Status And Influencing Factors Of Early Mobilization In Patients With Radical Cystectomy Based On Enhanced Recovery After Surgery

BackgroundRadical cystectomy and urinary diversion is the standard treatment for myometrial invasive bladder cancer,which has many problems,such as surgical trauma,postoperative complications and long hospital stay.Enhanced recovery after surgery(ERAS)can significantly shorten the postoperative exhaust time of patients,accelerate the postoperative rehabilitation process without increasing the early complications of patients.Enhanced recovery after surgery guidelines strongly recommend the early mobilization of patients after surgery,set up daily activity goals,and increase activity volume day by day.The mobilization assessment content and mobilization quantitative goals is closely related to different diseases and operations.At present,the status quo of patients’ early mobilization after radical cystectomy is not ideal.Previous studies on the early mobilization of radical cystectomy mainly focused on its effectiveness.Based on the status quo of patients’ early mobilization after radical cystectomy,the relevant research is very limited,which has not been reported in China,and the influencing factors of patients’ early activities are not clear.Objectives1.To investigate the early mobilization level of patients after radical cystectomy;2.To explore the influence factors of early mobilization and activity level in patients after radical cystectomy.Methods1.ParticipantsA total 121 patients with radical cystectomy and urinary diversion were recruited from Grade Ⅲ hospital From October 2018 to January 2020.2.Research Indicators2.1 General and surgical informationUsing questionnaire by self-designed.Including the age,gender,BMI,marital status,smoking history,chemotherapy history,number of complications,previous operation history,operation name,blood transfusion during operation,number of indwelling tubes,postoperative analgesia,etc.2.2 Grading of preoperative activity intensityAccording to the labor intensity grading standard recommended by DRIs of Chinese Nutrition Society in 2000,the preoperative activity level of patients was divided into three levels:light,medium and heavy.2.3 Muscle strength assessmentMBC(Medical Search Council)muscle strength scoring system was used to assess the muscle strength of lower limbs qualitatively,and the muscle strength of lower limbs was divided into 0-5 grades.2.4 Pain assessmentPain assessment includes rest pain and active pain,using the numerical rating scale(NRS)to assess and quantify the pain intensity,with a total score of 0-10.2.5 Grading of postoperative mobilizationThe method of mobilization level evaluation of surgical inpatients is used for the evaluation of postoperative mobilization level,including the evaluation of the frequency and distance of patients’ movement or activity(divided in the ward and out of the ward),so as to score and grade the patients’ postoperative mobilization objectively.The score of this scoring system ranged from 0-14,and according to the score,the postoperative mobilization level was divided into three levels:low(0-4),medium(5-7)and high(8-14).2.6 Orthostatic intoleranceIf the patient moves from lying position to standing position or walks with one of the following premonitory symptoms:dizziness,nausea,vomiting,fever or blurred vision,then the patient is recorded as having orthostatic intolerance.3.Study proceduresThe general data,clinical data and preoperative activity intensity were collected by investigator through electronic medical records and chief complaint of patients.On the first day after the operation,the investigator completed the activity evaluation of the patient and assisted patients with early mobilization.The whole process was accompanied by the investigator to ensure the safety of the early mobilization.The data of activity pattern,frequency and range,pain score,symptoms related to orthostatic intolerance were collected by the investigator.Results1.The status of early mobilization in patients after operation24.79%of the patients were in bed rest state on the first day after operation,without early mobilization.75.21%of the patients performed early postoperative mobilization,of which 57.1%completed the transfer from the bed to the bedside chair,which was of low mobilization level;38.5%of the patients completed the activities in the ward on the first day after surgery,which was of medium mobilization level;4.4%of the patients completed outdoor activities once on the first day after surgery,which was of high mobilization level.2.The current situation of pain and Vertical intolerance after operativeBefore activity(resting state)pain score:96.7%of patients have slight pain(pain score is 1-3),3.3%of patients have pain and affect sleep(pain score is 4-6);during activity pain score:46.2%of patients have slight pain(pain score is 1-3),48.4%of patients have pain and affect sleep(pain score is 4-6),5.5%of patients have severe pain and the pain is intolerable and affects appetite and sleep(pain score is greater than 6 points).The incidence of early active upright intolerance was 78.02%,and dizziness was the main symptom.3.Influencing factors of early mobilization after radical cystectomyGender,Body mass Index(BMI),coexisted diseases,number of indwelling tubes and postoperative resting pain score were the influencing factors of early mobilization(P<0.05).Female,preoperative low body mass index(BMI),preoperative complications more than or equal to 2,the number of indwelling tubes more than 4,and patients with high postoperative resting pain intensity are more difficult to start early activities.4.Influencing factors of early activity level of patients after radical cystectomyComplications,preoperative chemotherapy history and preoperative activity level were the influencing factors of postoperative early activity level(P<0.05).The number of complications before operation is more than or equal to 2,patients with chemotherapy history and low activity level before operation have low activity level after operation.ConclusionsPatients with radical cystectomy and urinary diversion had lower level of early mobilization.Preoperative body mass index(BMI),coexisted diseases,number of indwelling tubes,postoperative resting pain score,preoperative chemotherapy history and preoperative activity level were the influencing factors of patients’ early mobilization.medical workers need to combine the patients’ body reaction and psychological characteristics to carry out personalized evaluation and intervention on the early mobilization in patients after operation.The results of the study can provide a reference for the construction of early mobilization program of patients with radical cystectomy,and promote the scientific development of nursing in enhanced recovery after surgery.