Status And Influencing Factors Of Early Ambulation After Laparoscopic Cholecystectomy

Objective:To analyze the status of early ambulation in patients after laparoscopic cholecystectomy.To explore the influencing factors of early ambulation in patients after laparoscopic cholecystectomy.To complete the retrieval,screening and content analysis of clinical practice literature related to early ambulation in laparoscopic cholecystectomy patients.Combined with the expert group meeting method,a program for early ambulation of patients after laparoscopic cholecystectomy was established to provide a reference for the early activities of patients after laparoscopic cholecystectomy and promote the rehabilitation of patients.Method:(1)This study adopted convenience sampling method to select 292 patients who received laparoscopic cholecystectomy in the general surgery ward of Grade-III Class A general hospital in Dali Prefecture from February to August 2022 as the research objects to carry out a cross-sectional study.By collecting the general data,disease data,postoperative physical condition and ambulation of the subjects,the researchers analyzed and discussed the factors affecting the early ambulation of patients after surgery.(2)The original research literature related to early ambulation in patients after laparoscopic cholecystectomy was systematically retrieved,and the content of the literature that met the inclusion criteria was extracted and analyzed to form the content of the early ambulation program for patients after laparoscopic cholecystectomy,and revised based on the opinions of the expert group meeting.Results:(1)The status of 292 patients undergoing laparoscopic cholecystectomy was investigated in this study,and the proportion of patients getting out of bed early after surgery(getting out of bed within 24 hours after surgery and walking distance more than 5 meters)was 30.5%;The earliest time to get out of bed was 1 hour after surgery,and the latest time was 58 hours after surgery.The first time for patients to get out of bed was mainly from the first day after surgery to the first day after surgery.The form of getting out of bed for the first time was walking on the ground(75.0%).The scope of first ambulation was the bathroom(49.0%).The first movement distance of getting out of bed was 0 ～ 343 meters,with a median of 6 meters.The JH-HLM scores of the patients within 24 hours after surgery were between 2 and 8,with a median of 6.Those who assisted in getting out of bed for the first time were mainly family members.(2)The results of univariate analysis showed that there were significant differences in medical expenses,past history,abdominal drainage tube and urinary catheter between the early ambulation group and the non-early ambulation group(P < 0.05).The removal time of abdominal drainage tube and urinary catheter in the non-early ambulation group was later than that in the early ambulation group.Among the postoperative physiological indexes,the blood potassium level of early ambulation group 24 hours after operation was higher than that of non-early ambulation group.In terms of physical condition,the resting pain level,nausea and vomiting grade,and fatigue degree 24 hours after surgery in the early ambulation group were lower than those in the non-early ambulation group.(3)Logistic stepwise regression analysis showed that three variables were influencing factors of early ambulation in patients after laparoscopic cholecystectomy,which were the indwelling abdominal drainage tube,the level of resting pain 24 hours after surgery and the grade of nausea and vomiting 24 hours after surgery.They were all independent influencing factors of early ambulation.(4)A total of 19 original research papers(13 randomized controlled trials,4quasi-experimental studies,and 1 observational study)were included after systematic search and screening,including 18 Chinese and 1 English.On the basis of literature content analysis,the early ambulation program for patients after LC was constructed by using the method of expert group meeting.The content of the program included the evaluation of the early ambulation of patients and the formulation of the early ambulation plan(the concept,functionrole,method,relative contraindications and termination indicators of early ambulation,etc.)Conclusions:(1)In this study,the proportion of early ambulation after laparoscopic cholecystectomy was low,and the main forms of first activities were flat ground walking and beside standing.Patients with no abdominal drainage tube after surgery,no nausea and vomiting at 24 hours after surgery,and less resting pain at 24 hours after surgery have an earlier first ambulation time and a higher probability of early postoperative activities.(2)According to the results of literature content analysis,the current situation and influencing factors of early ambulation,combined with expert opinions,the program for early ambulation of patients after LC has certain rationality and applicability,which can provide reference for the intervention guidance of patients with laparoscopic cholecystectomy and clinical medical staff on early ambulation of patients.