基于循证的三联预康复在口腔癌根治术患者中的应用研究

蒋婕; 梁化坤; 刘璐璐; 徐锦程; 李建成; 李秀川

doi:10.16766/j.cnki.issn.1674-4152.003819

基于循证的三联预康复在口腔癌根治术患者中的应用研究

doi: 10.16766/j.cnki.issn.1674-4152.003819

蒋婕^{1, 2},
梁化坤²,
刘璐璐²,
徐锦程²,
李建成²,
李秀川^3, ,

1.
蚌埠医科大学护理学院，安徽蚌埠 233030
2.
蚌埠医科大学第一附属医院口腔科，安徽蚌埠 233004
3.
蚌埠医科大学第一附属医院护理部

基金项目:

安徽省教育厅研究项目 KJ2021ZD0088

蚌埠医科大学研究生创新项目 Byycx22087

详细信息

通讯作者:
李秀川，E-mail：Lixiuchuan2005@yeah.net

中图分类号: R739.85 R730.9
计量
- 文章访问数: 17
- HTML全文浏览量: 9
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2023-12-26
- 网络出版日期: 2025-01-20

Research on the application of evidence-based triple prehabilitation strategy in patients undergoing radical resection for oral cancer

1.
School of Nursing, Bengbu Medical University, Bengbu, Anhui 233030, China

摘要

摘要: 目的探讨三联预康复对改善口腔癌根治术患者的身心机能及临床结局的效果。方法选取2023年3—11月蚌埠医科大学第一附属医院拟行口腔癌根治术的84例患者为研究对象，采用随机数字表法分为对照组(42例)和干预组(42例)。对照组实施常规护理干预，干预组实施三联预康复干预。比较2组患者机体活动能力、营养水平、焦虑和抑郁及术后临床结局等指标。结果干预组术前1 d的6分钟步行距离(6MWD)明显高于入院第1天，且6MWD、6MWD提升率均明显高于对照组(P＜0.05)；干预组术前1 d、出院前1 d血清前白蛋白(PA)、白蛋白(ALB)和总蛋白(TP)水平均升高，且各项指标均高于对照组(P＜0.05)；2组患者术前1 d医院焦虑抑郁量表(HADS)评分较入院第1天升高，但干预组低于对照组，出院前1 d干预组HADS评分明显低于对照组(P＜0.05)；干预组气管切开后拔管时间、术后首次下床活动时间、术后首次经口进食时间、住院时间、并发症发生率及经济费用均低于对照组(P＜0.05)。结论三联预康复应用于口腔癌根治术患者可以提高术前运动能力，改善围手术期营养状态，缓解焦虑和抑郁，促进术后康复，并在一定程度上优化临床结局。
- 三联预康复 /
- 口腔癌 /
- 康复 /
- 临床结局 /
- 护理
Abstract: Objective To investigate the effectiveness of triple prehabilitation in improving physical and psychological functioning and clinical outcomes in patients undergoing radical oral cancer surgery. Methods A total of eighty-four patients undergoing radical resection at the First Affiliated Hospital of Bengbu Medical University were selected by random number table method to either an intervention group (n=42) or a control group (n=42) from March to November 2023. Patients in the control group received routine nursing, while those in the intervention group received triple prehabilitation intervention. Activity levels, nutritional levels, anxiety and depression, and postoperative clinical outcome indicators were compared between the two groups at baseline and post-intervention. Results In the intervention group, the 6-minute walk distance (6MWD) one day preoperatively was significantly higher than on admission day, with significantly higher 6MWD and improvement rates compared to the control group (P<0.05). The serum levels of serum prealbumin (PA), albumin (ALB) and total protein (TP) in the intervention group were increased one day preoperatively and one day before discharge, all indexes were higher than those in the control group (P<0.05). Hospital anxiety and depression scale (HADS) scores in both intervention and control groups increased from admission to one day preoperatively, but were lower in the intervention group compared to the control group, and significantly lower in the intervention group one day before discharge (P<0.05). The intervention group also experienced shorter times to extubation pots-tracheotomy, first ambulation, first oral intake, lower incidence of complications, and shorter total hospital stay compared to the control group (P<0.05). Conclusion The application of triple prehabilitation in oral cancer radical surgery patients can improve preoperative physical function and perioperative nutritional status, relieve anxiety and depression, promote postoperative recovery, and optimize clinical outcomes to a significant extent.
- Triple prehabilitation /
- Oral cancer /
- Rehabilitation /
- Clinical outcomes /
- Nursing

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表 1 2组口腔癌患者一般资料比较

Table 1. Comparison of general data between the two groups of patients with oral cancer

项目	对照组 (n=42)	干预组 (n=42)	统计量	P值
年龄(x±s，岁)	59.1±13.9	58.6±12.3	0.856^a	0.411
性别[例(%)]			0.808^b	0.369
男性	28(66.7)	24(57.1)
女性	14(33.3)	18(42.9)
身高(x±s，cm)	163.4±10.0	165.0±8.2	0.157^a	0.427
体重(x±s，kg)	65.2±15.1	65.1±14.2	0.635^a	0.976
教育程度[例(%)]			0.587^c	0.557
小学及以下	23(54.8)	25(59.5)
初中	10(23.8)	11(26.2)
中专/高中	7(16.6)	4(9.5)
大学及以上	2(4.8)	2(4.8)
婚姻状况[例(%)]			0.346^b	0.841
未婚	1(2.4)	2(4.8)
已婚	40(95.2)	39(92.8)
离婚	1(2.4)	1(2.4)
职业[例(%)]			3.735^b	0.588
农民	26(61.9)	22(52.4)
工人	5(11.9)	4(9.5)
退休	3(7.1)	6(14.3)
公职人员	0	2(4.8)
无业	6(14.3)	5(11.9)
自由职业	2(4.8)	3(7.1)
吸烟[例(%)]			2.400^b	0.121
从不吸	28(66.7)	21(50.0)
吸烟	14(33.3)	21(50.0)
饮酒[例(%)]			1.817^b	0.178
从不喝	13(31.0)	19(45.2)
喝酒	29(69.0)	23(54.8)
既往史[例(%)]			-0.472^c	0.637
无	22(52.4)	24(57.1)
1种	15(35.7)	14(33.4)
2种及以上	5(11.9)	4(9.5)
组织学类型[例(%)]			0.553^b	0.457
鳞癌	39(92.9)	37(88.1)
腺癌	3(7.1)	5(11.9)
注：^a为t值，^b为χ²值，^c为Z值。既往史包括高血压、糖尿病、心脏病。

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表 2 2组口腔癌患者6MWD比较

Table 2. Comparison of 6MWD between the two groups of patients with oral cancer

组别	例数	6MWD(x±s, m)		6MWD提升 [例(%)]
组别	例数	入院第1天	术前1 d	6MWD提升 [例(%)]
对照组	42	393.10±99.80	400.36±99.57	2(4.8)
干预组	42	409.52±94.93	446.90±99.46^b	11(26.2)
统计量		0.773^a	51.614^c	7.372^d
P值		0.445	< 0.001	0.007
注：^a为t值，^c为F值，^d为χ²值，与同组入院第1天比较, ^bP<0.05。

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表 3 2组口腔癌患者PA、ALB、TP比较(x±s)

Table 3. Comparison of PA, ALB, and TP between the two groups of patients with oral cancer (x±s)

组别	例数	PA(mg/L)
组别	例数	入院第1天	术前1 d	术后7 d	出院前1 d
对照组	42	205.81±57.48	225.00±45.15^a	165.86±48.86	189.52±54.17
干预组	42	198.45±47.66	264.21±61.46^a	198.69±41.84	227.33±44.90^a
F值		0.639	3.332	3.308	3.482
P值		0.525	＜0.001	＜0.001	＜0.001

组别	例数	ALB(g/L)
组别	例数	入院第1天	术前1 d	术后7 d	出院前1 d
对照组	42	40.46±4.39	40.73±3.67	33.47±4.85	36.59±3.11
干预组	42	38.24±4.71	43.41±3.79^a	37.15±4.13	39.05±3.63
F值		1.134	3.296	3.738	3.352
P值		0.666	＜0.001	＜0.001	＜0.001

组别	例数	TP(g/L)
组别	例数	入院第1天	术前1 d	术后7 d	出院前1 d
对照组	42	57.66±6.97	64.18±4.08^a	57.70±5.69	61.83±5.88^a
干预组	42	57.06±5.07	67.23±4.02^a	62.19±6.26	65.96±5.42^a
F值		0.451	3.449	3.443	3.350
P值		0.653	＜0.001	＜0.001	＜0.001
注：与入院第1天比较，^aP＜0.05。

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表 4 2组口腔癌患者HADS评分比较(x±s, 分)

Table 4. Comparison of HADS-A and HADS-D scores between the two groups of patients with oral cancer (x±s, points)

组别	例数	入院第1天		术前1 d		出院前1 d
组别	例数	HADS-A	HADS-D	HADS-A	HADS-D	HADS-A	HADS-D
对照组	42	11.19±2.79	11.33±2.37	19.36±1.40	19.19±0.94	10.14±2.46	11.05±2.63
干预组	42	11.38±2.53	10.79±2.15	18.60±1.31	18.60±1.04	8.93±1.89	9.43±2.61
F值		0.328	1.106	2.584	2.751	2.539	2.834
P值		0.744	0.272	0.012	0.007	0.013	0.006

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表 5 2组口腔癌患者术后临床结局比较

Table 5. Comparison of clinical outcomes between the two groups of patients with oral cancer

组别	例数	气管切开后拔管时间(x±s, d)	术后首次下床活动时间(x±s, d)	术后首次经口进食时间(x±s, d)	并发症 [例(%)]	住院时间 (x±s, d)	经济费用 (x±s, 元)
对照组	42	11.24±2.86	11.49±2.56	15.33±4.52	10(23.8)	31.26±5.97	107 276.23±22 659.45
干预组	42	10.24±1.93	10.47±2.16	12.96±2.42	3(7.1)	28.86±6.05	101 961.27±25 343.73
统计量		5.870^a	6.221^a	2.065^a	4.459^b	5.774^a	3.207^a
P值		＜0.001	＜0.001	0.047	0.035	＜0.001	＜0.001
注：^a为t值，^b为χ²值。

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