| BackgroundChina is a country with a high incidence of liver cancer,and the number of patients accounts for more than half of the world.The incidence of liver cancer ranks the 4th among malignant tumors and the mortality rate is high,which seriously threatens the lives and health of people.Surgical resection is the first choice for the treatment of early liver cancer.Postoperative abdominal distension is a common clinical nursing problem.Different degrees of abdominal distension have negative effects on patients.Severe abdominal distension will not only cause discomfort to patients,but even affect the healing of incision and anastomotic site.affecting patients recovery.How to alleviate the patients symptoms and improve their quality of life is an urgent problem for clinical medical staff.Bundle care is a collection of 3-5 evidence-based care measures,each of which has been shown to improve outcomes for patients.They are more effective than individually.It aims to provide more optimized and efficient nursing for patients.ObjectiveThe purpose of this study is to construct a care bundles program for postoperative abdominal distension in patients with primary liver cancer,and to test the feasibility and effectiveness of this program.It provides scientific basis for developing targeted nursing measures for patients with liver cancer and effectively alleviating the symptoms of abdominal distension,and also provides experience and reference for the development of clinical pathway of postoperative symptom management for patients with liver cancer.Methods1.Through evidence-based methods,this study initially formed bundles of nursing intervention program by consulting literatures,clinical practice guidelines and expert consensus,and finally established a bundle care intervention program for postoperative abdominal distension in patients with liver cancer by applying Delphi method and consulting experts.2.72 liver cancer patients who have undergone initial surgical treatment were selected as the study subjects,and randomly divided into the control group and the intervention group by random number table method.The control group formulated perioperative nursing measures according to The Clinical Nursing Practice Guide 2011 issued by the Ministry of Health of the Peopled Republic of China,while the intervention group adopted care bundles intervention measures,mainly including:diversification measures promote early postoperative activities;using the diet calendar(which listed the types and amounts of daily food in detail and refined to each meal after surgery)to guide the patients early-stage feeding and record;instructing the patients to take a warm foot bath with normal vital signs on the second day after surgery.The changes of abdominal distension symptoms and quality of life in the two groups of patients after intervention were evaluated by abdominal distension digital score,abdominal distension remission rate and the first postoperative exhaust time and defecation time were observed,and liver cancer patients quality of life assessment scale.SPSS 19.0 statistical software was used to analyze the data.Descriptive analysis and the rate was used for the statistics of the general data of the research subjects.t test were used to compare the abdominal distension score and the gastrointestinal recovery and quality of life.?2 test was used to analyze and abdominal distension remission rate of the two groups after intervention.The difference was statistically significant at P<0.05Results1.The postoperative abdominal distension scores of the control group and the experimental group were 4.17±0.94 and 3.75±1.06,scores of the two groups were not statistically significant(P=0.404).4 days after surgery,the score of the control group was 2.67±0.69,which was higher than that of the experimental group(2.03±0.57),with statistically significant difference(P=0.008).10 days after surgery,the score of the control group was 1.75±0.48,which was higher than that of the experimental group(1.14±0.36),the difference was statistically significant(P=0.013).2.The time of first exhaust and defecation was 63.33±23.76 h and 76.67±24.89 h in the experimental group,and 85.33±27.18 h and 98.67±30.24 h in the control group,the experimental group was shorter than that in the control group,the difference was statistically significant(P=0.001).3.4 days after surgery,the abdominal distension remission rate of the experimental group was 91.67%,which was higher than control group(63.89%),the difference was statistically significant(P=0.001).10 days after surgery,the abdominal distension remission rate of the experimental group was 94.44%,which was higher than control group(80.56%),and the difference was no statistically significant(P=0.075).4.HCC score in the experimental group was 165.94±10.79,which is higher than that of 158.56± 11.98 in the control group,the difference was statistically significant(P=0.008).The score in the physical function dimension test group was 45.39±3.64,higher than that in the control group,which was 40.58±5.15,the difference was statistically significant(P=0.001);there was no significant difference in symptom side effect,social function score and psychological function(P>0.05).ConclusionsThe evidence-based bundles care measures for patients with liver cancer is feasible,which can alleviate postoperative abdominal distension symptoms,shorten the duration and improve the quality of life.it provides preliminary evidence for the positive prognosis of liver cancer patients after surgery,and empirical reference for the clinical pathway of postoperative symptom management. |
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