Application Of Enhanced Recovery After Surgery In Perioperative Period Of Radical Cystectomy And Its Effect Evaluation

ObjectiveComparing with the traditional perioperative treatment scheme,to evaluate the feasibility,safety and efficacy of ERAS inpatients undergoing bladder cancer radical cystectomy.And on the basis of the comprehensive measures of ERAS,this paper studies the effect of teamwork urostomy health education on patients postoperative rehabilitation and recommendations for promoting rapid recovery after operation and improve the quality of life.Methods1.Under the peritoneoscope,comprative study of 115 cases(during January 2014 to June 2017)of bladder cancer patients with accepting Laparoscopic radical cystectomy were divided into the ERAS group(n=57)and conventional Treatment group(n=58)by using the method of random number table.The ERAS group was applied in ERAS,mainly include:(1)Inform ERAS programmes before operation.(2)Before operation,do not enema,and oral laxative was administered one day before operation,no routine indwelling gastric tube.(3)Encourage patients to activities after surgery on POD 1,chewing gum at 4 hours after surgery,and eating as early as possible,while the conventional group was applied in the conventionaltreatment,mainly include:(1)Normal health education before operation.(2)The bowel is prepared for three days before operation,and the gastric tube is retained after operation.(3)Have a good rest postoperative(3～4days).a long time forbidden diet.Observe a series of indexes which include first exhaust,first defecation,first bed-off time,intestinal obstruction,postoperative incision infection,incidence of pyelonephritis,the length of stay,readmission and so on.2.48 cases of patients(during October 2016 to December 2017)after radical cystectomy with creation of a urostomy were divided into the control group(n=24)and the observation group(n=24)by using the method of random number table.Under the ERAS model,the observation group was given teamwork health education in Urostomy,mainly include:(1)Preoperative information introduced urostomy,the nurse of urostomy demonstration and issuing of urostomy care manual.(2)Postoperative care by members of the urostomy group.While the control group was given routine health education in the perioperative period,mainly include:(1)Preoperative information introduced urostomy and issuing of urostomy care manual.(2)Postoperative nursing care of nurses was experienced in the ward.Observe a series of indexes which include the length of stay,urostomy complications and quality of life scores and so on.Results1.The first time of anal exsufflation and the first defecation time in ER AS group were 34.67±3.13h and 55.10±5.73h,while the first time of anal e xsufflationand the first defecation time in the conventional treatment group were 43.03±4.42h and 63.64±4.82h,respectively.The intestinal function re covery of patients in ERAS group was obviously reduced by comparing wit h the conventional treatment group.First bed-off time in ERAS group was 24.89±5.74h,which was also less than the conventional treatment group39.58±7.85h.The difference had the statistical significance(P<0.05).The lengt h of stay in ERAS group was 7.8 1±2.03d,which was less than the conventi onal treatment group13.56±1.99d.The difference had the statistical signific ance(P<0.05).But the incidence of intestinal obstruction in both groups(7.02%VS 6.90%,P>0.05)postoperative incision infection rate(3.51%VS 5.17%,P>0.05)incidence of pyelonephritis(7.01%VS1.72%,P>0.05)showed no significant difference in comparison.2.The length of stay in observation group was 6.83±2.14d,which was less than the control group8.23±1.99d.The difference had thestatistical Significance(P<0.05).Two groups of patients with stoma complications(16.7%VS37.5%,P>0.05),there was no statistically significant difference.The quality of life in observation group was 14.37±1.00,which was significantly higher than the control group13.67±0.94.The difference had the statistical significance(P<0.05).Conclusion1.Compared with the traditional scheme,perioperative bladder cancer radical cystectomy with ERAS pattern is feasibility,safe and effective.It can effectively reduce the stress of trauma surgery,promote gastrointestinal functional recovery,and shorten the average hospitalization day without increasing the complications of operation.2.On the basis of ERAS,strengthening the perioperative health education of urinary tract stoma can help to shorten the time of patients undergoing radical cystectomy with creation of a urostomy,and make them more acceptable and improve their quality of life.