老年结直肠癌衰弱患者围手术期运动方案的构建及应用研究

doi:10.3761/j.issn.0254-1769.2024.18.002

摘要/Abstract

摘要：

目的构建老年结直肠癌衰弱患者围手术期运动方案并验证初步应用效果。方法以目标导向理论为理论基础，在文献回顾的基础上，经专家函询后构建老年结直肠癌衰弱患者围手术期运动方案。采用便利抽样法，选取2022年7月—12月在苏州市某三级甲等医院普外科住院的老年结直肠癌衰弱患者为研究对象，进行初步应用。以病区为单位分为试验组和对照组，试验组在接受常规围手术期护理的基础上应用老年结直肠癌衰弱患者围手术期运动方案，对照组接受常规围手术期护理。评价方案的安全性、可行性及干预效果。结果 15名专家进行2轮德尔菲专家函询，权威系数为0.880，变异系数均<0.250，肯德尔和谐系数分别为0.167和0.224（均P<0.001）。最终方案包括术前运动、术后卧床运动、术后坐位运动和术后站立位运动4个阶段。初步应用结果显示，30例患者完成试验。广义估计方程结果显示，两组中文版15项恢复质量量表在交互效应上无统计学差异（P=0.752）；在干预效应和时间效应上得分均有统计学意义（P<0.05）。出院时，两组计时起立行走测试和巴氏指数得分差异均有统计学意义（P<0.05）。试验组2例感到轻微疼痛，未发生其他不良事件。结论该研究基于目标导向理论构建的老年结直肠癌衰弱患者围手术期运动方案具有科学性且安全、可行。在改善患者术后躯体功能、日常生活活动能力和术后早期恢复质量方面得到初步验证。

关键词: 老年人, 结直肠肿瘤, 衰弱, 运动, 围手术期护理

Abstract:

Objective To construct a perioperative exercise program for older frail patients with colorectal cancer，and to verify its effect. Methods Based on Goal-directed Theory and literature review，expert consultation was carried out to establish the perioperative exercise program for older frail patients with colorectal cancer. Then，from July to December 2022，the perioperative exercise program was established for older frail patients with colorectal cancer hospitalized in the General Surgery Department of a tertiary A hospital in Suzhou by convenience sampling method for preliminary application. It was divided in to the intervention group and the control group by the ward. The intervention group was applied with the constructed perioperative exercise program on the basis of routine perioperative nursing. The safety, feasibility and intervention effect of the program were evaluated. Results 15 experts were included for 2 rounds of expert consultations. The authority coefficient was 0.880；the coefficient of variation was <0.250；the Kendall concordance coefficient was 0.167 and 0.224，respectively. The final program contained 4 stages：preoperative exercise, postoperative bed rest，sitting and standing exercise. In the end，54 specific interventions were constructed. During the preliminary application，all the patients completed the program. Generalized estimation equation showed that, on the interaction effect, there was no statistical difference（P=0.752）；there were significant differences on the intervention effect and the time effect（P<0.05）. At discharge，there were significant differences in timed up and go test and Barthel Index between the 2 groups（P<0.05）. Only 2 patients experienced mild pain in the intervention group，and no other adverse events occurred. Conclusion The perioperative exercise program for older frail patients with colorectal cancer，based on Goal-directed Theory，is scientific, reliable and safe. It has been preliminarily verified in improving postoperative physical function，activities of daily living and early postoperative recovery of elderly frail patients with colorectal cancer.

Key words: Aged, Colorectal Neoplasms, Frailty, Exercise, Perioperative Nursing

王朦, 施小青, 陆静, 张越, 吴润达, 尹建花, 刘传道. 老年结直肠癌衰弱患者围手术期运动方案的构建及应用研究[J]. 中华护理杂志, 2024, 59(18): 2189-2196.

WANG Meng, SHI Xiaoqing, LU Jing, ZHANG Yue, WU Runda, YIN Jianhua, LIU Chuandao. Construction and preliminary application of a Perioperative Exercise Program for Frail Elderly Patients with Colorectal Cancer based on the goal-directed therapy[J]. Chinese Journal of Nursing, 2024, 59(18): 2189-2196.

图/表 4

表1 老年结直肠癌衰弱患者围手术期运动方案

Table 1 The perioperative exercise program of elderly patients with colorectal cancer

表2 两组一般资料的比较 [例(百分比,%)]

Table 2 General baseline data of 2 groups of patients [case(percentage,%)]

表3 两组计时起立行走测试、握力和巴氏指数得分的比较

Table 3 Comparison of TUG， grip and BI score between 2 groups before and after intervention

表4 两组中文版15项恢复质量量表得分的比较（分，$\bar{x} \pm s$）

Table 4 Comparison of QoR-15 score between 2 groups before and after intervention（score，$\bar{x} \pm s$）

参考文献 24

[1]	Clegg A, Young J, Iliffe S, et al. Frailty in elderly people[J]. Lancet, 2013, 381(9868):752-762. DOI PMID
[2]	Richards S, Cherry TJ, Frizelle FA, et al. Pre-operative frailty is predictive of adverse post-operative outcomes in colorectal cancer patients[J]. ANZ J Surg, 2021, 91(3):379-386.
[3]	Zhao H, Lu X, Zheng S, et al. Comparison of two frailty screening tools in older patients with colorectal cancer[J]. BMC Geriatr, 2023, 23(1):295. DOI PMID
[4]	陈思芮, 陈海林, 杨雪梅, 等. 老年结直肠癌患者术前衰弱与术后并发症的相关性[J]. 中华老年多器官疾病杂志, 2023, 22(2):119-123.
	Chen SR, Chen HL, Yang XM, et al. Correlation between preop-erative frailty and postoperative complications in elderly pa-tients with colorectal cancer[J]. Chin J Mult Organ Dis Elderly, 2023, 22(2):119-123.
[5]	Mcgovern J, Grayston A, Coates D, et al. The relationship between the Modified Frailty Index score(mFI-5),malnutrition,body composition,systemic inflammation and short-term clinical outcomes in patients undergoing surgery for colorectal cancer[J]. BMC Geriatr, 2023, 23(1):9.
[6]	Zhang LM, Hornor MA, Robinson T, et al. Evaluation of postoperative functional health status decline among older adults[J]. JAMA Surg, 2020, 155(10):950-958.
[7]	张爽, 陈影, 孙娜雅, 等. 综合运动训练对老年糖尿病患者衰弱和躯体功能的影响[J]. 中华护理杂志, 2020, 55(10):1445-1451. DOI URL
	Zhang S, Chen Y, Sun NY, et al. Effects of multi-component exercise training on frailty and physical function in elderly diabetic patients in communities[J]. Chin J Nurs, 2020, 55(10):1445-1451. DOI URL
[8]	Saur NM, Davis BR, Montroni I, et al. The American society of colon and rectal surgeons clinical practice guidelines for the perioperative evaluation and management of frailty among older adults undergoing colorectal surgery[J]. Dis Colon Rectum, 2022, 65(4):473-488. DOI PMID
[9]	中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021)(五)[J]. 协和医学杂志, 2021, 12(5):658-665.
	Chinese Society of Surgery,Chinese Society of Anesthesiology. Clinical practice guidelines for ERAS in China(2021)(Ⅴ)[J]. Med J PUMC Hosp, 2021, 12(5):658-665.
[10]	Nguyen HB, Jaehne AK, Jayaprakash N, et al. Early goal-directed therapy in severe sepsis and septic shock:insights and comparisons to ProCESS,ProMISe,and ARISE[J]. Crit Care, 2016, 20(1):160.
[11]	国家卫生健康委员会医政医管局, 中华医学会肿瘤学分会. 中国结直肠癌诊疗规范(2020年版)[J]. 中国实用外科杂志, 2020, 40(6):601-625.
	National Health Commission of the People’s Republic of China,Chinese Society of Oncology. Chinese protocol of diagnosis and treatment of colorectal cancer(2020 edition)[J]. Chin J Pract Surg, 2020, 40(6):601-625.
[12]	Julious SA. Sample size of 12 per group rule of thumb for a pilot study[J]. Pharm Stat, 2005, 4(4):287-291.
[13]	Cummings SR, Studenski S, Ferrucci L. A diagnosis of dismobility-giving mobility clinical visibility:a mobility working group recommendation[J]. JAMA, 2014, 311(20):2061-2062. DOI PMID
[14]	Mahoney FI, Barthel DW. Functional evaluation:the Barthel Index[J]. Md State Med J, 1965,14:61-65.
[15]	侯东哲, 张颖, 巫嘉陵, 等. 中文版Barthel指数的信度与效度研究[J]. 临床荟萃, 2012, 27(3):219-221.
	Hou DZ, Zhang Y, Wu JL, et al. Study on the reliability and validity of the Chinese Barthel Index[J]. Clin Focus, 2012, 27(3):219-221.
[16]	林雨轩. 恢复质量量表QoR-15用于肝切除术后患者早期恢复质量的评估[D]. 长沙: 中南大学, 2014.
	Lin YX. The use of 15-item Quality of Recovery Scale in the evaluation of early postoperative quality of recovery after liver resection[D]. Changsha: Central South University, 2014.
[17]	Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications:five-year experience[J]. Ann Surg, 2009, 250(2):187-196. DOI PMID
[18]	李秋萍, 韩斌如. 衰弱评估联合麻醉分级对老年患者术后并发症的预测研究[J]. 中华护理杂志, 2019, 54(5):645-648. DOI URL
	Li QP, Han BR. Prediction of postoperative complications in elderly patients using frailty assessment combined with American Society of Anesthesiologists physical classification[J]. Chin J Nurs, 2019, 54(5):645-648. DOI URL
[19]	李梦玲. 基于循证构建宫颈癌根治术后间歇导尿患者延续护理方案及初步应用[D]. 重庆: 重庆医科大学, 2020.
	Li ML. Construction and implementation of the transitional care program for patients with intermittent catheterization after radical hysterectomy of cervical cancer[D]. Chongqing: Chongqing Medical University, 2020.
[20]	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.
[21]	Molenaar CJ, van Rooijen SJ, Fokkenrood HJ, et al. Prehabilitation versus no prehabilitation to improve functional capacity,reduce postoperative complications and improve quality of life in colorectal cancer surgery[J]. Cochrane Database Syst Rev, 2022,5:D13259.
[22]	Bruns E, Argillander TE, Schuijt HJ, et al. Fit 4-surgery TV at-home prehabilitation for frail older patients planned for colorectal cancer surgery:a pilot study[J]. Am J Phys Med Rehabil, 2019, 98(5):399-406.
[23]	Wang YC, Liang CK, Chou MH, et al. The effectiveness of frailty intervention for older patients with frailty during hospitalization[J]. J Nutr Health Aging, 2023, 27(6):413-420. DOI PMID
[24]	Ommundsen N, Wyller TB, Nesbakken A, et al. Preoperative geriatric assessment and tailored interventions in frail older patients with colorectal cancer:a randomized controlled trial[J]. Colorectal Dis, 2018, 20(1):16-25. DOI PMID