早期床上抗阻运动对胃肠道肿瘤患者术后康复护理的影响

doi:10.3761/j.issn.0254-1769.2023.12.008

摘要/Abstract

摘要：

目的探讨早期床上抗阻运动对胃肠道肿瘤患者术后康复护理的影响。方法采用方便抽样法，选取2021年1月—12月在上海市某三级甲等医院胃肠外科接受胃肠道肿瘤手术治疗的150例患者作为研究对象，采用随机数字表法将患者分为试验组74例和对照组76例，试验组给予术后早期床上抗阻运动方案，对照组给予术后早期离床活动方案，在干预后分别比较两组疼痛评分、惯用手握力、消化道功能恢复时间、导管留置时间、术后住院时间、住院费用的差异，并评价抗阻运动的安全性。结果试验组干预后惯用手握力增加，差异具有统计学意义（P=0.017）；对照组首次排气时间早于试验组，差异具有统计学意义（P=0.032）；两组术后疼痛评分、导管留置时间、住院天数、住院费用比较，差异均无统计学意义（P>0.05）；试验组在运动后心率波动的患者例数与体力不支的患者例数少于对照组，差异均具有统计学意义（P<0.05），且在活动中未发生严重不良事件。结论早期床上抗阻运动可以增加胃肠道肿瘤术后患者的肌肉力量；降低早期活动后心率波动及乏力的症状，可以促进胃肠道肿瘤患者术后康复。

关键词: 胃肠道肿瘤, 抗阻运动, 早期活动, 快速康复, 护理

Abstract:

Objective To investigate the effect of early bed resistance exercise on postoperative rehabilitation in patients with gastrointestinal tumors. Methods By random sampling of experimental study design，150 patients who received gastrointestinal tumor surgery were selected from a tertiary A hospital in Shanghai during January to December 2021. The random number table method was employed to divide them into a test group with 74 cases and a control group with 76 cases. The test group received the postoperative early bed resistance exercise. The control group was given the early postoperative ambulation protocol. The differences in pain score，dominant hand grip strength，time to recovery of digestive tract function，catheter retention time，postoperative hospitalization time after the intervention were compared，and the safety of resistance exercise was evaluated. Results In the postoperative rehabilitation index of the 2 groups，the increase in dominant hand grip strength after the intervention was greater than that before the intervention（P=0.017）；the first exhaust time in the control group was earlier than that in the test group（P=0.032）；the remaining indicators included postoperative pain scores，catheter indwelling time，hospital days，hospitalization costs in both groups，and the differences were not statistically significant（P>0.05）. The number of patients with heart rate fluctuation after exercise and those with physical exhaustion was less than that of the control group，and all the differences were statistically significant（P<0.05），and no serious personal injury or serious adverse events occurred during the activities. Conclusion Early bed resistance exercise can increase muscle strength after gastrointestinal tumors，reduce heart rate fluctuation and fatigue after early activity and pro-mote postoperative recovery of gastrointestinal tumors.

Key words: Gastrointestinal Tumor, Resistance Exercise, Early Activity, Rapid Recovery, Nursing Care

顾一帆, 吴茜, 汪夏云, 周杰. 早期床上抗阻运动对胃肠道肿瘤患者术后康复护理的影响[J]. 中华护理杂志, 2023, 58(12): 1462-1468.

GU Yifan, WU Qian, WANG Xiayun, ZHOU Jie. Effect of early bed resistance exercise on postoperative rehabilitation in patients with gastrointestinal tumors[J]. Chinese Journal of Nursing, 2023, 58(12): 1462-1468.

图/表 5

表1 两组一般资料比较

Table 1 Comparison of general data in 2 groups

表2 两组活动时疼痛评分比较[分，M（P25，P75）]

Table 2 Comparison of pain scores during activity in 2 groups[score，M（P25，P75）]

表 3 两组干预前后惯用手握力指标比较（kg，$\bar{x}\pm s$）

Table 3 Comparison of dominant hand grip strength index in 2 groups before and after intervention（kg，$\bar{x}\pm s$）

表4 两组康复指标比较[M（P25，P75）]

Table 4 Comparison of rehabilitation indicators in 2 groups[M（P25，P75）]

表5 两组运动干预安全性评价比较[例（百分率，%）]

Table 5 Evaluation of intervention safety in 2 groups[case（pencentage，%）]

参考文献 21

[1]	Hyuna S, Jacques F, Rebecca L, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):1-41. DOI URL
[2]	陈凛, 陈亚进, 董海龙, 等. 加速康复外科中国专家共识及路径管理指南(2018版)[J]. 中国实用外科杂志, 2018, 38(1):1-20.
	Chen L, Chen YJ, Dong HL, et al. Chinese expert consensus and path management guidelines for accelerated rehabilitation surgery(2018 edition)[J]. Chin J Pract Surg, 2018, 38(1):1-20.
[3]	吴茜, 汪夏云, 顾一帆, 等. 胃肠道肿瘤患者术后早期下床活动现状及影响因素分析[J]. 护理学杂志, 2021, 36(15):27-29.
	Wu Q, Wang XY, Gu YF, et al. Analysis of early postoperative implantation activity status and influencing factors in patients with gastrointestinal tumors[J]. J Nurs Sci, 2021, 36(15):27-29.
[4]	刘丽. 快速康复外科护理对胃肠外科患者术后胃肠功能恢复及并发症发生率的影响[J]. 临床医药文献电子杂志, 2020, 7(50):95,104.
	Li L. Effect of rapid rehabilitation surgical care on postoperative gastrointestinal function recovery and complications rate in gastrointestinal surgery patients[J]. J Clin Med Lit, 2020, 7(50):95,104.
[5]	Hu Y, McArthur A, Yu ZH. Early postoperative mobilization in patients undergoing abdominal surgery:a best practice implementation project[J]. JBI Database System Rev Implement Rep, 2019, 17(12):2591-2611. DOI URL
[6]	de Almeida JP, Landoni G, et al. Early mobilization programme improves functional capacity after major abdominal cancer surgery:a randomized controlled trial[J]. Brit J Anaesth, 2017, 119(5):900-907. DOI URL
[7]	吕陈卉, 李冬果. 医学统计方法及SPSS实现[M]. 北京: 科学出社, 2016:1-334.
	Lü CH, Li DG. Medical statistical methods and SPSS implementation[M]. Beijing: Science Publishing Association, 2016:1-334.
[8]	丁佳凤, 朱渊. 早期抗阻力训练对冠状动脉旁路移植术后患者康复的影响[J]. 护理学杂志, 2022, 37(14):94-96.
	Ding JF, Zhu Y. Effect of early antiresistance training on patient recovery after coronary artery bypass grafting[J]. J Nurs Sci, 2022, 37(14):94-96.
[9]	王英杰, 乔然, 于彤, 等. 低负荷小强度抗阻运动对卧床老年患者肌力和心肺功能的影响[J]. 中华护理杂志, 2021, 56(11):1605-1611. DOI URL
	Wang YJ, Qiao R, Yu T, et al. Effect of low-load small-intensity resistance exercise on muscle strength and cardiopulmonary function in bedridden elderly patients[J]. Chin J Nurs, 2021, 56(11):1605-1611.
[10]	罗细菊, 邓思妍, 陈静, 等. 9种运动方式对提高血液透析患者透析充分性效果的网状Meta分析[J]. 中华护理杂志, 2022, 57(23):2921-2929. DOI URL
	Luo XJ, Deng SY, Chen J, et al. Reticular Meta-analysis of the effect of nine exercise modalities on improving dialysis adequacy in hemodialysis patients[J]. Chin J Nurs, 2022, 57(23):2921-2929.
[11]	孙烯辉, 杨丽, 黄德斌, 等. 床上脚踏车运动在住院卧床患者中应用的研究现状[J]. 中国护理管理, 2020, 20(1):151-155.
	Sun XH, Yang L, Huang DB, et al. Current status of the application of bed bicycle exercise in hospitalized bedridden patients[J]. Chin Nurs Manag, 2020, 20(1):151-155.
[12]	Hodgson CL, Stiller K, Needham DM, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults[J]. Crit Care (London,England), 2014, 18(6):658-667. DOI URL
[13]	张俊峰, 蔡莹莹, 郑可欣, 等. 术后急性疼痛患者自控镇痛管理相关指南的系统评价[J]. 中华护理杂志, 2021, 56(12):1868-1875. DOI URL
	Zhang JF, Cai YY, Zheng KX, et al. Systematic evaluation of guidelines related to the management of controlled analgesia in patients with postoperative acute pain[J]. Chin J Nurs, 2021, 56(12):1868-1875.
[14]	赵玉沛, 熊利泽. 加速康复外科中国专家共识暨路径管理指南(2018)[J]. 中华麻醉学杂志, 2018, 38(1):8-13.
	Zhao YP, Xiong LZ. Chinese expert consensus and path management guidelines for accelerating rehabilitation surgery (2018)[J]. Chin J Anesthesiol, 2018, 38(1):8-13.
[15]	刘冰心, 郭婷. 胃癌手术患者快速康复外科护理中量化活动方案的实施[J]. 护理学杂志, 2018, 33(10):27-30.
	Liu BX, Guo T. Implementation of quantitative activity programs in surgical care for rapid rehabilitation of patients undergoing gastric cancer surgery[J]. J Nurs Sci, 2018, 33(10):27-30.
[16]	高万露, 汪小海. 视觉模拟疼痛评分研究的进展[J]. 医学研究杂志, 2013, 42(12):144-146.
	Gao WL, Wang XH. Progress in visual analog pain score studies[J]. J Res Med Sci, 2013, 42(12):144-146.
[17]	Buchan J, Janda M, Box R, et al. A randomized trial on the effect of exercise mode on breast cancer-related lymphedema[J]. Med Sci Sports Exerc, 2016, 48(10):1866-1874. DOI URL
[18]	沈晓雯, 郑小芬, 董宁, 等. 有氧运动结合抗阻运动对恶性肿瘤患儿干预效果的Meta分析[J]. 中华护理杂志, 2021, 56(12):1846-1851. DOI URL
	Shen XW, Zheng XF, Dong N, et al. The effect of aerobic combined resistance exercise in children with malignant tumora meta-analysis[J]. Chin J Nurs, 2021, 56(12):1846-1851.
[19]	李呈, 孟爱凤, 程芳, 等. 抗阻运动对乳腺癌术后患者上肢淋巴水肿和肌肉力量影响的系统评价[J]. 护理学杂志, 2018, 33(9):97-101.
	Li C, Meng AF, Cheng F, et al. Systematic evaluation of the effects of resistance exercise on upper limb lymphedema and muscle strength in patients after breast cancer[J]. J Nurs Sci, 2018, 33(9):97-101.
[20]	陈巧玲, 赵慧玲, 邱文抒, 等. SICU重症患者身体功能和活动能力调查分析[J]. 护理学杂志, 2019, 34(7):12-15.
	Chen QL, Zhao HL, Qiu WS, et al. Investigation and analysis of physical function and mobility in severe SICU patients[J]. J Nurs Sci, 2019, 34(7):12-15.
[21]	张雨欣, 张开利. 老年人恐惧跌倒相关性活动限制的研究进展[J]. 中华护理杂志, 2023, 58(1):112-116. DOI URL
	Zhang YX, Zhang KL. Progress in the fear of fall-related activity limitations among older adults[J]. Chin J Nurs, 2023, 58(1):112-116.