胃癌患者术后抗阻运动方案的构建与应用研究

doi:10.3761/j.issn.0254-1769.2025.13.007

摘要/Abstract

摘要：

目的构建胃癌患者术后抗阻运动方案并探讨其应用效果，旨在为临床护理实践提供借鉴。方法基于互动达标理论，通过文献研究、专家会议、预试验构建胃癌患者术后抗阻运动方案。采用便利抽样法，选取在浙江省某三级甲等医院胃外科拟行胃癌根治术的患者为研究对象，2024年1月—3月住院的36例患者作为试验组，2023年11月—12月住院的36例患者作为对照组。试验组在常规快速康复外科护理的基础上接受抗阻运动方案干预，对照组接受常规快速康复外科护理。术前1天、术后第3天、术后第7天，采用安德森症状评估量表-胃肠道肿瘤特异性模块、癌症治疗功能评价量表-共性模块进行评估，并统计不良事件发生率。结果方案应用过程中，试验组、对照组各剔除1例，最终纳入70例。广义估计方程分析结果显示，两组手术相关症状群及能量缺乏症状群时间与组间存在交互效应（P<0.05）；简单效应分析显示，术后第7天，试验组、对照组的手术相关症状群得分分别为3（1,5）、5（3,9）分，能量缺乏症状群得分分别为6（8，18）、14（8，19）分，差异具有统计学意义（P<0.05）。术后第7天，试验组、对照组的生活质量得分分别为（82.06±9.89）（73.86±13.08）分，差异具有统计学意义（P=0.004）。两组均未发生不良事件。结论该研究构建的胃癌患者术后抗阻运动方案具有科学性、安全性及可行性，可改善胃癌术后患者手术相关症状群及能量缺乏症状群，并提高其生活质量。

关键词: 胃癌, 症状群, 抗阻运动, 症状管理, 生活质量, 护理

Abstract:

Objective To construct a postoperative resistance exercise program for patients with gastric cancer，and to explore its intervention effect on symptom clusters and quality of life. Methods Based on the interactive attainment theory，the resistance exercise program was constructed through literature analysis and expert meeting method，and the feasibility of the program was confirmed through pre-experiments. The patients undergoing radical gastrectomy in the Department of Gastric Surgery of a tertiary hospital in Zhejiang province were selected as the study subjects by convenience sampling method，with 36 patients from November to December 2023 as the control group and 36 patients from January to March 2024 as the experimental group，and the intervention continued for 7 days. The experimental group received a resistance exercise program on the basis of conventional rapid recovery surgical care，and the control group received routine rapid recovery surgical care. On the first day before surgery，the 3rd postoperative day，and the 7th postoperative day，the Anderson Symptom Assessment Scale-Gastrointestinal Tumor-Specific Module Scale and the Functional Assessment of Cancer Therapy-General were used for evaluation. Results During the application of the program，a case was excluded from the experimental group，and a case was excluded from the control group. Ultimately，70 patients were included. The results of generalized estimating equation showed that there was an interaction effect between the 2 groups in the surgery-related symptom cluster and the energy deficiency symptom cluster（P<0.05）. Simple effect analysis showed that on the 7th day after surgery，the scores of the surgery-related symptom cluster in the experimental group and the control group were 3（1，5） and 5（3，9） respectively，and the scores of the energy deficiency symptom cluster were 6（8，18） and 14（8，19） respectively，with statistically significant differences（P<0.05）. The quality of life scores of the experimental group and the control group were（82.06 ± 9.89） and（73.86 ± 13.08） respectively，with statistically significant differences（P=0.004）. No adverse events occurred in either group. Conclusion The resistance exercise program is scientific，safe and feasible，which can improve the surgery-related symptoms and energy deficiency symptoms，and improve the quality of life of patients with gastric cancer after surgery.

Key words: Gastric Cancer, Symptom Clusters, Resistance Exercise, Symptom Management, Quality of Life, Nursing Care

王杉珊, 吴婉英, 梁冠冕, 付欢英, 葛娇宇. 胃癌患者术后抗阻运动方案的构建与应用研究[J]. 中华护理杂志, 2025, 60(13): 1573-1580.

WANG Shanshan, WU Wanying, LIANG Guanmian, FU Huanying, GE Jiaoyu. Construction and application of a postoperative resistance exercise program for gastric cancer patients[J]. Chinese Journal of Nursing, 2025, 60(13): 1573-1580.

图/表 4

表1 胃癌患者术后抗阻运动方案

Table 1 Postoperative resistance exercise program for gastric cancer patients

表2 两组一般资料的比较

Table 2 Comparison of general data between the 2 groups

表3 两组干预前后症状群严重程度的比较[分，M（P725，P75）]

Table 3 Comparison of symptom clusters between the 2 groups before and after intervention[scores，M（P725，P75）]

表4 两组干预前后生活质量得分的比较（分，$\bar{x}±s$）

Table 4 Comparison of quality of life scores between 2 groups before and after intervention（scores，$\bar{x}±s$）

参考文献 28

[1]	郑荣寿, 陈茹, 韩冰峰, 等. 2022年中国恶性肿瘤流行情况分析[J]. 中华肿瘤杂志, 2024, 46(3):221-231.
	Zheng RS, Chen R, Han BF, et al. Analysis on the prevalence of malignant tumors in China in 2022[J]. Chin J Oncol, 2024, 46(3):221-231.
[2]	Dodd MJ, Miaskowski C, Paul SM. Symptom clusters and their effect on the functional status of patients with cancer[J]. Oncol Nurs Forum, 2001, 28(3):465-470.
[3]	陈鑫容, 常承婷, 杨婕, 等. 胃癌患者围术期症状群的研究进展[J]. 护理学报, 2023, 30(1):33-36.
	Chen XR, Chang CT, Yang J, et al. Research progress of perioperative symptom groups in patients with gastric cancer[J]. J Nurs(China), 2023, 30(1):33-36.
[4]	《消化道肿瘤患者运动干预专家共识》工作组, 刘慧钰, 李然. 消化道肿瘤患者运动干预专家共识[J]. 河北体育学院学报, 2024, 38(2):1-7.
	Expert Consensus on Exercise Interventions for Patients with Digestive System Neoplasm Work Group, Liu HY, Li R. Expert consensus on exercise interventions for patients with digestive system neoplasm[J]. J Hebei Sport Univ, 2024, 38(2):1-7.
[5]	李梅霞, 李智, 龚姝. 对腹部手术患者术后早期下床活动阻碍因素的认知调查分析[J]. 中华现代护理杂志, 2020, 26(3):311-315.
	Li MX, Li Z, Gong S. Cognitive investigation and analysis of obstacles to getting out of bed early after abdominal surgery[J]. Chin J Mod Nurs, 2020, 26(3):311-315.
[6]	刘凤春, 孟茜, 宋晓萌, 等. 基于互动达标理论的八段锦运动在帕金森病病人中的应用[J]. 护理研究, 2023, 37(18):3388-3391.
	Liu FC, Meng Q, Song XM, et al. The application of Baduanjin exercise in patients with Parkinson's disease based on the theory of interactive standard[J]. Chin Nurs Res, 2023, 37(18):3388-3391.
[7]	Rock CL, Thomson CA, Sullivan KR, et al. American Cancer Society nutrition and physical activity guideline for cancer survivors[J]. CA Cancer J Clin, 2022, 72(3):230-262.
[8]	Hayes SC, Newton RU, Spence RR, et al. The exercise and sports science Australia position statement:exercise medicine in cancer management[J]. J Sci Med Sport, 2019, 22(11):1175-1199.
[9]	Miaskowski C, Barsevick A, Berger A, et al. Advancing symptom science through symptom cluster research:expert panel proceedings and recommendations[J]. J Natl Cancer Inst, 2017, 109(4):djw253.
[10]	丛明华, 石汉平. 中国恶性肿瘤患者运动治疗专家共识[J]. 中国科学:生命科学, 2022, 52(4):587-602.
	Cong MH, Shi HP. Consensus of Chinese experts on exercise therapy for cancer patients[J]. Sci China Life Sci, 2022, 52(4):587-602.
[11]	王朦, 陆静, 尹如兰, 等. 结直肠术后患者加速康复护理中实施早期活动的范围综述[J]. 护理学杂志, 2023, 38(9):22-26.
	Wang M, Lu J, Yin RL, et al. Early mobilization in enhanced recovery after surgery programs for colorectal patients:a scoping review[J]. J Nurs Sci, 2023, 38(9):22-26.
[12]	梅凡. 腹腔镜胃癌根治术后患者早期活动方案的构建及实证研究[D]. 兰州: 兰州大学, 2022.
	Mei F. Construction and empirical study of early activity program for patients after laparoscopic radical gastrectomy for gastric cancer[D]. Lanzhou: Lanzhou University, 2022.
[13]	顾一帆, 吴茜, 汪夏云, 等. 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 YF, Wu Q, Wang XY, et al. Effect of early bed resistance exercise on postoperative rehabilitation in patients with gastrointestinal tumors[J]. Chin J Nurs, 2023, 58(12):1462-1468.
[14]	王硕, 姜灿, 张晓雪, 等. 早期渐进式抗阻运动方案对胰腺手术术后患者临床结局的影响及安全性评价[J]. 中国护理管理, 2021, 21(3):325-330.
	Wang S, Jiang C, Zhang XX, et al. Effects of early progressive resistance exercise program on the clinical outcome of patients after pancreatic surgery and its safety evaluation[J]. Chin Nurs Manag, 2021, 21(3):325-330.
[15]	Tanaka K, Taoda A, Kashiwagi H. Resistance exercise after laparoscopic surgery enhances improvement in exercise tolerance in geriatric patients with gastrointestinal cancer[J]. Cureus, 2021, 13(6):e15454.
[16]	Schram A, Ferreira V, Minnella EM, et al. In-hospital resistance training to encourage early mobilization for enhanced recovery programs after colorectal cancer surgery:a feasibility study[J]. Eur J Surg Oncol, 2019, 45(9):1592-1597.
[17]	de Almeida EM, de Almeida JP, Landoni G, et al. Early mobilization programme improves functional capacity after major abdominal cancer surgery:a randomized controlled trial[J]. Br J Anaesth, 2017, 119(5):900-907.
[18]	张莉. 足反射疗法联合音乐疗法对胃癌术后患者症状群及生活质量的影响[D]. 呼和浩特: 内蒙古医科大学, 2020.
	Zhang L. Effect of foot reflex therapy combined with music therapy on symptom groups and quality of life of patients with gastric cancer after operation[D]. Hohhot: Inner Mongolia Medical University, 2020.
[19]	Wang XS, Williams LA, Eng C, et al. Validation and application of a module of the M. D. Anderson Symptom Inventory for measuring multiple symptoms in patients with gastrointestinal cancer(the MDASI-GI)[J]. Cancer, 2010, 116(8):2053-2063.
[20]	陈仁旺. MDASI-GI中文版的信效度检验及临床应用研究[D]. 武汉: 华中科技大学, 2019.
	Chen RW. Reliability and validity test and clinical application of MDASI-GI Chinese version[D]. Wuhan: Huazhong University of Science and Technology, 2019.
[21]	Cella DF, Tulsky DS, Gray G, et al. The Functional Assessment of Cancer Therapy Scale:development and validation of the general measure[J]. J Clin Oncol, 1993, 11(3):570-579.
[22]	万崇华, 孟琼, 汤学良, 等. 癌症患者生命质量测定量表FACT-G中文版评介[J]. 实用肿瘤杂志, 2006, 21(1):77-80.
	Wan CH, Meng Q, Tang XL, et al. A review of the Chinese version of FACT-G,a quality of life scale for cancer patients[J]. J Pract Oncol, 2006, 21(1):77-80.
[23]	张丽丽, 韩明强, 崔占斌, 等. 中文版FACT-G量表在肿瘤患者生命质量评价中的适用性研究[J]. 中国卫生统计, 2022, 39(2):243-245.
	Zhang LL, Han MQ, Cui ZB, et al. Study on the applicability of Chinese version of FACT-G scale in evaluating the quality of life of tumor patients[J]. Chin J Health Stat, 2022, 39(2):243-245.
[24]	Lin YF, Docherty SL, Porter LS, et al. Common and cooccurring symptoms experienced by patients with gastric cancer[J]. Oncol Nurs Forum, 2020, 47(2):187-202.
[25]	Fenton S, Burrows TL, Collins CE, et al. Efficacy of a multi-component m-health diet,physical activity,and sleep intervention on dietary intake in adults with overweight and obesity:a randomised controlled trial[J]. Nutrients, 2021, 13(7):2468.
[26]	龚明俊, 唐桥, 谭思洁, 等. 运动干预对睡眠障碍的影响及作用机制研究进展[J]. 四川大学学报(医学版), 2024, 55(1):236-242.
	Gong MJ, Tang Q, Tan SJ, et al. Research progress in the effect of exercise intervention on sleep disorders and the mechanisms involved[J]. J Sichuan Univ Med Sci, 2024, 55(1):236-242.
[27]	江成琼, 郭忠琴, 徐栏. 多模态运动对鼻咽癌患者放疗期症状群和营养状况的改善作用[J]. 中国实用护理杂志, 2020, 36(21):1622-1627.
	Jiang CQ, Guo ZQ, Xu L. Effect of multimodal exercise on symptom groups and nutritional status of nasopharyngeal carcinoma patients during radiotherapy[J]. Chin J Pract Nurs, 2020, 36(21):1622-1627.
[28]	马景双, 王爱平, 王艳杰, 等. 基于前哨症状的肺癌术后化疗患者护理干预方案的构建及应用[J]. 中华护理杂志, 2024, 59(2):133-141.
	Ma JS, Wang AP, Wang YJ, et al. Intervention study of lung cancer patients undergoing postoperative chemotherapy based on sentinel symptoms[J]. Chin J Nurs, 2024, 59(2):133-141.