消化系统恶性肿瘤术后早期活动安全危险性的文献分析
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摘要
目的探讨外消化系统恶性肿瘤术后早期活动的安全性及危险因素,为临床护理实践和开展相关研究提供参考。方法以"胃肠、肝、胆囊、胰腺、结直肠"及"早期活动、下床活动、离床活动"为中文关键词检索中国生物医学文献数据库、万方、中国期刊全文数据库、维普等中文数据库;以"gastr~*、intestin~*、colo~*、rect~*、liver、hepat~*、gallbladder、pancreat~*"及"early ambulation、early mobilization、out-bed movement、postoperative ambulation、accelerated ambulation"为英文关键词检索Pubmed、Ovid、Em-base、Web of Science、EBSCO、CINAHL和Cochrane Library数据库等。检索时间为建库至2018年8月,重点提取术后首次下床活动时间、安全问题和危险因素等数据。结果共纳入17篇文献,纳入研究中术后早期活动的安全问题主要有伤口疼痛、晕厥或跌倒、直立性低血压或直立不耐受等,危险因素可概括为患者相关和医源性相关的危险因素。结论早期活动可能有利于降低消化道恶性肿瘤术后并发症的发生风险,但尚存在潜在的安全问题,临床实践中需及时评估危险因素,并加强早期活动的安全性管理。
Objective To conduct a review on safety issues and risk factors of early ambulation in postoperative gastrointestinal cancer patients, in order to provide the references for clinical nursing practice and further research.Methods Chinese biomedical literature database,Wanfang,Chinese Journal Full-text database,VIP and other Chinese databases were retrieved by using "gastrointestinal,liver,gallbladder,pancreas,colon and rectum" and "early activity, out-of-bed activity and leaving bed activity" as Chinese keywords.Pubmed,Ovid,Em-base,Web of Science,EBSCO,CINAHL and Cochrane Library databases were retrieved with "gastr~*,intestin~*,colo~*,rect~*,liver,hepat~*,gallbladder,pancreat~*" and "early ambulation, early mobilization,out-bed movement,postoperative ambulation,accelerated ambulation" as English keywords.The retrieval time was from the establishment of the database to August 2018.The data of the first time out-of-bed activity,safety problems and risk factors were extracted.Results A total of 17 literatures were included,the safety issues included incision pain, syncope and orthostatic hypotension,et al.Risk factors were classified into patient-related and iatrogenic factors.Conclusions Early ambulation can possibly reduce the risk of postoperative complications,but there are still potential safety issues.In clinical practice,risk factors should be evaluated timely and the safety management of early ambulation should be strengthened.
Objective To conduct a review on safety issues and risk factors of early ambulation in postoperative gastrointestinal cancer patients, in order to provide the references for clinical nursing practice and further research.Methods Chinese biomedical literature database,Wanfang,Chinese Journal Full-text database,VIP and other Chinese databases were retrieved by using "gastrointestinal,liver,gallbladder,pancreas,colon and rectum" and "early activity, out-of-bed activity and leaving bed activity" as Chinese keywords.Pubmed,Ovid,Em-base,Web of Science,EBSCO,CINAHL and Cochrane Library databases were retrieved with "gastr~*,intestin~*,colo~*,rect~*,liver,hepat~*,gallbladder,pancreat~*" and "early ambulation, early mobilization,out-bed movement,postoperative ambulation,accelerated ambulation" as English keywords.The retrieval time was from the establishment of the database to August 2018.The data of the first time out-of-bed activity,safety problems and risk factors were extracted.Results A total of 17 literatures were included,the safety issues included incision pain, syncope and orthostatic hypotension,et al.Risk factors were classified into patient-related and iatrogenic factors.Conclusions Early ambulation can possibly reduce the risk of postoperative complications,but there are still potential safety issues.In clinical practice,risk factors should be evaluated timely and the safety management of early ambulation should be strengthened.
引文
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[18]江海云,胡心超,谭秀平.临床护理路径在腹部大手术病人术后早期活动中的应用研究[J].护理研究:下旬版,2009,23(10):2752-2753.
[19]张红丽,张红,徐卉.“五步起床法”在腹部恶性肿瘤病人术后初次离床活动中的应用观察[J].护理研究:上旬版,2008,22(12):3115-3116.
[20]BROWNING L,DENEHY L,SCHOLES R L.The quantity of early upright mobilisation performed following upper abdominal surgery is low:an observational study[J].Aust J Physiother,2007,53(1):47-52.
[21]刘少君,周立平,王华.规范活动方式对老年大肠癌术后眩晕的预防作用[J].护理研究:中旬版,2005,19(11B):2392-2393.
[22]王还爱,张景.腹部术后病人不愿早期下床活动的原因分析[J].护理研究,2002,16(5):291.
[23]王雅菁.腹部手术病人早期下床活动的感受及需求的调查[J].护士进修杂志,2002,17(3):236-238.
[24]KARVONEN M J,KENTALA E,MUSTALA O.The effects of training on heart rate:a longitudinal study[J].Ann Med Exp Biol Fenn,1957,35(3):307-315.
[25]KALISCH B J.Missed nursing care:a qualitative study[J].J Nurs Care Qual,2006,21(4):306-313,quiz 314-315.
[26]尹娅红,邢小利,郑秀萍,等.品管圈应用于胃肠道肿瘤病人术后早期下床活动的效果评价[J].护理研究:上旬版,2015,29(5):1619-1621,1622.
[27]JURT J,SLIEKER J,FRAUCHE P,et al.Enhanced recovery after surgery:can we rely on the key factors or do we need the bel ensemble?[J].World J Surg,2017,41(10):2464-2470.
[28]KAUFMANN H.Consensus statement on the definition of orthostatic hypotension,pure autonomic failure and multiple system atrophy[J].Clin Auton Res,1996,6(2):125-126.
[29]MULLER R G,BUNDGAARD-NIELSEN M,KEHLET H.Early post-operative mobilization and orthostatic intolerance[J].Ugeskr Laeger,2011,173(36):2183-2186.
[30]HAINES K J,SKINNER E H,BERNEY S.Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery:an observational cohort study[J].Physiotherapy,2013,99(2):119-125.
[31]MORTENSEN K,NILSSON M,SLIM K,et al.Consensus guidelines for enhanced recovery after gastrectomy:enhanced recovery after surgery [ERAS(R)] society recommendations[J].Br J Surg,2014,101(10):1209-1229.
[32]LASSEN K,COOLSEN M M,SLIM K,et al.Guidelines for perioperative care for pancreaticoduodenectomy:enhanced recovery after surgery (eras?) society recommendations[J].World J Surg,2013,37(2):240-258.
[33]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.
[34]DOHERTY-KING B,BOWERS B.How nurses decide to ambulate hospitalized older adults:development of a conceptual model[J].Gerontologist,2011,51(6):786-797.
[2] LUBAWSKI J,SACLARIDES T.Postoperative ileus:strategies for reduction[J].Ther Clin Risk Manag,2008,4(5):913-917.
[3] SALVIA R,MALLEO G,BUTTURINI G,et al.Perioperative management of patients undergoing pancreatic resection:Implementation of a care plan in a tertiary-care center[J].J Surg Oncol,2013,107(1):51-57.
[4] 肖蔚,唐勇,谭莹,等.肠道手术后患者早期下床活动的集束化护理[J].实用临床护理学电子杂志,2017,2(36):66-69.
[5] Joint Commission International.Joint commission international accreditation standards for hospital[M].4 th ed.Chicago:Joint Commission Resources,2010:1-7.
[6] 中国医院协会.患者安全目标(2017版)细目[EB/OL].[2016-11-20].http://www.360doc.com/content/16/1120/10/36265496_607935371.shtml
[7] GRASS F,PACHE B,MARTIN D,et al.Feasibility of early postoperative mobilisation after colorectal surgery:a retrospective cohort study.[J].Int J Surg,2018(56):161-166.
[8] NI C Y,WANG Z H,HUANG Z P,et al.Early enforced mobilization after liver resection:a prospective randomized controlled trial[J].Int J Surg,2018,54(Pt A):254-258.
[9] HANADA M,TAWARA Y,MIYAZAKI T,et al.Incidence of orthostatic hypotension and cardiovascular response to postoperative early mobilization in patients undergoing cardiothoracic and abdominal surgery[J].BMC Surg,2017,17(1):111.
[10]周慧,蔡慧,倪春燕,等.肝切除术后第2天患者下床活动的可行性研究与效果分析[J].护理学报,2017,24(11):46-48.
[11]VAN DER LEEDEN M,HUIJSMANS R,GELEIJN E,et al.Early enforced mobilisation following surgery for gastrointestinal cancer:feasibility and outcomes[J].Physiotherapy,2016,102(1):103-110.
[12]邢小利,郑秀萍,张淑霞,等.胃癌患者术后早期下床活动状况调查及影响因素分析[J].中华现代护理杂志,2016,22(29):4179-4182.
[13]夏灿灿.加速康复外科胃癌术后患者早期下床活动及术后肠功能恢复的临床研究[D].蚌埠:蚌埠医学院,2016.
[14]邢小利,张淑霞,尹娅红,等.早期安全下床评估标准在胃癌术后患者中的应用效果[J].中华现代护理杂志,2016,22(30):4344-4346,4347.
[15]AHN K Y,HUR H,KIM D H,et al.The effects of inpatient exercise therapy on the length of hospital stay in stages Ⅰ-Ⅲ colon cancer patients:randomized controlled trial[J].Int J Colorectal Dis,2013,28(5):643-651.
[16]刘林,许勤,陈丽.胃肠术后患者首次下床活动状况及其影响因素分析[J].护理学杂志,2013,28(4):17-19.
[17]李晶,路潜.胃肠道恶性肿瘤患者术后早期下床活动现状调查[J].中华现代护理杂志,2012,18(5):500-504.
[18]江海云,胡心超,谭秀平.临床护理路径在腹部大手术病人术后早期活动中的应用研究[J].护理研究:下旬版,2009,23(10):2752-2753.
[19]张红丽,张红,徐卉.“五步起床法”在腹部恶性肿瘤病人术后初次离床活动中的应用观察[J].护理研究:上旬版,2008,22(12):3115-3116.
[20]BROWNING L,DENEHY L,SCHOLES R L.The quantity of early upright mobilisation performed following upper abdominal surgery is low:an observational study[J].Aust J Physiother,2007,53(1):47-52.
[21]刘少君,周立平,王华.规范活动方式对老年大肠癌术后眩晕的预防作用[J].护理研究:中旬版,2005,19(11B):2392-2393.
[22]王还爱,张景.腹部术后病人不愿早期下床活动的原因分析[J].护理研究,2002,16(5):291.
[23]王雅菁.腹部手术病人早期下床活动的感受及需求的调查[J].护士进修杂志,2002,17(3):236-238.
[24]KARVONEN M J,KENTALA E,MUSTALA O.The effects of training on heart rate:a longitudinal study[J].Ann Med Exp Biol Fenn,1957,35(3):307-315.
[25]KALISCH B J.Missed nursing care:a qualitative study[J].J Nurs Care Qual,2006,21(4):306-313,quiz 314-315.
[26]尹娅红,邢小利,郑秀萍,等.品管圈应用于胃肠道肿瘤病人术后早期下床活动的效果评价[J].护理研究:上旬版,2015,29(5):1619-1621,1622.
[27]JURT J,SLIEKER J,FRAUCHE P,et al.Enhanced recovery after surgery:can we rely on the key factors or do we need the bel ensemble?[J].World J Surg,2017,41(10):2464-2470.
[28]KAUFMANN H.Consensus statement on the definition of orthostatic hypotension,pure autonomic failure and multiple system atrophy[J].Clin Auton Res,1996,6(2):125-126.
[29]MULLER R G,BUNDGAARD-NIELSEN M,KEHLET H.Early post-operative mobilization and orthostatic intolerance[J].Ugeskr Laeger,2011,173(36):2183-2186.
[30]HAINES K J,SKINNER E H,BERNEY S.Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery:an observational cohort study[J].Physiotherapy,2013,99(2):119-125.
[31]MORTENSEN K,NILSSON M,SLIM K,et al.Consensus guidelines for enhanced recovery after gastrectomy:enhanced recovery after surgery [ERAS(R)] society recommendations[J].Br J Surg,2014,101(10):1209-1229.
[32]LASSEN K,COOLSEN M M,SLIM K,et al.Guidelines for perioperative care for pancreaticoduodenectomy:enhanced recovery after surgery (eras?) society recommendations[J].World J Surg,2013,37(2):240-258.
[33]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.
[34]DOHERTY-KING B,BOWERS B.How nurses decide to ambulate hospitalized older adults:development of a conceptual model[J].Gerontologist,2011,51(6):786-797.