早期下床活動對大腸直腸癌病人術後恢復情形之相關性探討

大腸直腸癌手術後病人常面臨眾多身心症狀的困擾，包括疼痛、噁心嘔吐、腹脹、食慾降低、焦慮憂慮，以及各種術後併發症 ;手術後各種症狀困擾除了造成病人不適、延長復原及住院時間，並可能加劇病人焦慮憂鬱程度。術後下床活動雖被視為可改善病人手術後復原的一項有效措施，但對於身心症狀緩解的效益以及具體施行辦法仍不明確。研究目的為了解大腸直腸癌病人手術後下床步行情形對於手術後腸胃道功能恢復、住院天數、身體及心理症狀困擾之影響。本研究為一縱貫式相關性研究（longitudinal correlation study）。於台灣北部一教學醫院之大腸直腸外科病房進行收案，收案對象為進行大腸直腸癌手術之病患。採連續取樣方式，於收案時進行基本資料收集並使用台灣身體活動量表收集手術前活動狀況；在手術後第一日至出院前一日以心跳偵測戒指以及下床活動日誌，紀錄個案術後下床步行之頻率、距離、活動時間，並且在手術後每日填寫身體症狀量表、手術前一日及出院前一日分別填寫醫院焦慮憂鬱量表（Hospital Anxiety & Depression Rating Scale, HADS），以了解個案手術後症狀困擾程度和焦慮憂鬱程度。取得資料後再進行描述性統計並以廣義估計函數式（Generalized estimating equation,GEE）檢定分析影響手術後恢復之相關性因素。總計有效收案人數為150人，收案時間共13個月。研究結果顯示：手術後下床活動的頻率越多，病人術後排氣時間及可進食固體食物時間越短；且身體症狀嚴重程度以及焦慮程度較低。而手術後下床活動的距離越遠，病人術後可開始進食固體食物時間越早、住院天數越短、身體症狀嚴重度以及焦慮程度越低。由研究結果可知，增加病人手術後下床活動的頻率以及距離對於病人手術後復原確實有正面影響，後續研究可再深入了解確切有效的活動量，在臨床應用上可提供更具體之實施指引。

關鍵字

大腸直腸癌；症狀困擾；術後復原；下床活動

並列摘要

The patients with colorectal cancer usually suffer from multiple symptoms after surgery. Pain, nausea, vomit, abdominal fullness, low appetite, anxiety, depression and various postoperative complications are experienced by the patients . The symptoms not only cause the discomfort, prolong the postoperative recovery and hospitalization period, but also worsen the psychological condition. Early postoperative ambulation is thought to be a useful treatment to improve the postoperative recovery. But how it really works and how to apply on clinical condition remain unclear. The study aims to understand the correlation between postoperative ambulation and the recovery of patients with colorectal cancer. We conducted a longitudinal correlation study with a set of structured questionnaire survey with consecutive sampling in a medical center in Northern Taiwan. The population was postoperative patients with colorectal cancer. The questionnaire included: (1) Preoperative part: demographic profiles, Taiwan International Physical Activity Questionnaire (IPAQ), Hospital Anxiety & Depression Rating Scale (HADS); (2) Postoperative part: walking diary, physical symptoms scale and the heart-rate sensor ring were applied every day. HADS was recorded on the day before discharge. Data were analyzed by descriptive statistics and generalized estimating equation (GEE). Finally, 150 patients were recruited in 13 months. The results indicated that: (1) the higher the frequency of postoperative ambulation is, the time of flatus and tolerating to solid food is earlier, and the degree of physical symptoms and anxiety are lower; (2) the longer the distance of postoperative ambulation is, the time of tolerating to solid food is earlier, the hospitalization period is shorter, the degree of physical symptoms and anxiety are lower. In conclusion, the increase of frequency and distance of postoperative ambulation certainly lead to a better postoperative recovery. Further studies on the exact amount of ambulation are recommended for developing the clinical guidelines for this population.

並列關鍵字

Colorectal cancer ； Symptom distress ； Postoperative recovery ； Ambulation

參考文獻

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早期下床活動對大腸直腸癌病人術後恢復情形之相關性探討

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