Research On Bundles Of Care Of Enhanced Recovery After Surgery For Patients With Primary Liver Carcinoma

Objective:To make a bundles of care of enhanced recovery after surgery for liver surgery by adopting the method of evidence-based nursing and applied it to the patients with liver cancer.To investigate the safety,efficiency and feasibility of the bundles of care of enhanced recovery after surgery in patients with hepatic resection for primary liver cancer.Methods:?Made a bundles of care of ERAS for liver surgery:Based on clinical practice and literature review,the PICO pattern was used to identify evidence-based problem.Evidence-based resource databases and original literature databases were fully researched.Selected literatures were evaluated according to inclusion and exclusion criteria and defined in terms of evidence grade and recommendation strength by JBI evidence grading system.Based on systematic review and evidence-based resources to make preliminary ERAS program and combined the ERAS program with expert interviews and patients demands.The care bundles of ERAS for liver surgery was made finally based on evidence-based study,expert interview and clinical practice;?The clinical intervention of bundles of care of ERAS for primary liver cancer patients:100 patients meeting inclusion criterias who were admitted to the Department of Hepatic Surgery in a hospital of Changsha from October 2015 to December 2016,were selected to participate this study.They were assigned randomly into ERAS group(n=50)and control group(n=50).The patients of ERAS group were treated with bundles of care of ERAS,while patients of control group were in routine nursing.The outcome measures of two groups were recovery time of bowel sound,the first time to flatus and defecation,time to get out of bed,postoperative length of stay,NRS on postoperative 24h and 48h,ADL score on preoperative and postoperative third day,mortality and readmission rate in 30 days.SPSS 13.0 was used for statistical analysis.Continuous variables were described by mean±standard(x±s),and T test was used for the comparison of two samples.Discrete variables were described by percentage,and ?2 test was used to compare.P<0.05 was considered statistically significant.Results:?There were no significant differences in the demographic data and operative details between the two groups,such as gender,age,Child classification,ASA classification,operative time,intraoperative blood loss,blood transfusion requirements and type of hepatectomy(P>0.05);?he recovery time of bowel sound of patients in ERAS group was 59.68±13.98h,which was shorter than control group(t=4.469,P=0.000).The first time to flatus and defecation of ERAS group were 74.46±18.03h and 128.22±37.47h,which were shorter than control group(t=2.835,P=0.006;t=2.622,P=0.010);?Time to get out of bed in ERAS group was 59.04±19.65h,lower than control group(t=3.771,P:=0.000).Postoperative stay length of ERAS group patients was 5.96±1,68d,which was shorter than 7.22±1.87d of contol group,being statistically significant(t=3.551,.P=0.001).There was no significant difference in ADL on preoperative,but the ERAS group had a higher score of ADL on the third postoperative day(t=-6.521,P=0.000);?The NRS on postoperative 24h and 48h of the ERAS groups were 5.52±2.49 and 4.70±1.91,while the control group were 5.36±2.36 and 5.24±2.01,the difference was not statistically significant(P>0.05);?Compared with the control group,ERAS group had lower rate of overall postoperative complications and general complications(?2=4.882,P=0.027;?2=4.762,P=0.029),but the surgery-related complications rate of two groups had no significant difference(P>0.05),There was no perioperative mortality or readmission of two groups in the study.Conclusion:Bundles of care of ERAS was safe,efficacious and feasible for patients undergoing hepatectomy for primary liver cancer and it may be superior to routine care.