and moderate level. There were statistical differences in age, preoperative hemoglobin level, anesthesia duration, and the number of indwelling catheters between the early mobilization group and the non-early mobilization group (all P<0.05). Initial exhaust time, initial defecation time and postoperative length of stay of the early mobilization group were significantly shorter than those of the non-early mobilization group (all P<0.05). There were no postoperative complications in the early mobilization group, while the postoperative complications occurred in 11 patients in the non-early mobilization group with the incidence of complications of 4.78%. Binary Logistic regression analysis showed that age≥70 years old, low preoperative hemoglobin level and long anesthesia duration had significant influence on postoperative early mobilization (all P<0.05). Conclusion ·Early mobilization of patients after laparoscopic radical resection of CRC can significantly accelerate postoperative rehabilitation, but the current status of early mobilization needs to be improved. Age, preoperative hemoglobin level and anesthesia duration are influencing factors of early mobilization.

Key words: early mobilization, colorectal cancer (CRC), laparoscopic surgery, enhanced recovery after surgery (ERAS), influencing factor

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