Research For Postoperative Delirium(POD) In Elderly Patients With Gastrointestinal Cancers

Incidence of gastrointestinal cancers is relatively high, and the number of elderly patients receiving gastrointestinal cancer surgery is on the rise. Due to the aging progress, the incidence of postoperative complications in elserly is higher than other age group, and the prognosis is worse. Thus, perioperative management for elderly patients is more complex than other age groups. In a variety of complications, postoperative delirium(POD) is very common. POD is defined as mental disorders of the patient in the cognitive impairment, thinking unlogically, memory lose and sleep deprivation after anesthesia recovery from surgery, which is also known as postoperative mental disorders and postoperative cognitive dysfunction. POD studies on surgery patients have been reported greatly, in which researchers all agree that POD increases the suffering of patients, prolongs hospital stay, increases the incidence of other complications and hospital costs, even improves the perioperative mortality, and hinders the rehabilitation of patients after surgery significantly.POD in elderly patients with gastrointestinal cancers can lead to prolonged postoperative recovery time, increased complications, and in severe cases long-term mental damage or even threat to life, but it did not cause enough attention till now. There are some drawbacks in diagnosis, prevention and treatment of POD in elderly patients with gastrointestinal cancers currently. In medical treatment, anesthetists should select drugs that are safer to patients. Surgeons should operate carefully to reduce blood and trauma. New drugs should be seeked to treat POD. In nursing, drawbacks are more obvious, nurses rarely perform preoperative assessment of elderly patients or predict POD; inadequate attention for POD after surgery results in missed or delayed diagnosis in some patients; comprehensive treatment for nursing-related measures of POD is inadequate, and the lack of nursing measures of POD lead to prolongation and aggravation. Thus prevention and timely diagnosis and treatment of POD targeting pathogens is of great importance for promoting recovery after surgery, and in this process nursing plays an essential role. So safe and effective managments for POD depend on knowledgable nurses and high-qulity nursing care. And a multidisciplinary collaboration is needed These measures and standards have yet to be improved and standardized by nurses through a series of clinical studies and effective prevention and treatment of POD in elderly patients are beneficial for recovery.The main contents of this study was from nursing perspective, which included sections as followings: ①Source of knowledge of clinical staff in gastrointestinal surgery for postoperative delirium(POD) in elderly, and to increase degree of attention, improve the therapeutic effect for POD.②Cognitive stimulation was applied in the postoperative care for elderly patients with gastrointestinal cancers, then prophylactic effect of cognitive stimulation to postoperative delirium(POD) was observed, and standardized preventive measures for POD were explored. Conclusions were drawn from these studies, and the conclusions were as followings: ①Understanding for POD knowelegement was incomplete for some clinical staff in gastrointestinal surgery. And various measures should be applied to improve the situation, so as to decrease incidence of POD in elderly, and improve the comprehensive treatment effect.②Early postoperative cognitive stimulation was effective for prevention to POD in patients with gastrointestinal cancers, which could promote the rehabilitation of patients. So cognitive stimulation is worth further study and clinical application to improved effect of comprehensive treatment to POD in patients with gastrointestinal cancers.The main contents of this article are as follows: Part one Cognition of clinical staff in gastrointestinal surgery for postoperative delirium in elderlyObjective: Purpose of this study was to investigate the cognition, knowledge requirement, source of knowledge of clinical staff in gastrointest- inal surgery for postoperative delirium(POD) in elderly, and to increase degree of attention, improve the therapeutic effect for POD.Methods: Questionnaire about POD designed by ourselves were distributed to 120 doctors and nurses in gastrointestinal surgery, who were from 3 general third class A level hospitals. The significance of results were explored from 117 effective papers.Results: From these papers, it was found that the answer of interviewees to the knowledge of POD in general situation, clinical manifestation, risk factors, prevention and treatment measures were limited. And misconceptions were found in some interviewees. For some interviewees, the source of knowledgement was limited.Summary: At present, understanding for POD knowelegement was incomplete for some clinical staff in gastrointestinal surgery. And various measures should be applied to improve the situation, so as to decrease incidence of POD in elderly, and improve the comprehensive treatment effect. Part two Effect of cognitive stimulation in prevention for postoperative delirium in elderly patients with gastrointestinal cancersObjects: Cognitive stimulation was applied in the postoperative care for elderly patients with gastrointestinal cancers, then prophylactic effect of cognitive stimulation to postoperative delirium(POD) was observed, and standardized preventive measures for POD were explored.Methods: Data of 74 elderly gastrointestinal cancer cases(≥60 years)from 2014.1-2014.12 were collected, during which 37 cases were recruited as intervention group, who accepted cognitive stimulation on the basis of routine treatment and nursing, and patients in control group only accepted routine treatment and nursing. The incidence of POD, VAS score, pain degree, indexes for recovery of gastrointestinal function, complications were collected and compared between 2 groups for 1 week.Results: The incidence of POD in intervention group was lower than in control group(P<0.05). No significance of complications was found in 2 groups(P>0.05).Summary: Early postoperative cognitive stimulation was effective for prevention to POD in patients with gastrointestinal cancers,which could promote the rehabilitation of patients. So cognitive stimulation is worth further study and clinical application.Conclusions:1 At present, understanding for POD knowelegement was incomplete for some clinical staff in gastrointestinal surgery. And various measures should be applied to improve the situation, so as to decrease incidence of POD in elderly, and improve the comprehensive treatment effect.2 Early postoperative cognitive stimulation was effective for prevention to POD in patients with gastrointestinal cancers,which could promote the rehabilitation of patients. So cognitive stimulation is worth further study and clinical application.