Effect Of Intraoperative Nursing Intervention On Postoperative Complications In Patients Undergoing Laparoscopic Bariatric Surgery

ObjectivesThis study intended to explore the factors associated with deep venous thrombosis and skin lesions in patients undergoing laparoscopic bariatric surgery.To establish a standard nursing system of laparoscopic bariatric surgery and evaluate the interventional effect of laparoscopic surgery on lower extremity deep venous thrombosis and skin lesions in patients undergoing laparoscopic bariatric surgery.To control and reduce the postoperative complications of laparoscopic bariatric surgery.MethodsBased on the related literature domestic and abroad and medical record format in our hospital,we designed the data collecting format.156 cases were enrolled and randomly aasigned into control group(78 cases)and experimental group(78 cases)from June 2013 to May 2017.Data were collected by two team members,including general information such as name,sex,age,marital status,education,body mass index(BMI),waist circumference,hip circumference,blood lipids and skin condition,and laboratory results,involving blood D-dimer preoperatively and 1 month afer discharge,the vertical and transverse diameter,velocity blood flow volume of femoral vein,before and after pneumoperitoneum,and DVT status while discharge.All data were measured 2 times with BECKMAN equipment.The control group received routine nursing care;the experimental group took the appropriate intraoperative nursing interventions on the lower extremity deep vein and compressed skin.Statistical method:The measurement data were expressed as mean±standard deviation(x±s),count data as rate and percentage.The K-S normal distribution test was performed for all the measured data.The paired t test was used to compare the successive variables.The discrete variables were tested by x2 test or Fisher exact test.P<0.05 was set as cutoff for statistically significant,all data analysis were completed using SPSS19.0 software.ResultsIn patients with preoperative diabetes mellitus 13patients,and 4 patients developed DVT while 9 patients did not;In patients without DM,3 developed DVT,62 did not.The complication rate of DVT was significantly lower in non-DM patients than that of the DM patients(P = 0.0026,chi-square test).In patients with preoperative hyperlipoidemia were 27,5 patients developed DVT while 22 patients pardoned;in patients wihout hyperlipoidemia,2 developed DVT,49 pardoned.The complication rate of DVT was significantly lower in normal blood lipids patients(P<0.05,chi-square test).In patients with preoperative hypertension were 43,6 patients developed DVT while 37 patients did not;in patients without preoperative hypertension,1 developed DVT,34 did not.The complication rate of DVT was not significantly lower in normal blood pressure patients(P = 0.088,chi-square test).The results showed that the diameter of femoral vein was significantly higher after pneumoperitoneum(P = 0.022).Blood flow velocity after pneumoperitoneum was lowest,the blood flow velocity before anesthesia was lower than that before pneumoperitoneum,but faster than pneumoperitoneum.Therefore,the diameter of femoral vein after pneumoperitoneum was meaningful(P<0.01).The diameter of the femoral vein at anesthesia recovery was also significantly smaller than that before the anesthesia(P<0.05).There was significant difference in the diameter of femoral vein during surgery between the two groups(P<0.05).There were 12 cases of stage Ⅰ ulcer,4 cases stage Ⅱ ulcer,with a total number of 16 skin pressure ulcer cases in the control group.In the experimental group,there were 3 cases of stage Ⅰ ulcer,no stage Ⅱ ulcer,with a less number of 3 skin pressure ulcer cases.(x2 = 5.1923,P<0.05).The incidence of pressure ulcers in diabetes mellitus was significantly increased,and the healing time was significantly longer(P<0.001).Conclusion1.Except hypertension,combined with hyperlipidemia and diabetes was the two important factors affecting the occurrence of postoperative DVT in obese patient.2、The usage of antithrombotic therapy instrument and vaseline foam for patients undergoing Laparoscopic Bariatric Surgery were effective and necessary,which became the standard of nurse practice in our hospital in laparoscopic Bariatric surgery.