| BackgroundOne of the core measures of Enhanced Recovery after surgery is to promote early postoperative ambulation;The elderly patients with gastric cancer,due to their special pathophysiological characteristics,are often affected by more factors comparing to the non-senile for early postoperative ambulation.At present,there are few studies on the early postoperative mobilization of elderly patients with gastric cancer as an independent group to learn,such evidence of evidence-based medicine is lacking.ObjectiveCombined with the perioperative management of ERAS and the characteristics of elderly patients with gastric cancer,the status and related factors,affecting the early postoperative ambulation,of elderly patients with gastric cancer were investigated.To find out the factors hindering the early postoperative ambulation and the deficiencies in the nursing process,and to make corresponding nursing measures to provide the basis for the early postoperative ambulation of the elderly patients with gastric cancer.MethodsFrom June,2016 to February,the patients with radical gastrectomy for gastric cancer were selected from the department of gastroenterology of Jinling Hospital affiliated to Nanjing University Medical College.Patients performed the perioperative treatment of Enhanced Recovery after Surgery,using the postoperative ambulation program(Previous research results),using:? patients general data and perioperative data questionnaires,? early postoperative ambulation log,? 6MWT and Borg score.First,to investigate the status of early postoperative ambulation in elderly patients with gastric cancer:including early postoperative ambulation completion rate,first time and distance to get out of bed to walking,the walking distance of POD1,and to analyze the early postoperative ambulation status within 24h completion and incompletion.And second,to investigate the influencing factors of early postoperative ambulation in elderly patients with gastric cancer:?The effect of early postoperative pain,fatigue and orthostatic intolerance on the time of ambulation after the first postoperative period(T),elderly patients with gastric cancer were divided into:T<12h,12h?T?24h,T>24h,three intervals ? the completion rate of early postoperative ambulation,the incidence of early fatigue and the incidence of orthostatic intolerance as a result of variable,nursing measures promoting early postoperative ambulation:early walking program introduction,6MWT,"3.3.3" training method,5 step out of bed method training,early removal of urethral catheter,early bed activities,activity supervision,30 minutes before activity,oral nonsteroidal anti-inflammatory drugs,as independent variables,to carry out single factor analysis;? the general data,perioperative data,effective influencing factors,single factor analysis of effective nursing measures,as the independent variable,whether to complete the first ambulation in 24h after operation as a dependent variable,set and assign values individually.Non-conditional Logistic regression analysis was used to analyze various indicators.Results1.The status of early postoperative ambulationAmong the patients included in the study,99 patients completed the early ambulation,and the completion rate was 63.46%.The time and distance for first ambulation(21.12±11.86)hours and(58.19±71.69)meters,duration and distance of post-operative day 1 is(1.03±0.69)h and(170.46±164.31)m.Among them,the completion of the patients' first time for postoperative ambulation was(15.03±3.27)h,and its distance was(49.11±43.11)m.Preoperative day 1,4 weeks,12 weeks of 6MWD respectively(510.1±73.5)meters?(380.5±69.2)meters and(519.8±92.5)meters,patients in the postoperative 12 weeks after the basic recovery to the preoperative physical condition;The patients were basically restored to preoperative physical condition at 12 weeks after surgery.There was no significant difference between the Borg fatigue and respiratory difficulty score before and after the experiment.2.The influence factors of the early postoperative ambulation of the elderly patients with gastric cancer.Early postoperative pain,fatigue,and orthostatic intolerance were associated with the time of postoperative ambulation in elderly patients with gastric cancer.In terms of the single factor analysis of the effects of various nursing measures,early removal of the catheter,early bed activity and activity supervision can promote the early postoperative ambulation;Oral nonsteroidal anti-inflammatory drugs prior to early ambulation and early bed activity can effectively prevent the occurrence of early fatigue;”3.3.3”Activity training and 5 step out of bed training method can effectively prevent the occurrence of early orthostatic intolerance.The results of multivariate logistic regression analysis for the early postoperative ambulation time were as follows:early postoperative fatigue and pain can hinder the early postoperative ambulation of the elderly patients with gastric cancer;In contrast,early removal of the catheter would promote early postoperative mobilization.ConclusionElderly patients with gastric cancer occupy more than half of the total gastric cancer,and males are the majority.More than half of the elderly patients with gastric cancer can complete ambulation in the postoperative 24h,in accordance with the postoperative mobilization program,which has a certain guiding significance and practical clinical results.To explore and analyze the influencing factors of early postoperative ambulation in elderly patients with gastric cancer,it is concluded that the evaluation of the patients' activity ability should be paid attention to,and it needs to be established on the basis of preoperative education,multimodal analgesia and so on,on the basis of ensuring the patient's safety,to remove all kinds of pipelines,such as urine tube,peritoneal drainage tube.At the same time,we should strengthen the management of postoperative fatigue and postoperative pain,in the safe and effective situation,as early as possible in the removal of urethral catheter.The effective nursing measures to the early postoperative out of bed activities in the evaluation of the program to reduce interference factors,improve the early postoperative ambulation effect,promote the patient postoperative recovery. |
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