结核与肺部疾病杂志2026，Vol.7Issue(3)：314-322,9.DOI:10.19983/j.issn.2096-8493.20250168
加速康复外科导向下肺癌根治术后早期离床活动体系的构建与临床实效评估
Construction and clinical efficacy evaluation of an early out-of-bed exercise system guided by enhanced recovery after surgery for post-radical resection of lung cancer
摘要
Abstract
Objective:Based on the core concept of enhanced recovery after surgery(ERAS),a standardized early mobilization protocol for patients after radical resection of lung cancer was developed,and its clinical application value was thoroughly evaluated.Methods:Through database retrieval and two rounds of Delphi expert consultation,an early mobilization program for patients after radical resection of lung cancer was developed.According to the inclusion criteria,170 patients who underwent video-assisted thoracoscopic radical resection of lung cancer in the Affiliated Pulmonary Hospital of Shanxi Medical University(Taiyuan Fourth People's Hospital)and Shanxi Hospital of Cancer Hospital,Chinese Academy of Medical Sciences from October 2024 to March 2025 were selected as the study cohort.Based on the admission sequence number,the subjects were equally divided into an observation group and a control group(85 cases each)using a random number table.The control group received conventional ERAS diagnosis,treatment,and nursing pathways;the observation group implemented the specific early mobilization program constructed in this study on the basis of ERAS.After excluding 3 patients who withdrew during the implementation,167 patients were finally included,with 83 cases in the observation group and 84 cases in the control group.The main outcome measures included:time to first out-of-bed activity postoperatively,time to first anal flatus and defecation,rate of out-of-bed activity within 24 hours postoperatively,length of postoperative hospital stay,incidence of activity-related adverse events(AE),comfort status(Kolcaba's Comfort Scale),pain level(visual analogue scale(VAS)),and emotional state(anxiety(SAS)and depression(SDS)scales).Results:After selecting 12 domain experts to participate in the correspondence consultation,an early mobilization plan was finally established,including 2 first-level items,7 second-level items,and 23 third-level specific items.After different nursing interventions,the first ambulation time((16.24±3.12)h),the first exhaust time((24.51±4.35)h),the first defecation time((36.72±5.41)h)and the postoperative hospitalization time((6.21±1.34)d)in the observation group were shorter than those in the control group((32.57±6.89)h,(41.83±7.62)h,(58.96±9.14)h,(8.75±2.16)d),with statistically significant difference(t=-19.690,-18.011,—19.112,-9.121,all P＜0.001).The rate of ambulation within 24 hours postoperatively(96.39％(80/83))was significantly higher than that in the control group(8.33％(7/84)),and the difference was statistically significant(x2=129.701,P＜0.001).There was no significant difference in the incidence of adverse events between the observation group(0(0/83))and the control group(5.95％(5/84))(Fisher's exact test,P=0.059).The VAS scores on postoperative days 1 to 3 of the observation group(2.23±0.07,0.97±0.11,0.47±0.06)were significantly lower than those of the control group(4.14±0.08,2.78±0.12,1.33±0.11).The GCQ scores in the observation group(83.08±0.36,96.21±0.29,95.97±0.39)were significantly higher than those in the control group(74.54±0.38,83.33±0.26,88.65±0.34).All differences were statistically significant(t=-164.249,-101.626.—62.819,149.104,302.077,129.225,all P＜0.001).The SAS and SDS scores at discharge in the observation group((41.38±5.26)and(38.64±3.36)points)were significantly lower than those in the control group((48.52±6.11)and(48.73±1.75)points),the differences were statistically significant(t=-8.051,-8.447,Ps＜0.001).Conclusion:The early mobilization program after radical lung cancer surgery developed in this study significantly accelerates postoperative physiological recovery,improves activity compliance,and does not increase safety risks.but whether it can bring continuous benefits in the long-term after surgery remains to be further verified.关键词
肺肿瘤/胸腔镜/外科手术,微创性/康复护理/早日下床活动/方案评价Key words
Lung neoplasms/Thoracoscopes/Surgical procedures,minimally invasive/Rehabilitation nursing/Early ambulation/Program evaluation分类
医药卫生引用本文复制引用
闫文华,史志强,陈丽英,陈文君,李文芳..加速康复外科导向下肺癌根治术后早期离床活动体系的构建与临床实效评估[J].结核与肺部疾病杂志,2026,7(3):314-322,9.基金项目
太原市"六个一批"专项行动2024年度科研项目 Taiyuan City's'Six Batches'Special Action 2024 Annual Scientific Research Project （）
