| Objective:To study the development of a respiratory management programme based on the ERAS concept and to investigate its impact on postoperative respiratory complications in patients undergoing hepatectomy for hepatocellular carcinoma.Methods:Reviewed domestic and international literature,summarized and analyzed the contents of perioperative respiratory management for patients undergoing hepatectomy,introduced the concept of multidisciplinary cooperation in ERAS,discussed and formed the first draft of the respiratory management plan based on the ERAS concept.The final intervention plan was revised and improved according to the expert review.Patients with hepatocellular carcinoma who met the inclusion criteria in the Department of Hepatobiliary Surgery of a tertiary care hospital in Wuxi City from November 2021 to November 2022 were selected for the study,and the patients were divided into a control group and a trial group,each with 38 cases.The control group was given conventional nursing measures,while the experimental group implemented a respiratory management program based on the ERAS concept on the basis of conventional nursing,to observe the effects of different interventions on the postoperative respiratory complications of patients in both groups.This study included post-operative pulmonary complications(respiratory infection,atelectasis,pleural effusion,pneumothorax,respiratory failure,bronchospasm and aspiration pneumonia),post-operative stress,ineffective sputum evacuation rate,hypoxaemia rate,time to first bed activity,post-operative hospital stay,readmission rate,exercise compliance and anxiety level.Postoperative pulmonary complications,ineffective sputum evacuation rate,hypoxaemia rate,time to first bed activity,postoperative hospital stay,exercise compliance were counted on the day of discharge;patients were assessed by C-Reactive Protein(CRP)and White Blood Cell(WBC)counts on the first day of admission,the third day of postoperative,and the seventh day of postoperative.The Anxiety Self-Assessment Scale was used to assess patients’anxiety levels on the initial day of admission,the first preoperative day,the third postoperative day and the seventh postoperative day;the readmission rate was counted at the time of review within 30days after surgery.The data were statistically analysed using SPSS software to assess the impact of the respiratory management programme developed based on the ERAS concept on postoperative respiratory complications in patients undergoing hepatectomy for hepatocellular carcinoma.Results:Three patients were shed in each of the two groups during the study,and data from 70 patients were eventually included in the analysis,35 each in the test and control groups.There was no statistical difference in the general data between the two groups(P>0.05).The test group outperformed the conventional care group in terms of postoperative pulmonary complications,stress response indicators,ineffective sputum evacuation rate,incidence of hypoxaemia,time to first bed activity,length of stay,exercise compliance and anxiety level after the perioperative respiratory management programme developed based on the ERAS concept(P<0.05).The results of postoperative pulmonary complications in the two groups showed that one case of respiratory infection and one case of pleural effusion occurred in the experimental group,with an incidence of 5.71%of pulmonary complications;two cases of respiratory infection,three cases of pleural effusion,two cases of pulmonary atelectasis and one case of aspiration pneumonia occurred in the control group,with an incidence of 22.86%of pulmonary complications.The incidence of pulmonary complications was significantly different between the two groups(P<0.05).The results of CRP and WBC counts,which were indicators of stress response in both groups,showed that on the first day of admission,the CRP count was(7.92±2.61)mg/L and the WBC count was(6.99±0.68)×10~9/L in the test group,which were not statistically significant when compared with the CRP count(8.27±2.19)mg/L and WBC count(7.11±0.82)×10~9/L in the control group.The differences were not statistically significant(P>0.05);the CRP and WBC counts in the test group were lower than those in the control group at the time points of the 3rd and 7th postoperative days,and the differences were statistically significant(P<0.05).The results of the ineffective postoperative sputum evacuation rate in both groups showed that the ineffective postoperative sputum evacuation rate in the test group was lower than that in the control group(5.71%vs 25.71%);the results of the hypoxaemia rate showed that the postoperative hypoxaemia rate in the test group was lower than that in the control group(8.57%vs 28.57%),and the difference was statistically significant(P<0.05).The results of the first postoperative bed activity time,postoperative hospitalization time and readmission rate of the two groups showed that the first postoperative bed activity time in the test group was(30.89±4.60)h,which was lower than the first postoperative bed activity time in the control group(42.40±6.71)h.The postoperative hospitalization time in the test group was(9.31±1.30)d,which was lower than the postoperative hospitalization time in the control group(11.77±2.17)d,The difference was statistically significant(P<0.05).The readmission rate within 30 d after surgery was 5.71%in the test group and 14.29%in the control group,with no statistically significant difference(P>0.05).The results of exercise compliance in the two groups showed that the test group had higher exercise compliance(94.29%vs 74.29%)than the control group,with a statistically significant difference(P<0.05).The anxiety scores of the two groups showed that on the first day of admission,the anxiety score of the test group was(58.83±5.48),compared with the anxiety score of the control group(58.29±4.93),the difference was not statistically significant(P>0.05);the anxiety level of both groups declined with time in the preoperative 1 d,the postoperative 3 d and the postoperative7 d.The anxiety level of the trial group was lower than that of the control group,and the difference was statistically significant.(P<0.05).Conclusion:The respiratory management programme based on the ERAS concept is effective in reducing the incidence of postoperative respiratory complications including pulmonary complications,stress reactions,ineffective sputum excretion and hypoxaemia in patients undergoing hepatectomy,shortening the time to first bed activity and length of stay,improving patient compliance,alleviating patients’anxiety during hospitalisation and promoting rapid postoperative recovery,and is worth promoting in clinical practice. |
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