ERAS理念护理胸腔镜术后肺癌患者早期下床活动现状及其影响因素分析

doi:10.19983/j.issn.2096-8493.20250087

摘要/Abstract

摘要：

目的: 探讨ERAS理念护理胸腔镜肺癌患者术后早期下床活动现状及其影响因素,为优化肺癌术后ERAS康复方案提供依据。方法: 采用观察性研究方法,参照入组标准选取2023年6月1日至2024年5月31日在中科院胸瘤医院山西医院和太原市第四人民医院行胸腔镜肺癌手术的患者为研究对象,通过一般资料调查表(包括年龄、性别、婚姻状况、文化程度、吸烟情况、手术方式、医护指导频次、运动时间、术后疼痛评分等)和早期下床活动日志,以及运动自我效能感量表(SEES)、数字评定量表(NRS)、社会支持评定量表(SSRS)收集研究相关资料。采用单因素及多因素logistic回归分析患者早期下床活动状况及其影响因素。结果: 研究共纳入符合入组标准的189例患者,并发放调查表和量表问卷189份,有效回收164份,有效回收率为86.77%(164/189),故最终以164例患者作为研究对象。164例患者中,有60例(36.59%)于术后24h内实现早期下床活动。多因素logistic回归分析显示,高年龄和疼痛评分为重度可使患者术后早期下床的活动率降低[OR(95%CI)值分别为1.046(1.009~1.084)、1.979(1.512~2.598)],3次/周和≥4次/周的医护指导频率及高SSRS评分可使患者术后早期下床的活动率显著增高[OR(95%CI)值分别为0.213(0.152~0.343)、0.160(0.123~0.253)、0.611(0.474~0.789)]。结论: 肺癌患者术后24h内早期下床活动的完成率有待提高,应加强术后疼痛强、高年龄、社会支持低及医护指导频率少患者的护理管理和健康教育,并制定针对性措施以优化ERAS康复方案。

关键词: 肺癌, 加速康复外科, 围手术期护理, 康复, 影响因素

Abstract:

Objective: To explore the current status and influencing factors of early ambulation in patients with lung cancer after thoracoscopic surgery with enhanced recovery after surgery (ERAS) concept nursing, and to provide evidence for optimizing the ERAS rehabilitation program after lung cancer surgery. Methods: This observational study enrolled patients who underwent thoracoscopic lung cancer surgery at Shanxi Hospital Cancer Hospital of Chinese Academy of Sciences and Taiyuan Fourth People’s Hospital between June 1, 2023, and May 31, 2024, according to the inclusion criteria. Data were collected using a general information questionnaire (including age, gender, marital status, education level, smoking status, surgical methods, frequency of medical guidance, exercise time, postoperative pain score, etc.) and scales (including early ambulation log and self-efficacy expectation scale (SEES), digital rating scale (NRS), social support rating scale (SSRS)). Univariate and multivariate logistic regression analysis were performed to examine early ambulation status and its influencing factors. Results: A total of 189 patients met the inclusion criteria, and 189 questionnaires and scales were distributed. Of these, 164 were validly returned, with an effective response rate of 86.77% (164/189). Therefore, 164 patients were finally included in the analysis. Among them, 60 cases (36.59%) achieved early ambulation within 24 h after surgery. Multivariate logistic regression analysis showed that older age and severe postoperative pain scores were significantly associated with reduced likelihood of early ambulation (OR (95%CI): 1.046 (1.009-1.084), 1.979 (1.512-2.598), respectively). Conversely, a frequency of medical guidance 3 times per week and ≥4 times per week, high SSRS scores were significantly associated with an increased likelihood of early ambulation rate ((OR (95%CI): 0.213 (0.152-0.343), 0.160 (0.123-0.253), and 0.611 (0.474-0.789), respectively). Conclusion: The completion rate of early ambulation within 24 hours after surgery in patients with lung cancer requires improvement. Nursing management and health education should be strengthened for patients with severe postoperative pain, older age, low social support and infrequent medical guidance. Targeted measures should be formulated to optimize the ERAS rehabilitation program.

Key words: Lung cancer, Enhanced recovery after surgery, Perioperative nursing, Rehabilitation, Influencing factors

中图分类号:

R473
R493

闫文华, 陈文君, 史志强. ERAS理念护理胸腔镜术后肺癌患者早期下床活动现状及其影响因素分析[J]. 结核与肺部疾病杂志, 2025, 6(5): 544-550. doi: 10.19983/j.issn.2096-8493.20250087

Yan Wenhua, Chen Wenjun, Shi Zhiqiang. Analysis of the status quo and influencing factors of early ambulation in patients with lung cancer after thoracoscopic surgery with enhanced recovery after surgery concept nursing[J]. Journal of Tuberculosis and Lung Disease, 2025, 6(5): 544-550. doi: 10.19983/j.issn.2096-8493.20250087

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参考文献 27

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变量	合计(164例)	24h内组(60例)	24h后组(104例)	统计检验值	P值
年龄[岁,M(Q₁,Q₃)]	52.0(41.0,58.0)	39.0(34.0,45.0)	57.0(53.0,61.0)	H=110.755	<0.001
性别[例(构成比,%)]				χ²=6.076	0.057
男性	94(57.32)	42(70.00)	52(50.00)
女性	70(42.68)	18(30.00)	52(50.00)
婚姻状况[例(构成比,%)]				χ²=23.513	0.335
已婚	108(65.85)	44(73.33)	64(61.54)
其他	56(34.15)	16(26.67)	40(38.46)
文化程度[例(构成比,%)]				χ²=36.000	1.010
小学及以下	40(24.39)	3(5.00)	37(35.58)
初中或高中	87(53.05)	34(56.67)	53(50.96)
大专及以上	37(22.56)	23(38.33)	14(13.46)
是否吸烟[例(构成比,%)]				χ²=17.675	0.006
是	46(28.05)	25(41.67)	21(20.19)
否	118(71.95)	35(58.33)	83(79.81)
手术方式[例(构成比,%)]				χ²=14.513	1.326
肺叶切除术	81(49.39)	44(73.33)	37(35.58)
亚肺叶切除术	83(50.61)	16(26.67)	67(64.42)
医护指导频次[例(构成比,%)]				χ²=58.543	<0.001
1~2次/周	21(12.81)	4(6.66)	17(16.35)
3次/周	37(22.56)	10(16.67)	27(25.96)
≥4次/周	106(64.63)	46(76.67)	60(57.69)
运动时间[例(构成比,%)]				χ²=57.979	<0.001
<30min/次	13(7.93)	3(5.00)	10(9.61)
30~60min/次	48(29.27)	25(41.67)	23(22.12)
>60min/次	103(62.80)	32(53.33)	71(68.27)
术后疼痛水平[例(构成比,%)]				χ²=26.169	<0.001
轻度(1~3分)	107(65.24)	44(73.33)	63(60.58)
中度(4~6分)	44(26.83)	11(18.33)	33(31.73)
重度(7~10分)	13(7.93)	5(8.34)	8(7.69)
SEE得分[分,M(Q₁,Q₃)]	55.0(28.0,58.0)	63.0(56.0,65.0)	43.0(38.0,46.0)	H=69.425	<0.001
SSRS得分[分,M(Q₁,Q₃)]	40.0(30.0,45.0)	45.0(41.0,51.0)	35.0(28.0,39.0)	H=58.414	<0.001

序号	变量	赋值	序号	变量	赋值
X₁	术后下床时间	24h内=1;24h后=2	X₅	运动时间	<30min/次=1;30~60min/次=2;>60min/次=3
X₂	年龄	原值带入	X₆	疼痛评分	轻度=1;中度=2;重度=3
X₃	吸烟	否=0;是=1	X₇	SEE得分	原值带入
X₄	医护指导频次	1~2次/周=1;3次/周=2;≥4次/周=3	X₈	SSRS得分	原值带入

变量	β值	s${}_{\overline{x}}$值	Wald χ²值	P值	OR值	95%CI值
年龄	0.045	0.018	6.258	0.012	1.046	1.009~1.084
吸烟	0.612	0.645	0.898	0.343	1.843	0.520~6.532
医护指导频次3次/周	0.763	0.305	6.203	0.013	0.213	0.152~0.343
医护指导频次≥4次/周	0.463	0.216	4.136	0.011	0.160	0.123~0.253
运动时间30~60min/次	0.182	0.391	31.134	0.854	0.113	0.052~0.243
运动时间>60min/次	0.817	0.481	34.360	0.882	0.062	0.023~0.153
术后疼痛评分-中度	0.095	0.529	0.033	0.857	1.100	0.390~3.105
术后疼痛评分-重度	0.682	0.153	20.035	<0.001	1.979	1.512~2.598
SEE得分	0.458	0.150	9.255	0.103	0.633	0.471~0.859
SSRS评分	0.492	0.130	14.258	0.002	0.611	0.474~0.789