量化式目标锻炼对食管癌患者微创术后快速康复的效果观察
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摘要
目的探讨食管癌患者微创术后应用量化式目标锻炼对康复速度和质量的影响。方法选取中国人民解放军海军总医院2015年10月—2017年11月行食管癌微创切除术的患者244例,采用随机数字表法分为观察组和对照组各122例,对照组患者术后采取常规护理措施,观察组在常规护理措施的基础上实施量化式目标锻炼。比较2组患者术后下床活动时间及日活动总量、术后康复情况(胃管拔除时间、排气时间、有关并发症的发生率)及住院时间。结果观察组和对照组患者在24 h内分别有86例和46例开始下床活动,观察组患者下床时间略早于对照组(P<0.05);观察组在24 h内、24～36 h、>36 h后这3个观察期间的活动时间也高于对照组(P<0.05);术后第1、2、3、4、5天的日活动总量观察组均不同程度高于对照组(P<0.05);观察组的胃管拔除时间是(58.0±14.8)h早于对照组的(69.0±12.6)h,差异有统计学意义(P<0.05),2组术后排气时间分别是(39.9±17.5)h和(44.8±15.6)h,观察组早于对照组(P<0.05);观察组并发症的发病率(10.65%)低于对照组(19.67%)观察组住院时间(10.6±1.2)d,短于对照组(11.7±1.3)d,差异有统计学意义(P<0.05)。结论微创食管癌切除术后患者采用量化式目标锻炼,可加快患者康复速度、提高康复质量,并缩短住院时间。
Objective To explore the effect of quantitative exercise on recovery speed and recovery quality of patients with esophageal cancer after minimally invasive esophagectomy. Methods A total of 244 esophageal cancer patients who underwent minimally invasive resection in our hospital from October 2015 to November 2017 were collected, and divided randomly and equally into observation group and control group. Patients in control group adopted routine nursing measures and patients in observation group adopted quantitative exercise besides routine nursing measures. Out-of-bed activity time, daily amount of exercise, rehabilitation assessment(the removal time of gastric tuber, intestinal exhaust time, the incidence of post-surgery complications) and post-surgery hospitalization duration. Results A total of 86 cases in observation group and 46 cases in control group had out-of-bed activity in 24 h post surgery, and out-of-bed activity time of patients in observation group is slightly earlier than that in control group(P<0.05). The same results were observed in the amount of out-of-bed activity of 24 h, 24-36 h and >36 h post surgery(P<0.05). The amount of out-of-bed activity of patients in observation group each day during the first five days post surgery were significantly higher than that in the control group(P<0.05). The gastric tuber detaining time of patients in observation group was shorter than that of patients in control group[(58.0±14.8)h vs.(69.0±12.6)h,P<0.05]. The same condition was observed on intestinal exhaust time[(39.9±17.5)h vs.(44.8±15.6)h, P<0.05] and hospitalization time [(10.6±1.2)h vs.(11.7±1.3)h, P<0.05]. The incidence of complications in observation group was lower than that in the control group(10.65% vs. 19.67%, P<0.05). Conclusion Quantitative exercise could accelerate the recovery rate, improve the rehabilitation quality and shorten the length of stay of patients after minimally invasive esophagectomy, and could be applied to clinical practice.
Objective To explore the effect of quantitative exercise on recovery speed and recovery quality of patients with esophageal cancer after minimally invasive esophagectomy. Methods A total of 244 esophageal cancer patients who underwent minimally invasive resection in our hospital from October 2015 to November 2017 were collected, and divided randomly and equally into observation group and control group. Patients in control group adopted routine nursing measures and patients in observation group adopted quantitative exercise besides routine nursing measures. Out-of-bed activity time, daily amount of exercise, rehabilitation assessment(the removal time of gastric tuber, intestinal exhaust time, the incidence of post-surgery complications) and post-surgery hospitalization duration. Results A total of 86 cases in observation group and 46 cases in control group had out-of-bed activity in 24 h post surgery, and out-of-bed activity time of patients in observation group is slightly earlier than that in control group(P<0.05). The same results were observed in the amount of out-of-bed activity of 24 h, 24-36 h and >36 h post surgery(P<0.05). The amount of out-of-bed activity of patients in observation group each day during the first five days post surgery were significantly higher than that in the control group(P<0.05). The gastric tuber detaining time of patients in observation group was shorter than that of patients in control group[(58.0±14.8)h vs.(69.0±12.6)h,P<0.05]. The same condition was observed on intestinal exhaust time[(39.9±17.5)h vs.(44.8±15.6)h, P<0.05] and hospitalization time [(10.6±1.2)h vs.(11.7±1.3)h, P<0.05]. The incidence of complications in observation group was lower than that in the control group(10.65% vs. 19.67%, P<0.05). Conclusion Quantitative exercise could accelerate the recovery rate, improve the rehabilitation quality and shorten the length of stay of patients after minimally invasive esophagectomy, and could be applied to clinical practice.
引文
[1] 胡红军.胸、腹腔镜联合手术与常规开胸手术治疗食管癌的近期疗效比较[J].山东医药,2015,55(5):71-73.
[2] 赵献军,付升旗,刘恒兴,等.食管中上段癌左右侧开胸两种手术径路疗效的比较[J].中国肿瘤临床与康复,2016,23(1):25-29.
[3] 王静,赵黎,周卫萍,等.快速康复理念在脑膜瘤围术期病人护理中的应用价值[J].浙江临床医学,2015,17(10):1840-1841.
[4] 周婷.快速康复护理在胃肠外科中的应用效果探讨[J].现代医药卫生,2017,33(22):3481-3482.
[5] 万康,丁明霞,张兴梅.预注地佐辛联合氟比洛芬酯对胸腔镜肺叶切除的镇痛效果观察[J].中华肺部疾病杂志(电子版),2015,8(6):742-744.
[6] 谢晓阳,王毅,易军.等.单腔、双腔气管插管在胸腔镜联合腹腔镜下食管癌三野根治术中临床应用观察[J].陕西医学杂志,2016,45(7):842-843.
[7] 洪强,姚维深,莫春生,等.左侧卧位、俯卧位胸腹腔镜食管癌切除术后患者肺功能比较[J].山东医药,2015,55(22):78-79.
[8] 李倩,章春芝,祁丽冉,等.食管癌根治术后的优质护理对策及对肺部并发症的影响[J].实用临床医药杂志,2017,21(16):176-178.
[9] 陈元良,徐丽丽,蓝志坚,等.七氟烷与丙泊酚复合瑞芬太尼对老年食管癌根治术后血流动力学水平的影响[J].中华全科医学,2017,15(2):198-201.
[10] HUNG C H,WAND J C,STRICHARTZ G R.Spontaneous chronic pain after experimental thoracotomy by conditioned place preference:morphine differentiates tactile evoked pain from spontaneous Pain[J].J Pain,2015,16(9):903-912.
[11] SOKOL G,VILOZNI D,HAKIMI R,et al.The short-term effect of breathing tasks via an incentive spirometer on lung function compared with autogenic drainage in subjects with cystic fibrosis[J].Respir Care,2015,60(12):1819-1825.
[12] 孙一茜,李健,孔祥静,等.帕瑞昔布钠对食管癌根治术患者炎性因子的影响及其超前镇痛的效果[J].医学临床研究,2017,34(7):1377-1378.
[13] 詹汉丽,高思慧,严敏俊.外科快速康复理念对老年前列腺增生患者术后康复的影响[J].中国煤炭工业医学杂志,2015,18(8):1415-1417.
[14] 盛琍,王敏,刘春容,等.胸部手术患者使用呼吸训练器的健康指导[J].中国实用医药,2015,10(35):248-249.
[15] 袁慧,邓攀.呼吸功能综合训练在食管癌患者围术期中的应用效果[J].实用临床医药杂志,2016,20(20):152-153,170.
[16] 杨泽山.431例老年食管癌患者术后肺部并发症情况及危险因素分析[J].中华全科医学,2015,13(11):1779-1781,1868.
[17] 陈文静,陈雪,张卫民.主动呼吸训练对食管癌术后患者肺功能及生活质量的影响[J].中华物理医学与康复杂志,2014,36(10):769-773.
[18] 王军岐,杨智,付小伟,等.胸腹腔镜联合食管癌根治术治疗老年食管癌的临床疗效及预后分析[J].现代生物医学进展,2015,15(15):2888-2890,2903.
[19] 钟璐颖,罗秋双,谢娜,等.递进式目标护理在股骨颈骨折术后功能康复训练中的应用[J].实用临床医药杂志,2016,20(4):56-58.
[20] 郑香琴.自我护理在食管癌放化疗患者中的应用价值[J].中华全科医学,2017,15(5):890-892.
[21] 韦升余.腹式呼吸训练结合雾化吸入预防食管癌术后肺部感染的护理体会[J].实用临床医药杂志,2013,17(2):11-13.
[2] 赵献军,付升旗,刘恒兴,等.食管中上段癌左右侧开胸两种手术径路疗效的比较[J].中国肿瘤临床与康复,2016,23(1):25-29.
[3] 王静,赵黎,周卫萍,等.快速康复理念在脑膜瘤围术期病人护理中的应用价值[J].浙江临床医学,2015,17(10):1840-1841.
[4] 周婷.快速康复护理在胃肠外科中的应用效果探讨[J].现代医药卫生,2017,33(22):3481-3482.
[5] 万康,丁明霞,张兴梅.预注地佐辛联合氟比洛芬酯对胸腔镜肺叶切除的镇痛效果观察[J].中华肺部疾病杂志(电子版),2015,8(6):742-744.
[6] 谢晓阳,王毅,易军.等.单腔、双腔气管插管在胸腔镜联合腹腔镜下食管癌三野根治术中临床应用观察[J].陕西医学杂志,2016,45(7):842-843.
[7] 洪强,姚维深,莫春生,等.左侧卧位、俯卧位胸腹腔镜食管癌切除术后患者肺功能比较[J].山东医药,2015,55(22):78-79.
[8] 李倩,章春芝,祁丽冉,等.食管癌根治术后的优质护理对策及对肺部并发症的影响[J].实用临床医药杂志,2017,21(16):176-178.
[9] 陈元良,徐丽丽,蓝志坚,等.七氟烷与丙泊酚复合瑞芬太尼对老年食管癌根治术后血流动力学水平的影响[J].中华全科医学,2017,15(2):198-201.
[10] HUNG C H,WAND J C,STRICHARTZ G R.Spontaneous chronic pain after experimental thoracotomy by conditioned place preference:morphine differentiates tactile evoked pain from spontaneous Pain[J].J Pain,2015,16(9):903-912.
[11] SOKOL G,VILOZNI D,HAKIMI R,et al.The short-term effect of breathing tasks via an incentive spirometer on lung function compared with autogenic drainage in subjects with cystic fibrosis[J].Respir Care,2015,60(12):1819-1825.
[12] 孙一茜,李健,孔祥静,等.帕瑞昔布钠对食管癌根治术患者炎性因子的影响及其超前镇痛的效果[J].医学临床研究,2017,34(7):1377-1378.
[13] 詹汉丽,高思慧,严敏俊.外科快速康复理念对老年前列腺增生患者术后康复的影响[J].中国煤炭工业医学杂志,2015,18(8):1415-1417.
[14] 盛琍,王敏,刘春容,等.胸部手术患者使用呼吸训练器的健康指导[J].中国实用医药,2015,10(35):248-249.
[15] 袁慧,邓攀.呼吸功能综合训练在食管癌患者围术期中的应用效果[J].实用临床医药杂志,2016,20(20):152-153,170.
[16] 杨泽山.431例老年食管癌患者术后肺部并发症情况及危险因素分析[J].中华全科医学,2015,13(11):1779-1781,1868.
[17] 陈文静,陈雪,张卫民.主动呼吸训练对食管癌术后患者肺功能及生活质量的影响[J].中华物理医学与康复杂志,2014,36(10):769-773.
[18] 王军岐,杨智,付小伟,等.胸腹腔镜联合食管癌根治术治疗老年食管癌的临床疗效及预后分析[J].现代生物医学进展,2015,15(15):2888-2890,2903.
[19] 钟璐颖,罗秋双,谢娜,等.递进式目标护理在股骨颈骨折术后功能康复训练中的应用[J].实用临床医药杂志,2016,20(4):56-58.
[20] 郑香琴.自我护理在食管癌放化疗患者中的应用价值[J].中华全科医学,2017,15(5):890-892.
[21] 韦升余.腹式呼吸训练结合雾化吸入预防食管癌术后肺部感染的护理体会[J].实用临床医药杂志,2013,17(2):11-13.