| ObjectiveThe purpose is to explore the effect of prehabilitation on the rehabilitation of elderly Chinese patients after laparoscopic cholecystectomy,so as to enrich their preoperative management strategies and provide guidance for clinical nursing work.MethodsA total of 80 elderly patients with cholecystolithiasis diagnosed in Hunan people's hospital from January 2019 to November 2019 who underwent elective laparoscopic cholecystectomy were selected as the research objects.Randomly divided into prehabilitation group and control group,with 40 cases in each.The control group received routine preoperative care.The prehabilitation group received prehabilitation interventions,including aerobic exercise,resistance exercise,nutritional support,and psychological support,from the day of the outpatient admission to the day before the operation.The duration of the intervention was the preoperative waiting time,about 2 weeks.Patients in both groups were followed up 30 days after surgery.The perioperative exercise ability of the two groups of patients was evaluated by 6-min Walking Distance(6MWD),and the degree of anxiety and depression was evaluated by Hospital anxiety and depression scale(HADS)score.The post-recovery quality was evaluated with the 9-item quality of recovery scoring system(QoR-9)score,the time to get out of bed for the first time,the time of the first anal exhaustion,postoperative hospital stay,and complications.SPSS 25.0 was used for statistical analysis of all data.ResultsIn this study,80 subjects were included.Finally,76 patients underwent surgery and completed a 30-day follow-up.There were 38 patients in the prehabilitation group and the control group.1.Comparison of baseline data: before the intervention,demographic data,previous history data,Child grading,ASA grading,6MWD,HADS score and surgical data of the two groups showed no statistically significant differences(P>0.05).2.Comparison of exercise capacity: In the comparison between the groups,the 6MWD of the prehabilitation group before intervention,1 day before operation,and 30 days after operation were 473.74±45.91 m,514.53±37.77 m,496.37±40.98 m,and the control group.They are 469.68±29.76 m,472.61±44.41 m,and 446.47±44.21 m.The results showed that the 6MWD of the patients in the prehabilitation group before operation and 30 days after operation were higher than those in the control group,and with a significant difference(P<0.001).The comparison results in the prehabilitation group showed that the 6MWD 1 day before surgery and 30 days after surgery were higher than those before intervention,and with a significant difference(P<0.001).3.Comparison of anxiety and depression: The HADS anxiety sc ores of patients in the prehabilitation group before intervention,1 d ay before surgery,and 30 days after surgery were 8.42±2.13 points,5.24±1.40 points,and 4.26±1.53 points,respectively in thecontrol g roup.8.26±2.11 points,7.16±2.12 points,6.26±2.32 points.The result s showed that the HADS depression scores of patients in the preha bilitation group 1 day before surgery and 30 days after surgery wer e lower than those in the control group,with a significant differenc e(P<0.001).The HADS depression scores of patients in the prehab ilitation group before intervention,1 day before surgery,and 30 da ys after surgery were 8.76±1.90 points,5.79±1.69 points,3.95±1.50 points,and the control group were 8.34±1.92 points and 7.16±1.83 points,5.45±1.79 points.The results showed that the HADS depre ssion scores of patients in the prehabilitation group 1 day before su rgery and 30 days after surgery were lower than those in the contr ol group,with a significant difference(P=0.001,P<0.001).When co mparing within the group,the HADS anxiety and depression scores in the prehabilitation group 1 day before surgery and 30 days afte r surgery were lower than those before intervention,with a signific ant difference(P<0.001).4.Comparison of postoperative recovery: The Qo R-9 score of patients in the pehabilitation group on the first postoperative day was 13.05±1.83 points,which was higher than the 12.05±1.87 points in the control group,with a significant difference(P=0.021);Patients' first time out of bed and anal exhaust time were 12.45±1.50 h and 16.97±1.34 h,which were lower than those of the control group at 13.32±1.95 h and 17.90±1.72 h,with a significant difference(P=0.032,P=0.015);the postoperative hospital stay in the prehabilitation group was 2.42±0.55 days,which was lower than the control group's 2.71±0.57 days,,with a significant difference(P=0.027).However,the QoR-9 score and postoperative complications of the two groups of patients were not statistically significant(P>0.05).Conclusion1.Prehabilitation can improve the exercise ability of the elderly before laparoscopic cholecystectomy and 30 days after surgery,and relieve anxiety and depression before and 30 days after surgery;2.Prehabilitation is a new preoperative method and is expected to become another preoperative measure for Enhanced Recovery After Surgery. |
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