| [Objectives]1 To explore the effects of sham feeding(chewing gum)on anxiety,depression and quality of life in patients after hepatectomy by Laparotomy.2 To explore the effects of sham feeding(chewing gum)on the stress index,liver function index,abdominal cavity drainage tube indwelling time,postoperative complications and hospitalization days in patients after hepatectomy by Laparotomy.3 To understand the after intervention factors influencing the anxiety of patients after hepatectomy by Laparotomy.[Methods]1 Research methodsWith convenience sampling method,the selection in April 2017 to January2018 in fuzhou with hepatocellular carcinoma in the hepatobiliary surgery ward of a tertiary general hospital after operation of liver cancer resection in patients with60 cases,were randomly divided into observation group and control group,30cases in each group.The leader of the responsible group who is qualified for training would intervene to the patient from day 1 to the 5th after surgery.Observation group was given chew gum and conventional nursing after liver resection.Patients were instructed to gargle with warm boiled water at 8:00A.M.and 14:00 P.M.every day following with sugar-free xylitol chewing mint gum,2 grain each time,15 min/time(chewing about 200 times).The control group was treated with routine hepatectomy.2 Data collection methodsThe basic information of patients was collected before the intervention(day 1after surgery)to measure anxiety,depression and quality of life.The above-mentioned aspects were measured after intervention at two points:5 days after surgery and 1 week later.To record the pathological types of the basic information in time,before and after intervention,and after 1 week of clinical data.3 Data analysis methodThe basic data of the patients were analyzed by Chi-square test,Fisher exact test or Mann-whitney U test.Evaluation of intervention effect:the score of anxiety and depression and the comparison of the norm were compared with the single sample t test;The independent sample t(t')test or Mann-whitney U test was used to compare the anxiety,depression,quality of life and their dimensions.The overall analysis of anxiety,quality of life and scores of each dimension was analyzed by generalized estimating equation(GEE),and the overall analysis of depression scores was analyzed by repeated measures of variance.The overall analysis of depression was analyzed by the trend Chi-square test,and the Chi-square test or Fisher's exact test were used for the comparison between groups.Before and after the intervention,the stress indexes and liver function indexes were compared with the paired t test or Wilcoxon signed rank test,and the independent sample t(t')test or Mann-whitney U test was used in the comparison between groups.Mann-whitney U test was used to compare the retention time of peritoneal drainage tube and postoperative hospitalization days.Fisher's exact test was used to compare the postoperative complications.Multivariate linear stepwise regression was used to analyze the influencing factors of post-intervention anxiety.[Results]1 Comparison of basic informationThere was no statistically significant difference between the two groups(P>0.05).2 Comparison of intervention effects2.1 Main observation indexes2.1.1 AnxietyBefore and after intervention,the anxiety scores of the two groups were compared with the norm,and the differences were statistically significant(P<0.05).1 weeks later,the observation group of male patients compared with norm,the difference was statistically significant(P<0.05),while the women in the observation group and control group with different gender compared with norm had no statistically significant difference(P>0.05).There was no statistically significant difference between the two groups before and after 1 week of intervention(P<0.05),and the difference between the two groups was statistically significant(P<0.05).The analysis of the GEE shows that the difference of time point,group and interaction of patients'anxiety scores is statistically significant(P<0.05).2.1.2 Stress indicatorsThe WBC difference between the two groups was statistically significant(P<0.05),and the CRP difference was not statistically significant(P>0.05).There was no statistically significant difference between WBC and CRP in the first two groups(P>0.05).The differences were statistically significant(P<0.05).2.1.3 DepressionThe depression scores of the control group were compared with the norm after1 week was not statistically significant(P>0.05),and the other differences were statistically significant(P<0.05).There was no statistically significant difference in depression scores between the two groups before and after the intervention(P>0.05),and the difference was statistically significant(P<0.05).Repeated measures of variance analysis showed that the difference of time point,group and interaction of patients with depression scores was statistically significant(P<0.05).The trend Chi-square analysis showed that the degree of depression of patients was statistically significant(P<0.05).Comparison between groups,intervention before and after 1 week differences in the two groups of patients with depression had no statistical significance(P>0.05),two groups of patients with depression after intervention degree difference was statistically significant(P<0.05).2.2 Secondary observation indexes2.2.1 Quality of lifeTwo groups of patients'life quality and its dimension comparison between groups,differences in quality of life and nutrition change dimension before intervention had no statistical significance(P>0.05),after intervention and 1 week after the differences were statistically significant(P<0.05),the rest of the dimension differences had no statistical significance(P>0.05).According to the analysis of the GEE,the difference of measurement time,group and interaction of patients'life quality and nutritional change dimension was statistically significant(P<0.05).Abdominal distension,changes in body,pain,fever,fatigue,and sex change six dimensions measurement point difference had statistical significance(P<0.05),group interaction and differences had no statistical significance(P>0.05).There was no statistically significant difference in the measurement time,group and interaction of jaundice(P>0.05).2.2.2 Liver function indexBefore and after intervention in the two groups of patients,there was no statistically significant difference in PT difference between the control group(P>0.05),however,the differences in liver function indexes of the other groups were statistically significant(P<0.05).There was no statistically significant difference between the two groups of liver function indicators(P>0.05).2.2.3 Peritoneal drainage tube retention timeThere was no statistically significant difference between the two groups of patients with peritoneal drainage tube retention time(P>0.05).2.2.4 Postoperative complicationsThe postoperative complications of the two groups were not statistically significant(P>0.05).2.2.5 Postoperative hospitalization daysPostoperative hospitalization days were compared between the two groups,and the difference was statistically significant(P<0.05).3 Analysis of influencing factorsMultiple stepwise linear regression showed that there were intervention measures,post-intervention depression and abdominal distention after intervention(R~2=0.508).[Conclusion]1 Chewing gum can effectively improve patients'anxiety and depression after laparotomy,reduce postoperative stress response and shorten postoperative hospitalization days.2 Chewing gum is effective in improving the degree of depression in patients after laparotomy for hepatocellular carcinoma.3 After laparotomy for hepatocellular carcinoma patients'anxiety,depression,and degree of depression and negatively correlated with the quality of life,and chewing gum to improve after open resection of liver cancer patients'anxiety,depression and depression level of comprehensive effect,dry mouth,taste disorders,the WBC and the comprehensive effect of depression and effective long-term utility.4 The effect of chewing gum on liver function isn't significant after laparotomy for hepatocellular carcinoma,and it isn't effective for postoperative complications and postoperative complications.5 The patients with the 5 days of anxiety after laparotomy for hepatocellular carcinoma are significantly affected by postoperative care,depression and abdominal distension after routine hepatectomy. |
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