Effect Of NEM Recovery Routine In Elderly Patients Udergoning Laparoscopic Radical Gastrectomy

Objective The purpose of this study was to evaluate the effect of NEM recovery routine in elderly patients udergoning laparoscopic radical gastrectomy,and give advice for nursing work at present.Methods 60 cases of elderly patients with advancing gastric cancer undergoing laparoscopic radical gastrectomy in general surgery department of one top three hospital in Tianjin were enrolled from December 2015 to December 2016.All the participants were randomly divided into experimental group and control group according to the outcome of coin toss.Participants in control group were given routine treatment and nursing care,while participants in experimental group were given routine nursing care and postoperative intervention according to the recovery pathway.The recovery pathway was independently designed after reffering to lots of related references by researcher and consulting with nursing specialists,clinical specialists and nutriology specialists.The pathway mainly included early enteral nutrition,early exercise and retention enema using Kuanchang Liqi Decoction.To evaluate the postoperative nutritional status and immunefunction in both groups,we respectively colleted the anthropometric parameters?weight,BMI,TSF,AC?and laboratory examinations[serum album,prealbumin,CD4⁺?%?,CD8⁺?%?,CD4⁺/CD8⁺ level] on 3^rd day preoperative,1^st and 8^th day postoperative.We also observed the postoperative time to gastrointestinal recovery?including time to flatus,defecation,removing the gastric tube and start eating liquid food?.Postoperative complications were recorded when they occurs,including hospital-acquaired infection,infection of incision wound,anastomotic fistula and gastrointestinal complication.A general condition survey self-designed was applied to collected general and disease related information of participants.SPSS20.0 software was applied to process and analyse the data.Measurement data was described using mean± standard deviation,while frequency and percentage were used to describe categorical data.When comparing preoperative data of two groups of participants,for measurement data,Kolmogorov-Smimov test for normal distribution need to do at first,then two independent sample t-tests was used for normal distribution,nonparametric statistics and the Mann-Whitney U test was used for non-normal distribution data.For counting data,chi-square test was used for calculation.When comparing postoperative data of two groups of participants,for measurement data,Kolmogorov-Smimov test for normal distribution need to do at first,then two independent sample t-tests or repeated measures analysis was used for normal distribution,nonparametric statistics and the Mann-Whitney U test was used for non-normal distribution data.For counting data,chi-square test or Fisher's exact test was used for calculation.Results 1.According to the inclcusion and exclusion criteria,60 cases of elderly patients with gastric cancer were recruited,and they were randomly distributed into two groups,31 cases in experimental group and 29 cases in control group.Social demography characteristics and disease related information were comparable between two groups?P>0.05?before operation.2.For participants in experimental group,the weight on 3^rd day preoperative and 8^th day after operation were 61.54±8.58 kg and 59.15±8.43 kg,the average weight decreased 2.41±0.89 kg;for control group,the weight on 3^rd day preoperative and 8^th day after operation were 60.62±8.87 kg and 57.76±8.62 kg,the average weight decreased 3.14±0.74 kg.The result of the two independent sample t-tests showed that there was statistically significant difference of weight change between two groups?t=3.439,P<0.05?.3.The BMI of two participants were all decreased in 8^th day after operation compared with that of 3^rd day preoperative.The BMI of experimental group in 8^th day after operation was 21.43±1.87 kg/m²,and the BMI of control group was 20.58±1.86 kg/m².The result of the two independent sample t-tests showed that there was no statistically significant difference between two groups?P>0.05?of BMI on 3^rd day preoperative and 8^th day after operation.4.Using repeated measures analysis of variance to analyse TSF,AC,ALB,PA,CD4⁺?%?,CD8⁺?%?,CD4⁺/CD8⁺ level between two groups on 3^rd day preoperative,1^st and 8^th day after operation.The results showed the main effects of time on TSF,AC,ALB,PA,CD4⁺?%?,CD8⁺?%?,CD4⁺/CD8⁺ level were statistically significant?P<0.05?.It means without considering the different interventions between two groups,the level of TSF,AC,ALB,PA,CD4⁺?%?,CD8⁺?%?,CD4⁺/CD8⁺ were significantly different over time.There were significant interactions between time factors and intervention factors on TSF,PA,CD4⁺?%?,CD8⁺?%?level.Using two independent sample t-tests to analyse the level of TSF,AC,ALB,PA,CD4⁺?%?,CD8⁺?%?,CD4⁺/CD8⁺ on 3^rd day preoperative,1^st and 8^th day after operation,the results showed that there were significantly different between two groups in PA,CD4⁺?%?,CD8⁺?%?level on 8^th day after operation,furthermore,the level of experimental group increased more than control group.5.In all the participants,the mean time to flatus after operation for the first time was 3.85±0.82 d,the first time to defecation was 4.33±1.17 d,the first time to eating liquid food was 6.50±1.76 d,and the mean time of removing the gastric tubin was 4.23±0.98 d.Compared to control group,participants in experimental group had shorter time in first flatus,defecation and eating liquid food?P<0.05?.Time of removing the gastric tube was shorter in experimental group,but there was no statistically difference between two groups?P>0.05?.6.The occurance of postoperative complication:Of all 60 cases participants in this study,15 participants had postoperative complication?25.00%?.10 participants had postoperative infection?16.67%?,including 9 cases of pulmonary infection,2 cases in experimental group while 7 cases in the control group;and 1 case of incision infection,occurred in control group.1 case had anastomotic fistula,occurred in control group.4 cases had discomfort in digestive tract,3 cases in experimental group while 1case in control group.After Fisher's exact test,the results showed that the incidence of postoperative infection was lower in experimental group,and there was statistically significant difference between two groups?P<0.05?.There was no statistically significant difference in anastomotic fistula and gastrointestinal complications between two groups either?P>0.05?.Conclusions 1.NEM recovery routine could help partly improving the nutritional status and immunefunction of elderly patients undergoing laparoscopic radical gastrectomy.2.NEM recovery routine could promote recovery of gastrointestinal function after operation,including shortening the time to first flatus,defecation,eating liquid food and time of removing the gastric tube.3.NEM recovery routine had a positive effect on reducing postoperative complications.