临床护理专题

院前多模式预康复对胃肠道恶性肿瘤患者术前功能及术后恢复效果的影响

  • 台瑞 ,
  • 孙菊芳 ,
  • 林英 ,
  • 章雅青 ,
  • 黄陈 ,
  • 方芳
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  • 1.上海交通大学医学院附属第一人民医院护理部,上海 200080
    2.上海交通大学护理学院,上海 200025
    3.上海交通大学医学院附属第一人民医院胃肠外科,上海 200080
台 瑞(1993—),女,主管护师,硕士;电子信箱:realltairui@163.com
方 芳,电子信箱:fang_fang0604@163.com

收稿日期: 2024-04-03

  录用日期: 2024-07-22

  网络出版日期: 2024-10-28

基金资助

上海交通大学医学院护理学科建设项目(SJTUHLXK2022);上海市第一人民医院特色研究项目(CCTR-2022N04);上海交通大学医学院护理科研项目(Jyhz2412)

Effect of prehospital multimodal prehabilitation on preoperative function and postoperative recovery in patients with gastrointestinal malignant tumors

  • Rui TAI ,
  • Jufang SUN ,
  • Ying LIN ,
  • Yaqing ZHANG ,
  • Chen HUANG ,
  • Fang FANG
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  • 1.Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
    2.Shanghai Jiao Tong University School of Nursing, Shanghai 200025, China
    3.Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
FANG Fang,E-mail: fang_fang0604@163.com.

Received date: 2024-04-03

  Accepted date: 2024-07-22

  Online published: 2024-10-28

Supported by

Nursing Development Program of Shanghai Jiao Tong University School of Medicine(SJTUHLXK2022);Clinical Research Innovation Plan of Shanghai General Hospital(CCTR-2022N04);Nursing Research Program of Shanghai Jiao Tong University School of Medicine(Jyhz2412)

摘要

目的·探索院前多模式预康复计划对胃肠道恶性肿瘤患者术前功能状态及术后恢复效果的影响。方法·纳入2023年6月—12月上海交通大学医学院附属第一人民医院胃肠外科收治的胃肠道恶性肿瘤患者78例,采用随机数字表将其分为对照组(n=40例)和院前多模式预康复组(PMP组,n=38例)。手术前,对照组遵循常规的术前指导,PMP组接受院前多模式预康复计划。收集患者的一般资料,比较2组患者在基线及术前1 d的6分钟步行距离(6-minute walk distance,6MWD),术后住院时间、首次排气/排便时间、首次口服进食时间、首次下床活动时间及引流管拔除时间和术后并发症发生率。结果·2组患者的一般资料和术前干预的时间比较,差异无统计学意义(P>0.05)。基线时,2组患者的6MWD比较,差异无统计学意义(P>0.05);术前1 d,PMP组的6MWD高于对照组(P=0.016);PMP组6MWD较基线增加(23.42±13.26)m,对照组6MWD较基线减少(3.75±12.08)m(P<0.001)。PMP组患者首次排气/排便时间、首次经口进食时间以及首次下床活动时间均早于对照组(P<0.05)。2组患者术后引流管留置时间、住院天数以及并发症发生率的差异无统计学意义(P>0.05)。结论·院前多模式预康复能够提高胃肠道恶性肿瘤患者术前的功能并且加快其术后恢复。

本文引用格式

台瑞 , 孙菊芳 , 林英 , 章雅青 , 黄陈 , 方芳 . 院前多模式预康复对胃肠道恶性肿瘤患者术前功能及术后恢复效果的影响[J]. 上海交通大学学报(医学版), 2024 , 44(10) : 1229 -1234 . DOI: 10.3969/j.issn.1674-8115.2024.10.003

Abstract

Objective ·To explore the effect of a prehospital multimodal prehabilitation program on the preoperative functional status and postoperative recovery of patients with gastrointestinal malignant tumors. Methods ·A total of 78 patients with gastrointestinal malignant tumors, hospitalized in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from June to December 2023, were enrolled. They were divided into the standard group (SD group, n=40) and the prehospital multimodal prehabilitation group (PMP group, n=38) by using random number table. From the time the operation was agreed upon by both the doctor and patient to the day before the operation, the SD group followed the routine preoperative guidance, while the PMP group received a home-based prehospital multimodal prehabilitation program. The general data of patients were collected, and the six-minute walk distance (6MWD) was compared between the two groups at baseline and on the day before operation.The length of postoperative hospitalization, time to first flatus, time to first ambulation, time to first oral intake, drainage removal time and postoperative complication rate were also compared between the two groups. Results ·There was no difference in general data and duration of preoperative intervention of patients between the two groups. At baseline, there was no significant difference in 6MWD between the two groups. On the day before operation, the 6MWD in the PMP group was higher than that in the SD group (P= 0.016). Changes in 6MWD in the PMP group were significantly higher compared to SD group during the preoperative period, with values of (23.42±13.59) m vs. (-3.75±12.08) m (P<0.001). Time to first flatus, time to first ambulation and time to first oral intake in the PMP group were earlier than those in the SD group (P<0.05). However, there was no significant difference in drainage removal time, postoperative hospitalization and postoperative complication rate between the two groups (P>0.05). Conclusion ·Prehospital multimodal prehabilitation can improve the preoperative function and accelerate the postoperative recovery in patients with gastrointestinal malignancies.

参考文献

1 HAN B, ZHENG R, ZENG H, et al. Cancer incidence and mortality in China, 2022[J]. JNCC, 2024, 4(1): 47-53.
2 李幼生. 从加速康复外科到预康复:理念更新与临床实践模式转变[J]. 中国实用外科杂志, 2024, 44(2): 155-159.
2 LI Y S. From enhanced recovery after surgery to prehabilitation: the new concepts and clinical practice[J]. Chinese Journal of Practical Surgery, 2024, 44(2): 155-159.
3 方芳, 台瑞, 余倩, 等. 预康复对胃肠道择期手术患者术后恢复效果的系统评价[J]. 上海交通大学学报(医学版), 2023, 43(1): 70-78.
3 FANG F, TAI R, YU Q, et al. Effect of prehabilitation on outcomes in patients undergoing elective gastrointestinal surgery: a systematic review[J]. Journal of Shanghai Jiaotong University(Medical Science), 2023, 43(1): 70-78.
4 LJUNGQVIST O, DE BOER H D, BALFOUR A, et al. Opportunities and challenges for the next phase of enhanced recovery after surgery: a review[J]. JAMA Surg, 2021, 156(8): 775-784.
5 BOUSQUET-DION G, AWASTHI R, LOISELLE S è, et al. Evaluation of supervised multimodal prehabilitation programme in cancer patients undergoing colorectal resection: a randomized control trial[J]. Acta Oncologica, 2018, 57(6): 849-859.
6 MINNELLA E M, AWASTHI R, LOISELLE S E, et al. Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery: A Randomized Clinical Trial[J]. JAMA Surgery, 2018, 153(12): 1081-1089.
7 BARBERAN-GARCIA A, UBRé M, ROCA J, et al. Personalised prehabilitation in high-risk patients undergoing elective major abdominal surgery: a randomized blinded controlled trial[J]. Ann Surg, 2018, 267(1): 50-56.
8 RAICHURKAR P, DENEHY L, SOLOMON M, et al. Research priorities in prehabilitation for patients undergoing cancer surgery: an international Delphi study[J]. Ann Surg Oncol, 2023, 30(12): 7226-7235.
9 台瑞, 方芳, 杨富, 等. 择期胃肠道手术患者预康复的最佳证据总结[J]. 中华护理杂志, 2024, 59(2): 236-244.
9 TAI R, FANG F, YANG F, et al. Best evidence summary on prehabilitation interventions of patients undergoing elective gastrointestinal surgery[J]. Chinese Journal of Nursing, 2024, 59(2): 236-244.
10 PECORELLI N, FIORE J J, GILLIS C, et al. The six-minute walk test as a measure of postoperative recovery after colorectal resection: further examination of its measurement properties[J]. Surg Endosc, 2016, 30(6): 2199-2206.
11 WANG X, CHEN R, GE L, et al. Effect of short-term prehabilitation of older patients with colorectal cancer: a propensity score-matched analysis[J]. Front Oncol, 2023, 13: 1076835.
12 TRIGUERO-CANOVAS D, LOPEZ-RODRIGUEZ-ARIAS F, GOMEZ-MARTINEZ M, et al. Home-based prehabilitation improves physical conditions measured by ergospirometry and 6MWT in colorectal cancer patients: a randomized controlled pilot study[J]. Support Care Cancer, 2023, 31(12): 673.
13 ANTONESCU I, SCOTT S, TRAN T T, et al. Measuring postoperative recovery: what are clinically meaningful differences?[J]. Surgery, 2014, 156(2): 319-327.
14 Al M M, Al S M, Al N Z, et al. Prevalence of fatigue in patients with cancer: a systematic review and meta-analysis[J]. J Pain Symptom Manage, 2021, 61(1): 167-189.
15 罗珊, 朱瑞芳, 邱服斌. 消化系统恶性肿瘤病人癌因性疲乏现状及其与膳食的关系[J]. 护理研究, 2024, 38(4): 719-725.
15 LUO S, ZHU R F, QIU F B. Status quo of cancer-related fatigue and its relationship with meals in patients with malignant tumor of digestive system[J]. Chinese Nursing Research, 2024, 38(4): 719-725.
16 MCTIERNAN A, FRIEDENREICH C M, KATZMARZYK P T, et al. Physical activity in cancer prevention and survival: a systematic review[J]. Med Sci Sports Exerc, 2019, 51(6): 1252-1261.
17 BURDEN S T, GIBSON D J, LAL S, et al. Pre-operative oral nutritional supplementation with dietary advice versus dietary advice alone in weight-losing patients with colorectal cancer: single-blind randomized controlled trial[J]. J Cachexia Sarcopenia Muscle, 2017, 8(3): 437-446.
18 刘春霞, 秦艳春, 贺雨, 等. 基于院前住院管理平台的预康复理念在机器人辅助腹腔镜肾肿瘤手术中的应用[J]. 中国微创外科杂志, 2022, 22(1): 63-68.
18 LIU C X, QIN Y C, HE Y, et al. Application of pre-rehablitation concept based on the pre-hospitalization center management system in robot-assisted laparoscopic renal tumor surgery[J]. Chinese Journal of Minimally Invasive Surgery, 2022, 22(1): 63-68.
19 于洁, 杨莉, 王彬, 等. 癌症预康复在胰腺癌手术患者中的临床应用:一项单中心历史对照类试验研究[J]. 解放军医学院学报, 2023, 44(11): 1235-1240.
19 YU J, YANG L, WANG B, et al. Clinical application of cancer prehabilitation program in pancreatic cancer patients undergoing surgery: a single-center historical control, quasi-experimental study[J]. Academic Journal of Chinese PLA Medical School, 2023, 44(11): 1235-1240.
20 BERKEL A, BONGERS B C, KOTTE H, et al. Effects of community-based exercise prehabilitation for patients scheduled for colorectal surgery with high risk for postoperative complications: results of a randomized clinical trial[J]. Ann Surg, 2022, 275(2): e299-e306.
21 CARLI F, BOUSQUET-DION G, AWASTHI R, et al. Effect of multimodal prehabilitation vs postoperative rehabilitation on 30-day postoperative complications for frail patients undergoing resection of colorectal cancer: a randomized clinical trial[J]. JAMA Surg, 2020, 155(3): 233-242.
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