| BackgroundHepatocellular carcinoma (Primary liver cancer, PLC) is one of the most common malignant disease. It can be divided into hepatocellular carcinoma, bile duct cell type and mixed type of liver cancer liver cancer, according to the pathlogical classification. PLC incidence have been increasing in the past two decades, worldwide, and its incidence and mortality are listed ranking No.7 and 4, respectively. The incidence of liver cancer ranks after lung cancer and stomach cancer in China, Mortality ratio of PLC was 23.7/10 million, followed with lung cancer. Generally, treatment for liver cancer includes surgical and non-surgical treatment. Surgical resection is considered the preferred most effective treatment of liver cancer at present, but not all are suitable for patients with liver cancer surgery. Only cardiopulmonary function better, more limited liver tumors, patients without metastasis were appropriate surgery. Most Chinese liver cancer patients have hepatitis, cirrhosis of history, it was reported that about 50%patients can not endure surgery clinic for various reasons.Fast-track surgery (FTS) has been developed by combining several techniques with evidence-based adjustments, including anesthetic, surgical, nursing, and pre-/intra-/post-operative management to accelerate recovery, reduce morbidity and shorten hospital stay of surgical patients.Fast track surgery in early rehabilitation after surgical abdominal surgery is not a new concept. In 1899 is beginning to have a foreign literature reports, it appears it is as old as the emergence of surgical abdominal surgery. In the United States, in 1946 there is a very detailed literature reports of its benefits.FTS application of this new concept is the team earlier in our country under the leadership of academician Jieshou has been successfully applied to surgery for colorectal cancer in the perioperative period, the idea was quickly accepted by many surgical fields.The rapid development of rapid rehabilitation surgery, accelerated rehabilitation patients and reduce complications. Recent studies have shown that fast recovery mode application in reducing surgical hospital stay and hospital costs with remarkable results.Recent studies have demonstrated that FTS can result in a decrease in hospital stay and hospital cost in colorectal, vascular, urologic, and pediatric procedures.FTS mode applications in the field of nursing, is the use of procedures for patients to take care assessment, diagnosis, planning, implementation and evaluation. At the same time from the surgery, the patient’s concerns flatus, pain control, the drainage, eating cases, intravenous infusion volume, and then dynamically adjusted according to the patient care plan specific circumstances, and with the treatment and rehabilitation process, adjustment and improvement plans.Modern rapid recovery does not advocate the concept of postoperative prolonged bed rest, as this will increase muscle atrophy, decreased muscle strength, damage to lung function and increase the formation of venous stasis and deep vein thrombosis. Studies have shown that the vast majority of patients with liver cancer have varying degrees of fear, anger, depression, anxiety and other psychological disorders, extremely detrimental to health. Knowledge and basic methods of psychological care nurses should have, starting from the concept of holistic nursing care of patients, more contact with patients, targeted guidance to patients with mental, psychological support, and establish the confidence to overcome the disease, maintain the normal function of the body improve their immunity. FTS care model to promote early extubation, limiting fluids, such as early ambulation different ideas and traditional values, the patient psychologically If you can not adapt, it may even lead to increased patient anxiety.Different ages, different levels of acceptance of different FTS mode, studies have shown that elderly patients due to poor acceptance of FTS mode, easy to produce anxiety. Studies have shown that the traditional concept of the affected patients are skeptical of the FTS mode, hope more medication, multiple transfusion, the use of nutritional support, do not want to eat and get out of bed early. Therefore, the use of FTS model there are still contentious. To further investigate the effectiveness of FTS mode, this study patients with primary liver cancer lines studied two groups of short-term effects.ObjectionCare model using FTS resection of hepatocellular carcinoma in patients with nursing intervention, explore FTS model of care for patients with primary liver resection and liver function recovery of anxiety if there is improvement, to further clarify the value of rapid rehabilitation program mode after liver cancer.MethodsSelect January 2012-December 2013 admitted to a hospital in Foshan, primary liver cancer confirmed by pathology underwent open surgery, using methods drawn from a random sample of 123 patients were prospectively studied. All patients were randomly divided into experimental and control groups. The control group received conventional treatment and care measures, the experimental group on the basis of conventional treatment and care, based on starting from perioperative care model by FTS guidance. Before and after the intervention, patients in both groups of state anxiety and trait anxiety were evaluated, the survey tools include:patients generally self-designed questionnaire, State Anxiety Inventory (SAI), and Trait Anxiety Inventory (TAI), biochemical tests Siemens ADVIA2400 detected by biochemical analyzer. General condition of patients after resection of hepatocellular carcinoma by comparison, including postoperative hospital stay, hospital costs, anal exhaust time, anxiety score cases, liver function, including alanine aminotransferase (ALT), albumin (ALB), bile red pigment (TBIL). The obtained data were Epidata3.1 software line double double entry, and check after the completion, whichever is inconsistent with the original data, and finally to export excel format for statistical analysis of the data. Using SPSS13.0 statistical software for statistical data analysis and processing, Multivariate stepwise regression analysis of factors affecting patients undergoing liver resection anxiety. Repeated measurements using repeated measures analysis of variance statistical analysis.Results:The result, the total number of days of hospitalization in the intervention group (16.56 days) and postoperative hospital stay (9.85 days) of the total number of days of hospitalization than the control group (19.16 days) and postoperative hospital stay (11.37 days) decreased, the total average length of stay decreased by 2.6 days after discharge time by 1.52 days, the difference was statistically significant (P= 0.013 and 0.039). After the implementation of FTS model of care interventions, compared with the control group, patients in the intervention group medical costs mean was 31,484.82 yuan, the control group mean was 33,916.73 yuan, the difference was statistically significant (p=0.0219). After the implementation of FTS care model, patients in the intervention group during the first postoperative flatus, disconnect the tube time, eating solid time (18.00±7.93,24.36±8.50,11.43±4.10,) after the first row of the control group of patients with anal when the gas, disconnect the tube time, eating solid time (30.56±12.55,40.56±10.079,20.00±7.120) differences were statistically significant, (p<0.001).Anxiety In this study,123 patients anxiety score was 53.85±10.15 points, SAI male score for 46.63±7.58, (t=-7.33, p<0.001) and in men TAI score of 45.02±6.86, (t=-4.72,p<0.001). SAI score for the female 49.69±6.54, (t=-5.02, p<0.001) TAI score for the female 48.69±4.98, (t=-3.88, p<0.001). FTS mode implementation intervention groups were SAI (p=0.424), TAI and STAI (p=0.04,p=0.040, p<0.05), TAI and STAI meaningful patients have decreased anxiety scores. Two groups of patients before and after surgery, postoperative anxiety scores between the two have decreased significantly compared to the previous surgery, but the decline in the intervention group than the control group.Liver function using two levels of two factors repeated measures analysis of variance, while the control group and intervention group of patients admitted to hospital, after one day, after three days, after 5 days and after 7 days of liver function were compared; time main effect of albumin (ALB) was statistically significant indicators (p<0.001), without considering factors that intervention, the patient ALB change with the change of time; mean there is a time factor and intervention water interaction (p=0.047). Experimental group and control group patients were decreased after 3 ALB two days and then began to rise, but the increase in the magnitude of watching from the intervention group than in the control group rose faster speed. Time main effects of alanine aminotransferase (ALT) was statistically significant indicator (p<0.001), from the overall situation, which rose by less than the control group. Total bilirubin (TBIL) indicators from the overall situation, which rose by less than the control group, the speed of recovery is also faster than the control group. Overall, the recovery trend of the three indicators integrated in the intervention group than in the control group to better effect.Patients with primary liver resection surgical care rapid recovery mode intervention, emotional intelligence effectively reduce patient focus, and accelerate postoperative liver function recovery time, shorter hospital stays and reduce health care costs, achieve the purpose of accelerated rehabilitation. |
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