| Objective : to evaluate the efficiency of fast-track surgery(FTS) nursing intervention in perioperative period of colorectal cancer in two kinds of operation. Methods:Our department established fast-track surgery team. Exclude the lost 7 cases, we obtained 126 cases which met our researching conditions. These cases were randomly divided into 67 cases of laparotomy and 59 cases of laparoscopic surgery, the two kinds of surgical patients were again randomly divided into 66 cases FTS group and 60 cases traditional nursing group in accordance with the physical condition of patients. The general information of patients in addition to traditional nursing of laparotomy ones with fewer combined disease, the rest had no obvious difference. After admission, we take care of these nursing methods.(1)FTS group:(1)No indwelling preoperative gastric tube, it shall not exceed the indwelling gastric tube after 24 hours;(2)preoperative patients fast for 4 hours;(3)gastric tube were extubate no more than 24 hours postoperative day;(4)FTS psychological intervention was implemented;(5)Preoperative patients took orally phosphate oral solution to bowel preparation;(6)within 24 h after laparoscopic surgery and with in 48 h after laparotomy o patients start to ambulate, ambulation time is not less than 10min.(7)Postoperative fasting continued 24 hours and begin to return to oral liquid diet, and the longest fasting time does not exceed 48 hours, until the recovery of intestinal function after a gradual transition to a normal diet.(2)Traditional nursing group:(1)Indwelling preoperative gastric tube;(2)preoperative patients fasting for 12 hours and no drink for 8 hours;(3)Cleaning enema until clear enema liquid was excluded;traditional psychological nursing; The postoperative gastric tube was extubated until anal exhaust;(6)patients start to ambulate on 2-3 days after laparotomy, and ambulate on 1-2 days in patients after laparoscopic surgery.(7)eating after Intestinal function recovery.We record: The general data of patients such as case number, gender, comorbidity, ASA grade, TNM stage. The operation situation such as colorectal cancer resection surgery bleeding, operation time and so on. Postoperative recovery including gastric tube indwelling time, postoperative eating time, postoperative ambulation time, postoperative anal exhausting time, postoperative hospital stay. The postoperative complications such as pulmonary infection, abdominal and pelvic infection, throat pain, anastomotic fistula, incision complications. The implementation of nursing and the clinical data recording were completed by the research team staff training system, and by double. We compared FTS group and traditional group in operation situation postoperative rehabilitation and complications in FTS group of laparotomy, tradition nusring group of laparotomy, FTS group of laparoscopic surgery and tradition nursing group of laparoscopic surgery. At the same the,we compared these results:(1)General results and intraoperative situation:(1)There were no statistical significant difference of two operative approaches for each group at patients age, gender, surgical method, ASA grade and TNM stage(P>0.05);(2)bleeding(ml):A1:186.8±74.2 A2162.7±59.4, B1:51.8±38.7, B2:53.7±34.9(3)operation time(min):A1: 192.5±64,A2:180.6±50.0,B1: 205.4±51.6,B2: 210.6±37.9There were the statistical significant difference at bleeding and operation time(P<0.05),but we didn’t found the difference of them in FTS group and traditional group(P>0.05)(2)Postoperative recovery index:(1)exhausting time(h):A1:101.1±27.6, A2:128.6±50.2, B1:67.5±13.1, B2:88.1±27.9(2)ambulation time(h):A1:89.3±57.6, A2:124.3±34.2,B1:45.8±16.7, B2:71.8±24.4(3)Postoperative eating time(h):A1:91.2±45.6,A2:136.8±48.8, B1:23.9±10.4, B2:43.1±14.2(4)postoperative hospital stay(d):A1: 11.4±4.8,A2: 12.9±4.7,B1: 8.3±4.8,B2: 10.6±4.5Comparison between laparoscopic surgery and laparotomy group, we found the difference of Anal exhausting time, ambulation time, Postoperative eating time and postoperative hospital stay(P<0.05)There were the statistical significant difference of Anal exhausting time, ambulation time, Postoperative eating time in FTS group and traditional group, too(P<0.05).Gastrointestinal tube: Comparison of two surgical methods, the difference of tube indwelling time and number of indwelling gastric tube was not statistically significant(P>0.05), We can see that the cases and gastric tube time in the FTS group were significantly less than the one of traditional nursing group.(3) Postoperative complications:(1)There was no significant difference between the four groups at pulmonary infection, intestinal obstruction and anastomotic leakage.(2)Wound complications were not identical in all groups(P>0.05), but there was no statistical significance in the two-two comparison. This may be due to the adjustment of the standard of test. According to the data of the operation, the difference between laparotomy and laparoscopic surgery was statistically significant(P<0.05). According to the data of the nursing method, no significant difference was found between the FTS and the traditional nursing group(P>0.05).(3)throat pain were not identical in all groups(P<0.001). There were significant differences between the FTS group and the traditional nursing group in the two operation methods.(A1:A2 is P=0.0001,B1:B2 is P<0.001)There was no significant difference between the laparoscopic operation group and the laparotomy group in the two perioperative nursing interventions(A1:B1is P=0.114, A2:B2 is P=0.063).conclusions:Fast-track surgery nursing intervention and laparoscopic surgery both are conducive to the rehabilitation of patients, if two were implemented at the same time patients can get the best effect... |
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