肿瘤细胞减灭术联合腹腔热灌注化疗腹膜癌患者术后早期康复护理方案的构建及应用OA

Objective To develop an early postoperative rehabilitation nursing protocol for patients with peritoneal cancer(PC)following cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC),and to evaluate its clinical effectiveness.Methods A total of 177 patients with PC who underwent CRS combined with HIPEC at Beijing Tsinghua Changgung Hospital,Tsinghua University from January to October 2024 were randomly assigned to control group and observation group by random number table method,with 94 and 83 cases in each group,respectively.The control group received conventional rehabilitation nursing,including basic daily care,position management,pulmonary function rehabilitation(once every two hours,twice daily,10-15 minutes per session),bedside activities(30 minutes per session,twice daily,seven days per week),lasting for two weeks.The observation group additionally received early postoperative rehabilitation nursing protocol,targeting the improvement of postoperative dysfunction after CRS combined with HIPEC,including aerobic exercise,resistance exercise,and balance training,60 minutes per session,twice daily,seven days per week,lasting for two weeks.Before intervention and one day prior to discharge,the Short Physical Performance Battery(SPPB)was used to evaluate physical performance by researchers blinded to group allocation;De Morton Mobility Index(DEMMI)was used to evaluate physical activity and mobility;Borg Rating of Perceived Exertion(RPE)was used to evaluate subjective fatigue;Barthel Index(BI)was used to evaluate activities of daily living;Six-Minute Walk Test(6MWT)was used to evaluate cardiopulmonary function;a pulse oximeter was used to measure pulse oxygen saturation(SpO2);and a portable spirometer was used to measure forced vital capacity(FVC).The incidence of postoperative adverse events,including atel-ectasis,deep vein thrombosis,intestinal obstruction,arrhythmia,and falls,as well as postoperative length of hospital stay and gastric tube retention time were compared between two groups.Results(1)SPPB,DEMMI,RPE and BI scores:compared with those before intervention,SPPB,DEMMI,and BI scores in both groups increased significantly after intervention(P＜0.05),while RPE score decreased significantly(P＜0.05).Compared with the control group,SPPB,DEMMI,and BI scores in the observation group were significantly higher after intervention(P＜0.05),while the RPE score was significantly lower(P＜0.05).(2)SpO2,6MWT and FVC:compared with those before intervention,SpO2 and 6MWT in both groups increased significantly after intervention(P＜0.05),and FVC in the observation group increased significantly after intervention(P＜0.05).Compared with the control group,SpO2,6MWT and FVC scores in the observation group were significantly higher after intervention(P＜0.05).(3)Postoperative length of hospital stay and gastric tube retention time:compared with the control group,postoperative hospital stay and gastric tube retention time in the observation group were significantly shorter(P＜0.05).(4)Incidence of adverse events:there was no statistically signifi-cant difference in the incidence of adverse events between two groups(P＞0.05).Conclusion The early postoperative rehabilitation nursing protocol can effectively facilitate physical functional recovery and improve cardiopulmonary function in PC patients who un-derwent CRS combined with HIPEC,as well as reduce hospital stay duration and gastric tube retention time.