| Object:1.Explore the application and impact of the triple prehabilitation strategy in the perioperative period of esophageal cancer patients in my country,so as to enrich the preoperative management plan and provide guidance for future clinical nursing work.2.Objective to explore the effect of triple prehabilitation strategy on postoperative outcomes and short-term quality of life in 30 days of patients with esophageal cancer,such as the time of first oral feeding,postoperative bed rest,indwelling time of nasogastric tube and duodenojejunal nutrition tube,indwelling time of thoracic drainage tube,hospitalization time and cost,complications and readmission.It provides evidence-based evidence for nursing staff in the future in accelerating rehabilitation nursing of esophageal cancer.Methods:From January to December 2020,88 patients who underwent elective esophageal cancer surgery for the first time in the Thoracic Surgery Department of a tertiary comprehensive Grade A hospital were selected as the research objects,and they were randomly divided into a triple prehabilitation group and a control group,with 44 cases in each.The control group performed nursing measures before routine surgery.The triple prehabilitation group added triple prehabilitation strategy on the basis of routine preoperative nursing measures,which mainly include body function exercise(aerobic exercise,anaerobic exercise and respiratory function exercise),nutritional support and psychological intervention.The intervention time was the continuous waiting time before operation,about 1-2 weeks.The control group and the triple prehabilitation group were followed up 30 days after the operation.The evaluation of the effects of the two groups of patients after intervention included: six-minute walk test(6MWT)was used to evaluate motor function,and the hospital anxiety and depression scale(HADS)was used to evaluate psychological status,respectively before the intervention,1 day before the operation,and 7 days after the operation.The data were collected before the intervention,1 day before the operation,7 days after the operation and 30 days after the operation;the nutritional status was evaluated using objective nutritional indicators(pre-albumin,albumin,and total protein),which were collected before the intervention,1 day before the operation,and 7 days after the operation;The short-term quality of life is evaluated using the SF-36 Health Survey Brief(SF-36),which was collected before the intervention and 30 days after the operation.In addition,the postoperative outcomes include: The first oral feeding time after the operation,the time in bed after the operation,the indwelling time of the nasogastric tube and duodenal jejunal nutrition tube,the indwelling time of the thoracic drainage tube,the length of stay and the cost of hospitalization,the occurrence of complications within 30 days after the operation and after discharge Re-admission within 30 days.Use SPSS24.0 for statistical analysis.Results:The study included 88 subjects,44 cases in the triple prehabilitation group and the control group,and both groups of patients underwent surgery and completed follow-up 30 days after surgery.1.Comparison of general data: There was no statistically significant difference in the comparison of demographic data,past history data,surgical data,ASA classification,Child classification,NRS-2002,BMI,6MWT before intervention,HADS before intervention,SF-36 score before intervention and various nutrition before intervention between the two groups(Ρ>0.05).2.Comparison of exercise capacity: The results showed that the 6MWD of 1 day before operation,7 days after operation and 30 days after operation,the triple prehabilitation group was higher than before the intervention when compared within the group,the difference was statistically significant(Ρ<0.05);the triple prehabilitation group was higher than the control group when compared between the groups,the difference was statistically significant(Ρ<0.05).Using repeated measures analysis of variance,6MWD had significant differences in time effect,group effect,and interaction at 4 time points before intervention,1 day before operation,7 days after operation,and 30 days after operation(Ρ<0.05).3.Comparison of nutritional indicators:(1)Comparison of prealbumin: the results showed that the prealbumin of 1 day before operation and 7 days after operation,the triple prehabilitation group was higher than before the intervention when compared within the group,and the difference was statistically significant(Ρ<0.005);the triple prehabilitation group was higher than the control group when compared between groups,the difference was statistically significant(Ρ <0.05).Prealbumin preoperation before the intervention was analyzed by repeated measurement variance,and there was a significant difference in time effect in 3 hours after surgery,3 days after surgery,and interaction(Ρ<0.05);(2)Comparison of albumin: the results showed that the albumin of 1 day before operation and 7 days after operation,the triple prehabilitation group was higher than the pre-intervention and control group,the difference was statistically significant(Ρ<0.05).It is a significant difference in time effect,group effect,interaction,and interaction between 3 days before the intervention,1 day before surgery,7 days after surgery,and there is a significant difference in time effect,group effect,and interaction(Ρ<0.05).(3)Comparison of total protein : the results showed that the total protein in the triple prehabilitation group was higher than that in the pre-intervention and control group,the difference was statistically significant(Ρ<0.05).The total protein was analyzed by repeated measurement variance before the intervention,and there was a significant difference in time effects,group effects and interactions(Ρ<0.05)in three days before surgery,7 days after surgery.4.Comparison of Anxiety and Depression Scale Scores:(1)Comparison of Anxiety Table Rating: Comparison between groups,1 day before the triple prehabilitation group,the anxiety table score is lower than the control group,and the difference is statistically significant(Ρ<0.05),postoperative The 30-day anxiety meter score has no statistical significance(Ρ> 0.05).1 day before surgery,anxiety table score after 7 days and 30 days after surgery,the triple prehabilitation group was lower than the intervention,and the difference was statistically significant(Ρ<0.05).Analysis of the repeated measurement variance analysis anxiety table score before intervention,1 day before surgery,7 days after surgery,4 times in time in 4 times in time,the group,the group,the interaction,the interaction is significantly different(Ρ<0.05).(2)Comparison of Anxiety Table Rating: Comparison between groups,1 day of depression in 1day before the triple prehabilitation group,the number of Hads depressed measuring tables is lower than the control group,and the difference is statistically significant(Ρ <0.05),postoperative The 30-day Depression Table Rating No statistically significant(Ρ> 0.05).1 day before surgery,the depression meter score after 30 days after surgery,the triple prehabilitation group was lower than the intervention,and the difference was statistically significant(Ρ<0.05).Using a repeated measurement variance analysis Hads depression table score before intervention,1 day before surgery,7 days after surgery,4 hours after surgery,there is a significant difference in the interaction(Ρ<0.05).5.Comparison of postoperative clinical outcomes: The total number of patients in the triple pre-rehabilitation group postoperatively in bed,postoperative nasogastric tube and duodenal jejunal nutrition tube indwelling time,thoracic drainage tube indwelling time,hospital stay,and the total number of complications within 30 days after surgery were lower than the control group,the difference was statistically significant(Ρ<0.05).There was no significant difference between the triple prehabilitation group and the control group in the time of first oral feeding,hospitalization expenses and re-admission within 30 days after discharge(Ρ>0.05).6.Comparison of health survey summary scores: The results showed that the BP,GH,MH,PF,RP,SF,and VT of the seven dimensions of SF-36 at 30 days after surgery were higher in the triple pre-rehabilitation group than before the intervention and the control group,and the difference was statistically significant(Ρ<0.05);30 days after operation,the BP of SF-36,the triple pre-rehabilitation group and the control group were lower than before the intervention,the difference was statistically significant(Ρ<0.005);There was no significant difference in the RE of SF-36 between the two groups of patients at 30 days postoperatively(Ρ>0.05).Conclusion:1.The triple prehabilitation strategy can significantly improve the perioperative motor function,nutritional status,anxiety and depression and short-term quality of life of patients with esophageal cancer,and can provide a set of scientific and effective methods for future preoperative care.2.Triple prehabilitation strategy can significantly improve the physical and mental reserve conditions of patients,and strive for more surgical opportunities for patients with esophageal cancer.3.The triple prehabilitation strategy can significantly reduce the time of bed stay,the retention time of nasogastric tube and duodenal jejunum nutrition tube,the retention time of thoracic drainage tube,the hospitalization time and the complications within 30 days,improve the clinical outcome and accelerate the prognosis after operation. |
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