| Objective1.To describe the current status of patients with liver cancer after intervention under the concept of Enhanced Recovery After Surgery(ERAS),and to analyze the status and influencing factors of postoperative complications.2.To formulate an intervention plan based on the ERAS concept for perioperative TCM nursing technology for postoperative complications in patients with liver cancer,combining TCM nursing technology,literature review,group discussion and expert consultation results.3.To explore the effect of perioperative TCM nursing technical scheme based on ERAS concept on postoperative pain,abdominal distension,nausea,vomiting and fever in patients with liver cancer interventional therapy,as well as the level of Alanine Aminotransferase(ALT)in postoperative patients.The effect of numerical changes.The purpose of this study is to provide a strong basis for the clinical intervention of perioperative traditional Chinese medicine nursing technology for the intervention of complications in patients with liver cancer after intervention.Methods1.Investigative research stage.Case review convenience sampling was used to select a total of 84 patients with liver cancer who underwent perioperative intervention based on ERAS concept from November 2019 to April 2020 in a tertiary and first-class hospital in Shijiazhuang City.The general information of the patients was collected,and the functional status of the patients was measured by the Kamofsky scale(Kamofsky,KPS).The degree of liver function was assessed by the Child-Pugh modified grading method to assess the acquired liver function of the patients,and the status of complications after interventional liver cancer was analyzed,and the influencing factors were analyzed by univariate and Logistic multivariate regression.2.The construction stage of the research intervention plan:under the guidance of the literature review and the traditional Chinese medicine nursing technology of the ERAS concept,the Delphi expert consultation is carried out.The Delphi method has its own set of independent forecasting procedures,which mainly include the following three stages:the preparation stage,the polling stage,and the data processing stage.Two rounds of letter questionnaires were used in the process of letter inquiry in this study.The first round was conducted in the form of a paper version of the letter questionnaire,and the second round was conducted in the form of an electronic version of the questionnaire.Statistical analysis was carried out on the results of the experts’ letter inquiries,and the intervention plan was adjusted according to the results of the letter inquiries.3.The implementation stage of the research intervention program.(1)Pre-intervention preparation:①A multidisciplinary team(Multidisciplinary treatment,MDT)based on the concept of ERAS will be established.The team consists of interventional vascular surgeons,anesthesiologists,TCM specialist nurses and non-specialist nurses.Nurses with senior experience jointly supervise,find problems,adjust in time,and intervene dynamically.Team nurses are responsible for implementing the nursing plan.②ERAS and TCM nursing knowledge training:The researcher is responsible for formulating a training plan,organizing TCM specialist nurses to train nursing staff,continuing to expand ERAS-related knowledge and TCM nursing techniques by using the morning shift and business learning model,and conduct knowledge assessment after the study,and only those who pass the assessment can participate in the implementation of the plan.(2)Implementation of intervention:The convenience method selected 79 patients with liver cancer interventional therapy from May 2020 to November 2020 as the research objects,and the convenience sampling method was divided into the control group and the intervention group,and strict diagnostic criteria,inclusion criteria,Exclusion criteria,withdrawal criteria,and general data of the two groups of patients were investigated and analyzed.The control group received routine perioperative care for liver cancer patients based on the ERAS concept,while the intervention group added traditional Chinese medicine nursing techniques in the perioperative period according to the syndrome and condition of the patients after surgery.The time of first gassing after operation,time of first defecation,time of getting out of bed voluntarily,postoperative body temperature,liver function and eating situation of patients were evaluated.SPSS 25.0 statistical software was used for data analysis,chi-square test was used for comparison between groups,and the median and interquartile range were used to represent measurement data with skewed distribution.There were differences in data between the two groups,P<0.05,the difference was Statistical significance.Results1.Investigative research stage.(1)A total of 84 patients with liver cancer undergoing interventional surgery were selected,of which 18(21.43%)had nausea and vomiting,28(33.33%)had abdominal distension,60(71.43%)had fever,and 68(80.95%)had pain.(2)Univariate analysis showed that there were significant differences in age,abdominal distension,and pain score between patients with nausea and vomiting and those without nausea and vomiting(P<0.05);patients with abdominal distension and those without abdominal distension had a significant difference in fasting time,postoperative period,and pain.There were significant differences in the time of getting out of bed after operation(P<0.05);there were significant differences in age,liver function classification,and embolizing agent dosage between patients with fever and those without fever(P<0.05);patients with pain There were significant differences in age,embolizing agent dosage,and perioperative invasive operation between patients with no pain and those without pain(P<0.05).(3)Logistic multivariate regression analysis found that age,abdominal distension,and degree of pain were independent risk factors for postoperative nausea and vomiting(P<0.05);Postoperative fasting time and postoperative ambulation timewere independent risk factors for postoperative abdominal distension(P<0.05).and liver function classification were independent risk factors for postoperative fever(P<0.05);while age,embolizing agent dosage and perioperative period Invasive operation was an independent risk factor for postoperative pain(P<0.05).2.Intervention program construction stage.(1)After two rounds of consultations with 15 experts in Guangzhou and Hebei after literature review and Delphi method expert correspondence,the intervention plan of traditional Chinese medicine nursing technology based on the ERAS concept for postoperative complications of liver cancer patients was finally determined,including There are 3 first-level indicators and 15 second-level indicators,and the expert authority coefficient Cr is 0.890.(2)Form an intervention team,and finally include 2 chief physicians,2 deputy chief physicians,2 attending physicians,4 TCM specialist nurses,and 6 non-TCM specialist nurses.The working life is 10 to 30 years.The team intervention method is used to implement the intervention plan,in which the doctor is responsible for the issuance of the doctor’s order and the treatment of the patient’s condition,and the nurse is mainly responsible for the implementation of the intervention.Based on the concept of ERAS,the perioperative intervention starts from the 1st day before the operation to the 7th day after the operation and ends before discharge.,during the hospitalization of patients,group intervention combined with individual intervention led by the patient’s needs.The nurses used the VAS scale to evaluate the patient’s pain and clinical indicators related to abdominal distension at 8h,24h,48h,72h,and 96h after the operation:the time of the patient’s first flatulence,the time of the first bowel movement,the time to get out of bed voluntarily,On the 1st,3rd,and 7th days after the operation,the liver function damage-related index ALT,and the patient’s appetite and the first eating time were evaluated on the 2nd day after the operation.On the day of operation and on the 1st,2nd,and 3rd days after the operation,the team nurses recorded the body temperature of the two groups of patients by measuring the axillary temperature.3.The implementation stage of the intervention plan:A total of 79 subjects were selected in this study,and the subjects were divided into the intervention group(40 cases)and the control group(39 cases)using the convenience sampling method.-.Among them,1 patient in the intervention group dropped out and was actually.included in the study.In 39 cases,there was no object shedding and loss in the control group.(1)In the intervention group,there were 32 males and 7 females,with an average age of(52.49±7.51)years old,and the proportion of liver function Child-Pugh modified grade A was 5.13%,grade B accounted for 74.36%,and grade C accounted for 20.51%;the control group included 31 males and 8 females,with an average age of(52.25±7.29)years old.The proportion of functional Child-Pugh modified grade A was 7.69%,B grade was 69.23%,and C grade was 23.08%.The age,sex ratio,liver function Child-Pugh grade and other general information of the two groups of patients were compared For comparison,the results showed that there was no significant difference in the data between the groups,P>0.05,the difference was not statistically significant,and it was comparable.(2)Further simple effect analysis was performed.The group effect showed that there was no significant difference in the VAS pain score at 8h after surgery between the two groups(P>0.05),but the VAS score at 24h,48h,72h,and 96h after surgery between the two groups was lower.At 8h after operation,the difference was statistically significant(P<0.05).Among the clinical indicators related to abdominal distension after operation between the two groups,the time of first exhausting,defecation and getting out of bed in the intervention group was shorter than that in the control group,and the difference was statistically significant(P<0.05).In terms of appetite and diet related to the complications of nausea and vomiting,the postoperative good and good rate of appetite in the intervention group was higher than that in the control group,and the first eating time was shorter than that in the control group,and the differences were statistically significant(P<0.05).From the day of operation to the third day after operation,the mean postoperative body temperature and fever rate of the intervention group were lower than those of the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the value of ALT related to the damage of complication liver function on the 1st day after the operation between the two groups(P>0.05).The values were lower than the 1st day after operation,and the ALT in the intervention group was lower than that in the control group on the 3rd and 7th days after the operation,and the difference was statistically significant(P<0.05).Both groups were studied until the 7th day after operation.One patient in the intervention group was lost to follow-up due to transfer to a hospital,while no case in the control group was lost to follow-up.Comparing the incidence of complications during the follow-up between the two groups,the incidence of complications in the intervention group was lower than that in the control group.Conclusion1.Complications still occur in patients with liver cancer after intervention under the ERAS concept.There is a close relationship between age,abdominal distension,and pain level with the occurrence of nausea and vomiting.Postoperative fasting time and postoperative ambulation time are closely related to the occurrence of abdominal distension.There is a close relationship between age,liver function classification,embolic agent dosage and the occurrence of fever,age,embolic agent dosage,perioperative invasive operation and the occurrence of pain are closely related,and clinical measures should be taken for targeted intervention.2.TCM nursing technology based on the concept of ERAS can relieve the postoperative pain of patients with liver cancer interventional therapy,and can correct the patient’s nausea and vomiting by adjusting the patient’s appetite,reduce the mean fever from day to 3 days after operation,help improve the level of ALT in patients with liver cancer after intervention.It is a scientific and systematic nursing technology,which can effectively interfere with the occurrence and development of complications in patients with liver cancer after intervention,and is suitable for promotion and application. |
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