| Objectives:To develop the enhanced recovery after surgery(ERAS)nursing pr ogram of lung cancer thoracoscopic surgery based on the literature review and summing up experience.Furthermore,the program was applied in the periopera tive care of patients and evaluated the effect of enhanced recovery after surger y nursing program among lung cancer patients who underwent thoracoscopic ra dical resection.This study was proposed on the development of enhanced reco very after surgery care,then summarizing and analyzing the effect of ERAS nursing program and forming a standardized ERAS nursing process,providing a theoretical and practical basis for the implementation of ERAS nursing for lu ng cancer patients,and promoting its measures for other cancer diseases.Methods:There were 160 lung cancer patients who underwent the operation in the Department of Thoracic Surgery fron Yunnan Cancer Hospital,from January 2018 to October 2018 enrolled in this study.Two groups including experimental group and control group with the sample size at 84 and 76 patients respectively.The control group received routine nursing care after thoracic surgery,and the experimental group used ERAS nursing measures.To compare the postoperative recovery of the two groups(including the chest drainage on the first postoperative day;the chest drainage and time of chest move;the time point of first getting out of bed;pain scores 3 days after surgery and the incidence of postoperative complications),the length of hospitalization and its total cost.Furthermore,lung function,quality of life,ftmctional exercise compliance were compared at the time point of before,after surgery(1 and 3 months).Thus,the effects of this nursing program were evaluated and the nursing experience was summarized in the procedure.Results:1.There were no significant differences in the general information and clinical information from patients between the observation and comparison group(P>0.05).2.Comparison of postoperative recovery and economic indicators between the t wo groups:the postoperative first time to get out of bed in the ERAS group was 14.59±4.42 h,while that in the control group was 20.61 ± 11.30 h.The d ifference between the two groups was statistically significant(p=0.028).The E-RAS group had 284±126ml of thoracic drainage on the first day after surgery,while the control group had 288±133ml.The thoracic drainage on the first da y between the two groups has no statistically difference(p=0.86).In ERAS g roup,the extraction time of thoracic drainage tube was 36.7±18.9 h,While tha t in control group was 51.5±24 h.The difference between the two groups wa s statistically significant(p=0.01).The ERAS group’s length of stay in hospital was 186±42 h,and the control group was 242±56 h.The difference bebwee n the two groups was statistically significant(p=0.031).The ERAS group’s tot al hospital expense was 48565±14692 yuan,while the control group was 49889+15273 yuan.The difference between the two groups was not statistically si gnificant(p=0.079).3.Comparison of the incidence of complications between the two groups:ERA S group of pulmonary infection had 4 cases(5.1%)and the control group in p ulmonary infection 15 cases(20.5),compared the two groups were statistically sig1ificant(p=0.004),ERAS group complications were 10 cases(12.8%)and control group complications were 21 cases(28.7%),compared the two groups was statistically significant(p=0.02).There was no significant difference in other incidences of complications between the two groups(p>0.05).4.Comparison of pain conditions between the two groups:the pain scores of t he experimental group at rest 3 days after surgery and at cough was lower tha n in the control group,and the differences were statistically significant(P<0.05).5.Comparison of lung function between the two groups:the ERAS group and the control group showed no statistically significant difference in lung functio n before intervention(p=0.267),and the ERAS group was statistically significa nt difference in MVV from the control group one month after surgery(p=0.001),while the difference in FEV1(%)and FEV1/FVC(%)was not statistically significant(p>0.05).The difference in lung function between the ERAS gro up and the control group 3 months after surgery was statistically significant.6.Comparison of quality of life between the two groups:Repeated measures analysis of variance showed:(1)Comparison between groups:There was no significant difference in the scores of the quality of life scores before intervention(p>0.05);1 month and 3 months after surgery,the ERAS group were higher than the control group in the field of physical function,role function,emotional function,with statistical difference(P<0.05);fatigue,nausea,vomiting,pain,dyspnea,insomnia,appetite loss items in the ERAS group scores were lower than the control group(P<0.05),with statistical differences;(2)intra-group comparison:the third month after the ERAS group,physical function,role function,emotional function,cognitiye function,The overall health status was higher than the first month after surgery(P<0.05);fatigue,nausea and vomiting,pain,dyspnea,and loss of appetite loss in the symptom area were significantly lower than those in the first month after surgery(P<0.05).In the third month after the operation,the physical function,role function and overall health status of the control group were higher than those in the first month after operation(P<0.05).The score of fatigue,nausea and vomiting,pain,dyspnea,loss of appetite in the symptom area were significantly lower in the first month(P<0.05).7.Comparison of functional exercise compliance between the two groups:ERAS group and the control group showed no statistically significant difference in functional exercise compliance before intervention(p=0.625).One month after surgery,the ERAS group’s total score was 38.74±6.12,and the control group was 32.43±6.52.The difference between the two groups was statistically significant(p=0.023).In the third month after surgery,the functional exercise score(45.80±10.74)of ERAS group was higher than the control group(35.68±8.64),and the difference shown statistically significant(P=0.01 1)Conclusion1.ERAS nursing program used in lung cancer patients who underwent thoracoscopic radical resection could promote the early extraction of the thoracic drainage tube,promote patient out of bed early,and reduce postoperative complications2.ERAS nursing program used in lung cancer patients who underwent thoracoscopic radical resection could improve postoperative analgesia,reduce postoperative pain effectively,and facilitate rest and sleep.3.ERAS nursing program used in lung caneer patients who underwent thoracoscopic radical resection could shorten the length of hospitalization,which was conducive to speeding up the turnover rate of hospital beds,and achieved the goal of saving medical resources and reducing hospitalization expenses.4.ERAS nursing program could improve the compliance of functional exercise,promote the recovery of lung function and improve their quality of life significantly among lung cancer patients who underwent thoracoscopic radical resection.5.ERAS nursing program could transform rehabilitation concept among nurses,improve professional quality,further standardize postoperative rehabilitation nursing care for cancer patients.It provides a reference for accelerating the rehabilitation of clinical nursing pathways and nursing guidelines. |
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