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

doi:10.19983/j.issn.2096-8493.20250168

结核与肺部疾病杂志 ›› 2026, Vol. 7 ›› Issue (3): 314-322.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

闫文华¹(), 史志强², 陈丽英³, 陈文君⁴, 李文芳¹

¹ 山西医科大学附属肺科医院/太原市第四人民医院外科, 太原 030053
² 中国医学科学院肿瘤医院山西医院胸外科, 太原 030053
³ 山西医科大学附属肺科医院/太原市第四人民医院胸外科, 太原 030053
⁴ 山西医科大学附属肺科医院/太原市第四人民医院感染科, 太原 030053

收稿日期:2025-11-16 出版日期:2026-06-20 发布日期:2026-06-12
通信作者: 闫文华 E-mail:184204996@qq.com
基金资助:
太原市“六个一批”专项行动2024年度科研项目

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

Yan Wenhua¹(), Shi Zhiqiang², Chen Liying³, Chen Wenjun⁴, Li Wenfang¹

¹ Department of Surgery, Affiliated Pulmonary Hospital of Shanxi Medical University/Taiyuan Fourth People’s Hospital, Taiyuan 030053, China
² Department of Thoracic Surgery, Chinese Academy of Sciences Cancer Hospital Shanxi Hospital, Taiyuan 030053, China
³ Department of Thoracic Surgery, Affiliated Pulmonary Hospital of Shanxi Medical University/Taiyuan Fourth People’s Hospital, Taiyuan 030053, China
⁴ Department of Infectious Diseases, Affiliated Pulmonary Hospital of Shanxi Medical University/Taiyuan Fourth People’s Hospital, Taiyuan 030053, China

Received:2025-11-16 Online:2026-06-20 Published:2026-06-12
Contact: Yan Wenhua E-mail:184204996@qq.com
Supported by:
Taiyuan City’s ‘Six Batches’ Special Action 2024 Annual Scientific Research Project

摘要/Abstract

摘要：

目的: 基于加速康复外科(enhanced recovery after surgery, ERAS)核心理念,构建针对肺癌根治术后患者的早期离床活动标准化方案,并深入评估其临床应用价值。方法: 通过检索数据库和2轮德尔菲专家函询,构建肺癌根治术后患者早期离床活动方案。参照入组标准,选取2024年10月至2025年3月在山西医科大学附属肺科医院/太原市第四人民医院和中国医学科学院肿瘤医院山西医院接受电视辅助胸腔镜肺癌根治术的170例患者为研究队列。依据入院时序编号,利用随机数字表法将受试者均分为观察组与对照组(各85例)。对照组实施常规ERAS诊疗护理路径;观察组则在ERAS基础上,实施本研究构建的早期离床活动专项方案。剔除实施过程中3例退组患者后最终纳入167例患者,其中,观察组83例、对照组84例。主要观测指标涵盖:术后首次离床时间、首次肛门排气及排便时间、术后24h离床活动率、术后住院时间、活动相关不良事件发生率、舒适状况[Kolcaba舒适状况量表(GCQ)]、疼痛情况[视觉模拟评分法(VAS)]、情绪状态[焦虑(SAS)和抑郁(SDS)量表]。结果: 经遴选12位领域专家参与函询,最终确立包含2个一级条目、7个二级条目及23个三级具体条目的早期离床活动方案。经不同护理干预后,观察组患者首次离床时间[(16.24±3.12)h]、首次肛门排气时间[(24.51±4.35)h]、首次排便时间[(36.72±5.41)h]、术后住院时间[(6.21±1.34)d]均明显少于对照组[分别为(32.57±6.89)h、(41.83±7.62)h、(58.96±9.14)h、(8.75±2.16)d],差异均有统计学意义(t=-19.690、-18.011、-19.112、-9.121,P值均<0.001);术后24h离床活动率[96.39%(80/83)]明显高于对照组[8.33%(7/84)],差异有统计学意义(χ²=129.701,P<0.001);活动相关不良事件发生率[0(0/83)]与对照组[5.95%(5/84)]的差异无统计学意义(Fisher精确概率法,P=0.059)。观察组术后干预1~3d的VAS得分[分别为(2.23±0.07)分、(0.97±0.11)分、(0.47±0.06)分]均明显低于对照组[分别为(4.14±0.08)分、(2.78±0.12)分、(1.33±0.11)分],GCQ得分[分别为(83.08±0.36)分、(96.21±0.29)分、(95.97±0.39)分]均明显高于对照组[分别为(74.54±0.38)分、(83.33±0.26)分、(88.65±0.34)分],差异均有统计学意义(t=-164.249、-101.626、-62.819、149.104、302.077、129.225,P值均<0.001)。观察组出院时的SAS和SDS得分[分别为(41.38±5.26)分和(38.64±3.36)分]均明显低于对照组[分别为(48.52±6.11)分和(48.73±1.75)分],差异均有统计学意义(t=-8.051、-8.447,P值均<0.001)。结论: 本研究构建的肺癌根治术后早期离床活动方案能显著加速患者术后生理机能恢复,提升其活动依从性,且未增加安全风险,但其能否带来持续的长期益处尚待进一步验证。

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

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 (χ²=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.

Key words: Lung neoplasms, Thoracoscopes, Surgical procedures, minimally invasive, Rehabilitation nursing, Early ambulation, Program evaluation

中图分类号:

R619+.9

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. doi: 10.19983/j.issn.2096-8493.20250168

Yan Wenhua, Shi Zhiqiang, Chen Liying, Chen Wenjun, Li Wenfang. 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[J]. Journal of Tuberculosis and Lung Disease, 2026, 7(3): 314-322. doi: 10.19983/j.issn.2096-8493.20250168

图/表 4

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项目	对照组(84例)	观察组(83例)	统计检验值	P值
年龄(岁,$\bar{x}$±s)	52.61±13.81	52.04±13.22	t=0.273	0.791
性别[例(构成比,%)]			χ²=0.054	0.822
男性	48(57.14)	46(55.42)
女性	36(42.86)	37(44.58)
吸烟[例(构成比,%)]			χ²=0.067	0.812
是	39(46.43)	37(44.58)
否	45(53.57)	46(55.42)
文化程度[例(构成比,%)]			-	0.971
小学及以下	33(39.29)	30(36.14)
初中	27(32.14)	32(38.55)
高中	16(19.05)	14(16.87)
专科	3(3.57)	3(3.61)
本科及以上	5(5.95)	4(4.83)
婚姻状况[例(构成比,%)]			-	0.121
已婚	80(95.24)	83(100.00)
丧偶	4(4.76)	0(0.00)
病理类型[例(构成比,%)]			χ²=10.691	0.005
腺癌	56(66.67)	70(84.34)
鳞癌	18(21.43)	12(14.46)
其他	10(11.90)	1(1.20)
手术方式[例(构成比,%)]			χ²=0.013	0.921
VATS肺叶切除术	35(41.67)	34(40.96)
VATS亚肺叶切除术	49(58.33)	49(59.04)
术中出血量(ml,$\bar{x}$±s)	132.61±57.94	128.72±60.56	t=0.423	0.683
手术时间(h,$\bar{x}$±s)	3.22±0.75	3.35±0.77	t=-1.080	0.281

组别	SAS得分				SDS得分
组别	术前	出院时	t值	P值	术前	出院时	t值	P值
观察组(83例)	60.25±7.12	41.38±5.26	19.651	<0.001	52.64±2.43	38.64±3.36	30.759	<0.001
对照组(84例)	59.87±7.08	48.52±6.11	11.733	<0.001	53.39±3.80	48.73±1.75	10.209	<0.001
t值	0.344	-8.051			0.233	-8.447
P值	0.731	<0.001			0.820	<0.001

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

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组别	首次离床时间 (h,$\bar{x}$±s)	首次排气时间 (h,$\bar{x}$±s)	首次排便时间 (h,$\bar{x}$±s)	24h离床活动 [例(发生率,%)]	术后住院时间 (d,$\bar{x}$±s)	不良事件[例 (发生率,%)]
观察组(83例)	16.24±3.12	24.51±4.35	36.72±5.41	80(96.39)	6.21±1.34	0(0.00)
对照组(84例)	32.57±6.89	41.83±7.62	58.96±9.14	7(8.33)	8.75±2.16	5(5.95)
统计检验值	t=-19.690	t=-18.011	t=-19.112	χ²=129.701	t=-9.121	-
P值	<0.001	<0.001	<0.001	<0.001	<0.001	0.059

组别	VAS得分				GCQ得分
组别	术前	术后第1天	术后第2天	术后第3天	术前	术后第1天	术后第2天	术后第3天
观察组(83例)	1.53±0.20	2.23±0.07	0.97±0.11	0.47±0.06	74.47±0.28	83.08±0.36	96.21±0.29	95.97±0.39
对照组(84例)	1.44±0.20	4.14±0.08	2.78±0.12	1.33±0.11	74.16±0.27	74.54±0.38	83.33±0.26	88.65±0.34
t值	2.908	-164.249	-101.626	-62.819	7.282	149.104	302.077	129.225
P值	0.004	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

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