Effect of early goal-directed activity on gastrointestinal function recovery after pancreatic surgery

doi:10.3969/j.issn.1674-8115.2024.10.004

Abstract

Abstract:

Objective ·To investigate the safety and feasibility of early goal-directed mobilization in the recovery of gastrointestinal function after pancreaticoduodenectomy. Methods ·The non-contemporaneous controlled studies were conducted. Subjects who underwent pancreaticoduodenectomy were included. From Sep 2022 to May 2023, forty patients were selected as the control group, and forty patients were selected from June 2023 to February 2024 as the experimental group. The general clinical data of the two groups were collected. The control group was treated with the nursing routine after pancreaticoduodenectomy, and there were no specific requirements for the time and goal of early activity. The experimental group had daily activity goals established for early mobilization, which were performed by the patients and their families, while the rest of their care was identical to that of the control group. The main index of effectiveness evaluation was the time of first flatus and first defecation, and the secondary indexes included the time of first getting out of bed, the time of oral drinking, the time of the gastric tube removal, and the postoperative levels of K⁺, Na⁺, and Cl^- on the 3rd day of the postoperative period. Safety evaluations included chyle leak, postoperative pancreatic fistula, biliary leak and delayed gastric emptying, postoperative hemorrhage, unplanned reoperation, unplanned extubation, falls and death. Results ·There was no statistically significant difference in the general clinical data of the patients in the 2 groups. After the implementation of early goal-directed mobilization, the time of first flatus was advanced from (3.95±1.68) d to (2.88±0.91) d (t=-3.560, P=0.001), and the time of first defecation was advanced from (4.90±1.61) d to (3.80±1.30) d (t=-3.352, P=0.001). The time of first getting out of bed was advanced from (5.18±1.77) d to (2.30±0.88) d (t=-9.205, P<0.001), and the time of oral drinking was advanced from (4.10±1.89) d to (2.73±1.20) d (t=-3.883, P<0.001). Significant differences were also observed in postoperative day 3 Na⁺ (t=-2.745, P=0.008) and Cl^- (t=-2.033, P=0.045) levels. Conclusion ·Early goal-directed activity programs are safe and effective in promoting the recovery of gastrointestinal function after pancreaticoduodenectomy.

Key words: pancreaticoduodenectomy, postoperative gastrointestinal dysfunction, early goal directed mobilization (EGDM)

CLC Number:

R473.6

YAO Hui, ZHANG Yun, DAI Chenjun, GAO Wenqing, YAO Wenjie, DUAN Xiaolei, YANG Fu. Effect of early goal-directed activity on gastrointestinal function recovery after pancreatic surgery[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(10): 1235-1240.

Figures/Tables 3

TrendMD

References 15

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Item	Experimental group (n=40)	Control group (n=40)	χ²/t value	P value
Gender/n(%)			1.342	0.184
Male	16 (40.0)	22 (55.0)
Female	24 (60.0)	18 (45.0)
Age/year	59.3±12.01	62.4±10.97	-1.186	0.239
BMI/(kg·m^-2)	22.08±3.44	22.64±2.90	-0.781	0.437
Before surgery
CRP/(mg·L^-1)	11.05±29.31	16.86±46.19	-0.671	0.504
K⁺/(mmol·L^-1)	3.91±0.36	3.81±0.32	1.346	0.182
Na⁺/(mmol·L^-1)	140.78±2.84	140.95±2.41	-0.293	0.770
Cl^-/(mmol·L^-1)	105.27±3.44	106.03±3.02	-1.058	0.293
Alb/(g·L^-1)	36.43±4.44	37.53±4.64	-1.083	0.282
PA/(mg·L^-1)	208.84±58.96	222.83±73.58	-0.938	0.351
RBP/(mg·L^-1)	31.33±10.08	35.54±10.47	-1.833	0.071
D-Dimer/(mg·L^-1)	0.58±0.49	0.75±0.63	-1.385	0.170
Pathological type/n(%)			-0.827	0.411
PCN	7 (17.5)	9 (22.5)
Ductal adenocarcinoma	31 (77.5)	29 (72.5)
CP	2 (5.0)	0 (0)
PanIN	0 (0)	1 (2.5)
Duodenal stromal tumor	0 (0)	1 (2.5)

Item	Experimental group (n=40)	Control group (n=40)	χ²/t value	P value
Gender/n(%)			1.342	0.184
Male	16 (40.0)	22 (55.0)
Female	24 (60.0)	18 (45.0)
Age/year	59.3±12.01	62.4±10.97	-1.186	0.239
BMI/(kg·m^-2)	22.08±3.44	22.64±2.90	-0.781	0.437
Before surgery
CRP/(mg·L^-1)	11.05±29.31	16.86±46.19	-0.671	0.504
K⁺/(mmol·L^-1)	3.91±0.36	3.81±0.32	1.346	0.182
Na⁺/(mmol·L^-1)	140.78±2.84	140.95±2.41	-0.293	0.770
Cl^-/(mmol·L^-1)	105.27±3.44	106.03±3.02	-1.058	0.293
Alb/(g·L^-1)	36.43±4.44	37.53±4.64	-1.083	0.282
PA/(mg·L^-1)	208.84±58.96	222.83±73.58	-0.938	0.351
RBP/(mg·L^-1)	31.33±10.08	35.54±10.47	-1.833	0.071
D-Dimer/(mg·L^-1)	0.58±0.49	0.75±0.63	-1.385	0.170
Pathological type/n(%)			-0.827	0.411
PCN	7 (17.5)	9 (22.5)
Ductal adenocarcinoma	31 (77.5)	29 (72.5)
CP	2 (5.0)	0 (0)
PanIN	0 (0)	1 (2.5)
Duodenal stromal tumor	0 (0)	1 (2.5)

Item	Experimental group (n=40)	Control group (n=40)	H/t value	P value
Primary index
The time of first flatus/d	2.88±0.91	3.95±1.68	-3.560	0.001
The time of first defecation/d	3.80±1.30	4.90±1.61	-3.352	0.001
Secondary index
The time of first getting out of bed/d	2.30±0.88	5.18±1.77	-9.205	<0.001
The time of oral drinking/d	2.73±1.20	4.10±1.89	-3.883	<0.001
Gastric tube removal time^①/d	5.32±1.45	6.10±3.12	0.290	0.590
D3 K⁺/(mg·L^-1)	3.89±0.42	3.76±0.44	1.390	0.169
D3 Na⁺/(mg·L^-1)	138.88±3.10	140.79±3.11	-2.745	0.008
D3 Cl^-/(mg·L^-1)	102.87±3.65	104.66±4.19	-2.033	0.045

Item	Experimental group (n=40)	Control group (n=40)	H/t value	P value
Primary index
The time of first flatus/d	2.88±0.91	3.95±1.68	-3.560	0.001
The time of first defecation/d	3.80±1.30	4.90±1.61	-3.352	0.001
Secondary index
The time of first getting out of bed/d	2.30±0.88	5.18±1.77	-9.205	<0.001
The time of oral drinking/d	2.73±1.20	4.10±1.89	-3.883	<0.001
Gastric tube removal time^①/d	5.32±1.45	6.10±3.12	0.290	0.590
D3 K⁺/(mg·L^-1)	3.89±0.42	3.76±0.44	1.390	0.169
D3 Na⁺/(mg·L^-1)	138.88±3.10	140.79±3.11	-2.745	0.008
D3 Cl^-/(mg·L^-1)	102.87±3.65	104.66±4.19	-2.033	0.045

Item	Experimental group (n=40)	Control group (n=40)	χ² value	P value
Safety of early goal directed mobilization/n(%)			0.156	0.692
Number of patients without complications	37 (92.5)	36 (90.0)
Chyle leak	1 (2.5)	1 (2.5)
POPF	1 (2.5)	1 (2.5)
Biliary leak	1 (2.5)	0 (0)
DGE	0 (0)	2 (5.0)