Analyses of status and influencing factors of early ambulation in patients with gastric cancer under enhanced recovery surgery mode_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIONG Fangli ¹ , HE Yuhua ² ,  JIANG Xiaolian ³

1. West China School of Nursing, Sichuan University / Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Colorectal Cancer Center, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu 610041, P. R. China;
3. West China School of Nursing, Sichuan University / West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

JIANG Xiaolian, Email: jiang_xiaolian@126.com

Keywords：

enhanced recovery after surgery; gastric cancer; surgery; early ambulation

DOI：

10.7507/1007-9424.202206084

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Objective To investigate the completion of early ambulation in patients with gastric cancer under the enhanced recovery after surgery (ERAS) management mode in the West China Hospital of Sichuan University, and analyze the influencing factors. Methods From November 1, 2021 to March 31, 2022, the patients with gastric cancer who met the inclusion criteria of this study in the West China Hospital of Sichuan University were selected as the survey objects. At 48 h after the operation, the patients were enquired at the bedside and the electronic medical records were accessed to collect the general information, diseases information, etc. of the patients. The postoperative data were also investigated, and the time of early ambulation was investigated, and the influencing factors were analyzed by logistic regression. Results According to the inclusion and exclusion criteria of this study and the sample size requirements, 140 eligible patients with gastric cancer were investigated, 34 of whom got out of bed early, and the rate of early ambulation was 24.3%. The results of binary logistic regression analysis showed that indwelling urinary catheter within 48 h after operation [OR=10.031, 95%CI（1.037, 97.061）, P=0.046] and American Society of Anaesthesiologists (ASA) grade Ⅲ [OR=4.209, 95%CI（1.792, 9.886）, P=0.001] decreased the probability of early ambulation after operation in patients with gastric cancer. Conclusions From the results of this survey, the completion rate of early ambulation in patients with gastric cancer under ERAS mode is lower, which may be improved by reducing the placement of the urinary catheter or shortening the indwelling time of the urinary catheter. For patients with ASA grade Ⅲ having functional decline before surgery, doctor or nurse needs to evaluate their mobility after surgery and help them to finish early ambulation or exercise on hospital bed within their tolerances.

Citation： XIONG Fangli, HE Yuhua, JIANG Xiaolian. Analyses of status and influencing factors of early ambulation in patients with gastric cancer under enhanced recovery surgery mode. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(12): 1618-1622. doi: 10.7507/1007-9424.202206084 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Kattar N, Wang SX, Trojan JD, et al. Enhanced recovery after surgery protocols for head and neck cancer: systematic review and meta-analysis. Otolaryngol Head Neck Surg, 2022 Mar 15: 1945998221082541. doi: 10.1177/01945998221082541.
3.	譚銀歡, 林小佳, 梁彩云. 加速康復外科結合全程管理在乳腺癌患者中的應用效果. 護理實踐與研究, 2021, 18(14): 2148-2150.
4.	馬中飛, 寧長青. 加速康復外科在腹腔鏡結直腸腫瘤手術的術前應用. 浙江臨床醫學, 2020, 22(6): 829-830.
5.	Nishijima M, Baba H, Murotani K, et al. Early ambulation after general and digestive surgery: a retrospective single-center study. Langenbecks Arch Surg, 2020, 405(5): 613-622.
6.	陸云, 宋麗菁, 陳珊. 胃癌術后患者下床活動水平現狀及影響因素分析. 護士進修雜志, 2017, 32(2): 178-180.
7.	Brown CJ, Friedkin RJ, Inouye SK. Prevalence and outcomes of low mobility in hospitalized older patients. J Am Geriatr Soc, 2004, 52(8): 1263-1270.
8.	張蕾, 張巧麗, 張雨. 胃腸手術患者術后120 h內下床活動水平及其影響因素分析. 護理學雜志, 2014, 29(18): 21-24.
9.	王梅. 加速康復外科老年胃癌患者術后早期下床活動現狀及影響因素研究. 南京: 南京大學, 2018.
10.	P?dziwiatr M, Mavrikis J, Witowski J, et al. Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery. Med Oncol, 2018, 35(6): 95. doi: 10.1007/s12032-018-1153-0.
11.	Daabiss M. American Society of Anaesthesiologists physical status classification. Indian J Anaesth, 2011, 55(2): 111-115.
12.	Meyer R, Stratton R. Basic concepts in nutrition: epidemiology of malnutrition. e-ESPEN J, 2008, 3(4): e167-e170. doi: 10.1016/j.eclnm.2008.04.002.
13.	Christensen T, Bendix T, Kehlet H. Fatigue and cardiorespiratory function following abdominal surgery. Br J Surg, 1982, 69(7): 417-419.
14.	Treede RD, Rief W, Barke A, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain, 2019, 160(1): 19-27.
15.	王才康, 胡中鋒, 劉勇. 一般自我效能感量表的信度和效度研究. 應用心理學, 2001, 7(1): 37-40.
16.	中華醫學會外科學分會, 中華醫學會麻醉學分會. 加速康復外科中國專家共識及路徑管理指南(2018版). 中國實用外科雜志, 2018, 38(1): 1-20.
17.	黃財生, 謝飲吉. 腹部外科手術后患者早期下床活動的意義及其影響因素. 現代診斷與治療, 2014, 25(3): 606-606.
18.	楊俊華. 老年病人胃癌術后肺部感染的危險因素分析及護理對策. 航空航天醫學雜志, 2015, 26(5): 641-643.
19.	邢小利, 鄭秀萍, 張淑霞, 等. 胃癌患者術后早期下床活動狀況調查及影響因素分析. 中華現代護理雜志, 2016, 22(29): 4179-4182.
20.	孔怡儒, 李曉銀, 虎倩, 等. 加速康復外科理念下胃癌患者術后早期下床活動現狀及影響因素研究. 臨床研究, 2021, 29(10): 14-17.
21.	Nachiyunde B, Lam L. The efficacy of different modes of analgesia in postoperative pain management and early mobilization in postoperative cardiac surgical patients: a systematic review. Ann Card Anaesth, 2018, 21(4): 363-370.
22.	張曉蕾, 王軍. 神經外科手術患者術后早期下床活動的影響因素分析. 中華現代護理雜志, 2021, 27(2): 227-231.
23.	Kara S, Küpeli E, Y?lmaz HEB, et al. Predicting pulmonary complications following upper and lower abdominal surgery: ASA vs. ARISCAT risk index. Turk J Anaesthesiol Reanim, 2020, 48(2): 96-101.
24.	Hirahara N, Tajima Y, Fujii Y, et al. Prediction of postoperative complications and survival after laparoscopic gastrectomy using preoperative Geriatric Nutritional Risk Index in elderly gastric cancer patients. Surg Endosc, 2021, 35(3): 1202-1209.
25.	孫燕婷, 薛榮亮, 王寧, 等. 衰弱對老年胃癌患者圍術期的影響. 臨床醫學研究與實踐, 2021, 6(31): 57-59, 66.
26.	Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001, 56(3): M146-M156. doi: 10.1093/gerona/56.3.m146.
27.	Partridge JS, Harari D, Dhesi JK. Frailty in the older surgical patient: a review. Age Ageing, 2012, 41(2): 142-147.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Kattar N, Wang SX, Trojan JD, et al. Enhanced recovery after surgery protocols for head and neck cancer: systematic review and meta-analysis. Otolaryngol Head Neck Surg, 2022 Mar 15: 1945998221082541. doi: 10.1177/01945998221082541.
3. 譚銀歡, 林小佳, 梁彩云. 加速康復外科結合全程管理在乳腺癌患者中的應用效果. 護理實踐與研究, 2021, 18(14): 2148-2150.
4. 馬中飛, 寧長青. 加速康復外科在腹腔鏡結直腸腫瘤手術的術前應用. 浙江臨床醫學, 2020, 22(6): 829-830.
5. Nishijima M, Baba H, Murotani K, et al. Early ambulation after general and digestive surgery: a retrospective single-center study. Langenbecks Arch Surg, 2020, 405(5): 613-622.
6. 陸云, 宋麗菁, 陳珊. 胃癌術后患者下床活動水平現狀及影響因素分析. 護士進修雜志, 2017, 32(2): 178-180.
7. Brown CJ, Friedkin RJ, Inouye SK. Prevalence and outcomes of low mobility in hospitalized older patients. J Am Geriatr Soc, 2004, 52(8): 1263-1270.
8. 張蕾, 張巧麗, 張雨. 胃腸手術患者術后120 h內下床活動水平及其影響因素分析. 護理學雜志, 2014, 29(18): 21-24.
9. 王梅. 加速康復外科老年胃癌患者術后早期下床活動現狀及影響因素研究. 南京: 南京大學, 2018.
10. P?dziwiatr M, Mavrikis J, Witowski J, et al. Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery. Med Oncol, 2018, 35(6): 95. doi: 10.1007/s12032-018-1153-0.
11. Daabiss M. American Society of Anaesthesiologists physical status classification. Indian J Anaesth, 2011, 55(2): 111-115.
12. Meyer R, Stratton R. Basic concepts in nutrition: epidemiology of malnutrition. e-ESPEN J, 2008, 3(4): e167-e170. doi: 10.1016/j.eclnm.2008.04.002.
13. Christensen T, Bendix T, Kehlet H. Fatigue and cardiorespiratory function following abdominal surgery. Br J Surg, 1982, 69(7): 417-419.
14. Treede RD, Rief W, Barke A, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain, 2019, 160(1): 19-27.
15. 王才康, 胡中鋒, 劉勇. 一般自我效能感量表的信度和效度研究. 應用心理學, 2001, 7(1): 37-40.
16. 中華醫學會外科學分會, 中華醫學會麻醉學分會. 加速康復外科中國專家共識及路徑管理指南(2018版). 中國實用外科雜志, 2018, 38(1): 1-20.
17. 黃財生, 謝飲吉. 腹部外科手術后患者早期下床活動的意義及其影響因素. 現代診斷與治療, 2014, 25(3): 606-606.
18. 楊俊華. 老年病人胃癌術后肺部感染的危險因素分析及護理對策. 航空航天醫學雜志, 2015, 26(5): 641-643.
19. 邢小利, 鄭秀萍, 張淑霞, 等. 胃癌患者術后早期下床活動狀況調查及影響因素分析. 中華現代護理雜志, 2016, 22(29): 4179-4182.
20. 孔怡儒, 李曉銀, 虎倩, 等. 加速康復外科理念下胃癌患者術后早期下床活動現狀及影響因素研究. 臨床研究, 2021, 29(10): 14-17.
21. Nachiyunde B, Lam L. The efficacy of different modes of analgesia in postoperative pain management and early mobilization in postoperative cardiac surgical patients: a systematic review. Ann Card Anaesth, 2018, 21(4): 363-370.
22. 張曉蕾, 王軍. 神經外科手術患者術后早期下床活動的影響因素分析. 中華現代護理雜志, 2021, 27(2): 227-231.
23. Kara S, Küpeli E, Y?lmaz HEB, et al. Predicting pulmonary complications following upper and lower abdominal surgery: ASA vs. ARISCAT risk index. Turk J Anaesthesiol Reanim, 2020, 48(2): 96-101.
24. Hirahara N, Tajima Y, Fujii Y, et al. Prediction of postoperative complications and survival after laparoscopic gastrectomy using preoperative Geriatric Nutritional Risk Index in elderly gastric cancer patients. Surg Endosc, 2021, 35(3): 1202-1209.
25. 孫燕婷, 薛榮亮, 王寧, 等. 衰弱對老年胃癌患者圍術期的影響. 臨床醫學研究與實踐, 2021, 6(31): 57-59, 66.
26. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001, 56(3): M146-M156. doi: 10.1093/gerona/56.3.m146.
27. Partridge JS, Harari D, Dhesi JK. Frailty in the older surgical patient: a review. Age Ageing, 2012, 41(2): 142-147.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analyses of status and influencing factors of early ambulation in patients with gastric cancer under enhanced recovery surgery mode

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