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

Video：

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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.	谭银欢, 林小佳, 梁彩云. 加速康复外科结合全程管理在乳腺癌患者中的应用效果. 护理实践与研究, 2021, 18(14): 2148-2150.
4.	马中飞, 宁长青. 加速康复外科在腹腔镜结直肠肿瘤手术的术前应用. 浙江临床医学, 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.	陆云, 宋丽菁, 陈珊. 胃癌术后患者下床活动水平现状及影响因素分析. 护士进修杂志, 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.	张蕾, 张巧丽, 张雨. 胃肠手术患者术后120 h内下床活动水平及其影响因素分析. 护理学杂志, 2014, 29(18): 21-24.
9.	王梅. 加速康复外科老年胃癌患者术后早期下床活动现状及影响因素研究. 南京: 南京大学, 2018.
10.	Pędziwiatr 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, 胡中锋, 刘勇. 一般自我效能感量表的信度和效度研究. 应用心理学, 2001, 7(1): 37-40.
16.	中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识及路径管理指南(2018版). 中国实用外科杂志, 2018, 38(1): 1-20.
17.	黄财生, 谢饮吉. 腹部外科手术后患者早期下床活动的意义及其影响因素. 现代诊断与治疗, 2014, 25(3): 606-606.
18.	杨俊华. 老年病人胃癌术后肺部感染的危险因素分析及护理对策. 航空航天医学杂志, 2015, 26(5): 641-643.
19.	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. 中华现代护理杂志, 2016, 22(29): 4179-4182.
20.	孔怡儒, 李晓银, 虎倩, 等. 加速康复外科理念下胃癌患者术后早期下床活动现状及影响因素研究. 临床研究, 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.	张晓蕾, 王军. 神经外科手术患者术后早期下床活动的影响因素分析. 中华现代护理杂志, 2021, 27(2): 227-231.
23.	Kara S, Küpeli E, Yılmaz 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.	孙燕婷, 薛荣亮, 王宁, 等. 衰弱对老年胃癌患者围术期的影响. 临床医学研究与实践, 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. 谭银欢, 林小佳, 梁彩云. 加速康复外科结合全程管理在乳腺癌患者中的应用效果. 护理实践与研究, 2021, 18(14): 2148-2150.
4. 马中飞, 宁长青. 加速康复外科在腹腔镜结直肠肿瘤手术的术前应用. 浙江临床医学, 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. 陆云, 宋丽菁, 陈珊. 胃癌术后患者下床活动水平现状及影响因素分析. 护士进修杂志, 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. 张蕾, 张巧丽, 张雨. 胃肠手术患者术后120 h内下床活动水平及其影响因素分析. 护理学杂志, 2014, 29(18): 21-24.
9. 王梅. 加速康复外科老年胃癌患者术后早期下床活动现状及影响因素研究. 南京: 南京大学, 2018.
10. Pędziwiatr 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, 胡中锋, 刘勇. 一般自我效能感量表的信度和效度研究. 应用心理学, 2001, 7(1): 37-40.
16. 中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识及路径管理指南(2018版). 中国实用外科杂志, 2018, 38(1): 1-20.
17. 黄财生, 谢饮吉. 腹部外科手术后患者早期下床活动的意义及其影响因素. 现代诊断与治疗, 2014, 25(3): 606-606.
18. 杨俊华. 老年病人胃癌术后肺部感染的危险因素分析及护理对策. 航空航天医学杂志, 2015, 26(5): 641-643.
19. 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. 中华现代护理杂志, 2016, 22(29): 4179-4182.
20. 孔怡儒, 李晓银, 虎倩, 等. 加速康复外科理念下胃癌患者术后早期下床活动现状及影响因素研究. 临床研究, 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. 张晓蕾, 王军. 神经外科手术患者术后早期下床活动的影响因素分析. 中华现代护理杂志, 2021, 27(2): 227-231.
23. Kara S, Küpeli E, Yılmaz 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. 孙燕婷, 薛荣亮, 王宁, 等. 衰弱对老年胃癌患者围术期的影响. 临床医学研究与实践, 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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