| Objective Oropharyngeal complications after general anesthesia directly affect the incidence of pulmonary infection.The purpose of this study is to explore the need to move forward systematic intervention to prevent pulmonary infection after liver cancer surgery;based on the theory of symptom management,analyze the symptom group experience and management requirements of early postoperative patients with liver cancer;use the evidence-based method to construct the management plan of oropharyngeal complications after liver cancer surgery,And to carry out clinical application research,evaluate the application effect of symptom management theory in clinical nursing practice,provide theoretical basis for ultra-early prevention of lung infection of liver cancer,and promote the development of clinical nursing of liver cancer.Method The First Part Qualitative research on the early symptom experience and management needs of patients with liver cancer after operation: Maximum difference sampling method was used for qualitative research,and purposive sampling method was used to select patients undergoing elective partial hepatectomy under general anesthesia for semi-structured in-depth interview,with on-site recording.After data saturation,13 cases were interviewed,and the original data were analyzed by Colaizzi analysis.The Second Part The construction of oropharyngeal complications management plan in the early stage after liver cancer surgery: using evidence-based method to construct oropharyngeal symptoms management plan.2.1 Evidence generation and evaluation: the clinical practice guidelines,systematic reviews and randomized controlled trials of oropharyngeal management of patients after general anesthesia were searched,and the best evidence was selected to form a network meta-analysis.2.2 Evidence application: the results of evidence evaluation were applied in small sample clinical practice,and the obtained evidence was comprehensively analyzed to explore the effect of different management measures on oropharyngeal complications.2.3 Scheme Construction: Based on the theory of symptom management and the results of evidence-based evaluation and evidence application,improve the management scheme of oropharyngeal complications after liver cancer surgery.The Third Part The clinical application of early postoperative oropharyngeal complications management in patients with liver cancer: the patients who were hospitalized in Department of hepatobiliary surgery of the First Affiliated Hospital of Guangxi Medical University from August 2020 to December 2020 and underwent elective surgery under general anesthesia were selected as the research objects,55 patients in the observation group and 55 patients in the control group respectively;the observation group was nursed according to the routine nursing after hepatobiliary surgery,and the symptom tube was applied.The control group received routine nursing after hepatobiliary surgery.The two groups were compared:(1)thirst score;(2)bitterness score;(3)sore throat score;(4)oral comfort score;(5)salivary p H value;(6)moistening degree of oral mucosa;(7)salivary flow rate;(8)overall comfort score;and(9)incidence of pulmonary infection.Result Part one Qualitative Research(1)The early postoperative symptoms and management needs of patients with liver cancer can be summarized into the following three high-level themes and four sub level themes: the diversity of symptom experience(surgical trauma symptom group,psychological symptom group),patients’ self-coping style and patients’ great demand for effective symptom management.(2)The top three pain symptoms of liver cancer patients within 12 hours after operation were dry mouth,sore throat and bitter mouth in turn;the top three pain symptoms within 24 hours after operation were sore throat,bitter mouth(pain and its juxtaposition)and dry mouth in turn;the top three pain symptoms within 72 hours after operation were wound pain,abdominal distension,dry mouth and bitter mouth;among them,oropharyngeal discomfort was the first chief complaint within 24 hours after operation,And the patients’ demand for the management of this symptom is higher than that of abdominal distension and wound pain.The Second Part The construction of oropharyngeal management plan after liver cancer surgery 1.A total of 8 RCTs involving 715 patients were included in this meta-analysis.The results of reticular Meta-analysis showed that in terms of thirsty score,the efficiency of ice saline spray and lemonade spray was significantly higher than that of routine nursing and placebo,and the difference was statistically significant(P < 0.05).Meanwhile,the efficiency of lemonade spray was better than that of vitamin C spray,and the difference was statistically significant(P< 0.05).There was no difference between 22 methods in other methods.There was no statistical significance(P > 0.05).The ranking results were: lemon water spray,ice physiological saline spray,normal saline spray,vitamin C spray,plum spray and routine nursing.And oral comfort score,lemonade spray was also better than ice physiological saline spray,and the difference was statistically significant(P < 0.05).2.A total of 60 patients were included in the small sample clinical trial.They were randomly assigned to lemon spray,plum spray,ice physiological saline spray and vitamin C spray group,with 15 patients in each group.2.1 Comparison of general data such as gender,age,liver cirrhosis of the four groups of liver cancer patients,the difference was not statistically significant(P﹥0.05),and they were comparable;dry mouth score,mouth pain score,sore throat score,and oral comfort score Before and after operation,the difference was not statistically significant(P﹥0.05).2.2 Mouth dry score: after intervention of 2h,4h and 6h,lemon water spray was significantly better than ice water spray in improving dry mouth score(P﹤0.05).2.3 Mouth bitterness score: After 6 hours of intervention,the bitterness score of the lemonade spray group was significantly lower than that of the ice saline spray and vitamin C spray groups(P﹤0.05).2.4 Sore throat score: Compared with 4h and 6h,the scores of sore throat in lemon water spray group were significantly lower than those in plum spray group and ice physiological saline spray group(P﹤0.05).2.5 Oral comfort score: Lemonade spray is better than the other three measures in improving oral comfort score after intervention(P﹤0.05).3.To improve the management of oropharyngeal complications after general anesthesia for liver cancer: including the evaluation of symptoms,the formulation of symptom management strategy and the observation of effect.Among them,symptom management strategies include 8 "W" : management strategy name(what),intervener(who),intervener(who),intervener(when),intervention time point(when),intervention place(where),intervention purpose(why),how to intervene(how)and intervention frequency(how much).The third part the clinical application of oropharyngeal management after hepatectomy 1.Randomly divide 110 patients with liver cancer into observation group(n=55)and control group(n=55).A total of 4 cases were dropped in this study.2 cases in the control group were transferred to the surgical ICU due to changes in their condition;1 case in the observation group was transferred to the surgical ICU due to changes in the condition,and 1 case needed to be transferred to the department of gynecology due to changes in the condition.In the end,53 cases were included in the observation group and the control group.There was no statistically significant difference in the baseline data of the two groups of liver cancer patients(P﹥0.05),and they were comparable.2.The incidence of pulmonary infection in patients with different sore throat and thirst: The difference in the incidence of lung infection in patients with different sore throat and thirst is statistically significant(P﹤0.05).3.The scores of sore throat,thirst,bitterness,saliva flow rate,saliva in the two groups of liver cancer patients There were no statistically significant differences in p H value,lip mucosal moisture score,oral comfort score,and overall comfort score before and after surgery(P﹥0.05).4.The sore throat score of the observation group was lower than that of the control group at intervention 4h,intervention 6h(P﹤0.05),the difference was statistically significant(P﹤0.05);the observation group’s thirst score was at intervention 2h,intervention 4h,intervention 6h were lower than the observation group,the difference was statistically significant(P﹤0.05);the mouth pain score of the observation group was significantly lower than the control group at 4h,6h(P﹤0.05);observation The saliva flow rate of the group of patients was significantly higher than that of the control group at 4h,6h after the intervention,and the difference was statistically significant(P﹤0.05);the saliva p H of the two groups of liver cancer patients was compared before and after the intervention,and the difference was not statistically significant(P﹥0.05);At all observation time points after the intervention,the lip mucosal moisturization score of the observation group was significantly higher than that of the control group,and the difference was statistically significant(P ﹤ 0.05);after intervention 2h,intervention 4h,intervention 6h.The oral comfort score of the observation group was significantly higher than that of the control group(P﹤0.05).The comfort score of the observation group was significantly higher than that of the control group at 6h fter the intervention,and the difference was statistically significant(P﹤0.05).5.The results of repeated measures analysis of variance showed that the time effects,inter-group effects and interaction effects of sore throat score,thirst score,mouth pain score,oral comfort score,saliva flow rate and overall comfort score were all statistically significant(P﹤0.05);The time effect of saliva p H is statistically significant(P﹤0.05),while the inter-group effect and interaction effect are not statistically significant(P﹥0.05);6.The results of the generalized estimation equation show that the difference in the degree of moisturization of the oral mucosa in time and grouping is statistically significant(P﹤0.05).7.Incidence rate of lung infection: After the intervention,there was no statistically significant difference in the rate of lung infection between the two groups of liver cancer patients(P﹥0.05).However,the incidence of lung infection in the observation group(5.67%)was lower than that in the control group(13.21%).Conclusion 1.Early postoperative oropharyngeal complications are serious,the incidence is high,and accompanied by systemic symptoms,suggesting that clinical staff should pay more attention to them.2.Based on the theory of symptom management,the management plan of oropharyngeal complications after liver cancer general anesthesia constructed by evidence-based method is feasible and reflects more humanistic nursing.3.The "management plan of oropharyngeal complications after general anesthesia for liver cancer" adopts the systematic intervention of demand forward,which can effectively reduce the early postoperative oropharyngeal complications of patients with liver cancer,and provide new ideas and methods for early prevention of postoperative pulmonary infection. |
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