The Application Of Operating Room Holistic Nursing Based On ERAS Concept In Patients With Laparoscopic Precise Hepatectomy

ObjectiveBased on the concept of enhanced recovery after surgery(ERAS),an optimized holistic nursing scheme for operating room was established,which was applied to patients undergoing precise laparoscopic hepatectomy to evaluate its nursing effectiveness,providing reference for the application of ERAS concept in holistic nursing of operating room,and improving the perioperative ERAS nursing process.MethodsA total of 108 patients who underwent laparoscopic precise hepatectomy and who met the selection criteria in a hepatobiliary and pancreatic surgery at a tertiary Class A hospital in Hengyang from September 2017 to March 2019 were selected as the research subjects and randomly divided into control group(n=54)and the intervention group(n=54),the patients in the control group received routine operating room care,and the patients in the intervention group received holistic operating room care based on the ERAS concept.During the intervention,4 cases were lost in each group.The number of cases that completed the intervention process was the control group(n = 50)and the intervention group(n = 50).Compare the following indicators of the two groups of patients:(1)anxiety scores at admission,entering operating room,one week after surgery and at discharge;(2)preoperative thirst and hunger;(3)intraoperative situation;(4)the change of core body temperature during the operation;(5)The incidence of postoperative hypothermia and postoperative resuscitation: the incidence of chills and restlessness,tracheal tube removal time,stay time in post-anesthesia care unit(PACU);(6)Postoperative laboratory indicators: detection values of white blood cells(WBC),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),albumin(ABL)on postoperative day 1,4,and 7;(7)Postoperative complications: nausea and vomiting,moderate to severe pain,general surgical complications(incision infection,pulmonary infection,deep venous thrombosis);(8)postoperative rehabilitation: first meal time,first anal exhaust time,first time out of bed activity;(9)postoperative hospitalization time,hospitalization costs;re-admission rate within 30 days after operation;(10)Patient satisfaction.The data were analyzed using Statistical Product and Service Solutions(SPSS 22.0),and t-test,chi-square test,and repeated measures analysis of variance were used for statistical analysis of the research data.Results(1)There was no significant difference in general information between the two groups of patients(P> 0.05).(2)There was no significant difference in the anxiety scores between the two groups of patients when they were admitted to the hospital(P> 0.05).The anxiety scores of the intervention group on entering the operating room,on postoperative one week,and at discharge were significantly lower than those in the control group(P <0.01).(3)The preoperative rates of thirst and hunger in the intervention group were significantly lower than those in the control group(P <0.05).(4)There was no significant difference in the duration of surgery,the amount of bleeding,the number of blood transfusion cases,and the number of liver resections in the two groups of patients(P> 0.05).(5)The core body temperature of patients in the test group were higher than those in the control group at 30 minutes(T1),60 minutes(T2),90 minutes(T3)after general anesthesia,entering PACU after surgery(T4),and leaving PACU(T5)(P <0.001).(6)The incidence of postoperative hypothermia,chills,and agitation was significantly lower in the intervention group than in the control group.The tracheal tube removal time and the duration of the resuscitation room were significantly shorter than those in the control group(P <0.05).(7)The incidence of moderate to severe pain and general postoperative complications(incision infection,lung infection,deep venous thrombosis)in the intervention group were significantly lower than those in the control group(P <0.05).There was no significant difference in the incidence of postoperative nausea and vomiting,surgery-specific complications(abdominal bleeding,bile leakage,liver failure)between the two groups(P> 0.05).(8)White blood cells in the intervention group was significantly lower than that in the control group(P <0.05).Albumin was significantly higher than that in the control group(P<0.001),and there was no significant difference in alanine aminotransferase,aspartate aminotransferase,total bilirubin detection values between the two groups after surgery(P> 0.05).(9)The first postoperative feeding time,anal exhaust time,time to get out of bed,and length of stay in the intervention group were significantly shorter than those in the control group,and the total cost of hospitalization was significantly lower than that in the control group(P <0.05).There was no significant difference in the readmission rate between the two groups within 30 days after surgery(P> 0.05).(10)The satisfaction score of patients in the intervention group on the quality of nursing care in the operating room was significantly higher than that in the control group(P <0.05).ConclusionIt is safe and effective to integrate the ERAS concept into the holistic nursing care of the operating room in patients undergoing laparoscopic precise hepatectomy.It can reduce the perioperative anxiety level,maintain the stability of core body temperature during the operation,reduce postoperative complications,shorten the postoperative resuscita-tion time and hospital stay time,reduce hospitalization costs,and improve satisfaction of the surgery patient.