| 1.BackgroundEnhanced recovery after surgery(ERAS)is currently a hot topic in surgery and anesthesia research.The post-anesthesia care unit(PACU)is an important place for patient to be closely monitored and treated until the patient's vital signs are restored.It is the basis for the practice of ERAS.Patients with general anesthesia are prone to various life-threatening complications due to surgical trauma,pain,residual effects of anesthetic drugs,and the protective reflex have not yet recovered.However,PACU has a large workload,high risk,fast pace of work,intensive technical operation,and the changing characteristics of patients at any time,so that their physical and mental state is always in a state of high tension,improve the quality management of PACU medical care,and ensure the safety and comfort of patients after surgery is especially important.Postoperative delirium(POD)is a complication of patients after surgery,resulting in prolonged mechanical ventilation and ICU retention time,increasing the incidence of perioperative complications and death rate.Studies have shown that 30%to 40%of postoperative delirium is preventable.Intraoperative anesthesia depth monitoring can reflect the patient's anesthesia and sedation depth,and guide the individualized anesthetic dosage,improve patient recovery and reduce postoperative complications.However,the effect of intraoperative anesthesia depth monitoring on the occurrence of POD and the improvement of nursing quality has not been reported.The purpose of this study was to use Narcotrend monitoring for patients undergoing abdominal surgery under general anesthesia,to observe the occurrence of adverse events such as POD during the recovery period,and to explore the impact of PACU nursing workload and quality of care to ensure the safety of PACU patients.2.ObjectiveThe purpose of this study was to use Narcotrend monitoring for patients undergoing abdominal surgery under general anesthesia,to observe the occurrence of adverse events such as POD during the recovery period,and to explore the impact of PACU nursing workload and quality of care to ensure the safety of PACU patients3.Methods3.1 Research objectsA total of 120 patients,aged 20-80 years and ASA grade ?-?,underwent abdominal surgery were divided into 2 groups(60 cases in each group)by random number table method.Inclusion criteria:ASA ?-?,estimated operation time 2-3 h,body mass index(BMI)?30 kg/m2.No obvious preoperative abnormalities of cardiovascular system,respiratory system,digestive system,and urinary system function.Exclusion criteria:those with cerebrovascular disease,cognitive impairment or long-term use of antipsychotic drugs;those who are speechless or unable to cooperate;those who are alcoholic,drug dependent and audio-visual dysfunction;history of severe allergic and general anesthesia Intolerance;and those who plan to transfer to the ICU after surgery.All patients were divided into two groups by random number table method,Narcotrend guidance group(N group)and control group(C group,without Narcotrend guidance),60 cases in each group.Anesthesiologist was responsible for Narcotrend and vital signs monitoring and recording during operation.Anesthesia nurse was responsible for monitoring,evaluating and recording data of patients during PACU.The two individuals are independent.3.2 Anesthesia and monitoring methodsNarcotrend monitoring in group N was performed during the operation,and the anesthetic dosage was adjusted according to the Narcotrend index(NI)value.NI value was maintained in normal anesthesia state DO-2(37-64).Patients of group C were not monitored with Narcotrend and the depth of anesthesia was regulated according to clinical signs.3.3 Research indicator3.3.1 Physiological indexMean arterial pressure(MAP),heart rate(HR),and pulse oximetry(Sp02)of the patient during the operation and in the PACU were observed and recorded at the beginning of the operation(TO),after extubation(T1),10 min after extubation(T2),and departure from PACU(T3).3.3.2 Delirium assessmentNursing delirium screening scale(Nu-DESC)was used to assess cognitive function in patients who met the criteria for Release from PACU.The investigator was trained before the start of the study,and was required to be proficient of Nu-DESC scale,and to accurately use the scoring method for evaluation without affecting the normal work of PACU.3.3.3 Recovery parameters and PACU complicationsThe patient's recovery period parameters including extubation time,PACU retention time were observed and recorded.Adverse events(complications)during PACU stay,including nausea,vomiting,respiratory related complications(such as Sp02<90%or arterial oxygen partial pressure<60 mmHg,or need mask pressure for oxygen supply,jaw-lift,manual ventilation,and re-intubation),and cardiovascular related complications(such as blood pressure exceeds preoperative value ± 20%,HR>120 beats/min or<50 beats/min,ornewly appeared arrhythmia or ischemia),severe pain,chills/hypothermia(skin temperature<35 ?),and unplanned transfer to ICU were also observed and recorded.3.3.4 Nursing activity AssessmentNursing activity scores(NAS)was used to evaluate nursing workload in PACU.The researcher evaluated the actual nursing work amount required by the patient according to the nursing work items on the NAS scale.3.3.5 Nursing satisfaction scoreThe patients were followed up for anesthesia and nursing satisfaction scores at 24 hours after operation.The scores are divided into three levels:excellent,general,and poor.3 4 Statistical methodsThe data were analyzed by SPSS 20.0 software.The measurement data were expressed as mean ± standard deviation(x±S).The comparison between the two groups was performed by two independent samples t-test,and the comparison of counting data by ?2 test.P<0.05 indicates that the difference was statistically significant.4.Results4.1 Comparison of surgery and anesthesia data in patientsThere were no significant differences in the operation time,anesthesia time,intraoperative blood loss and the volume of fluid imput between the two groups(P>0.05).4.2 Comparison of perioperative vital signs in patientsThe HR and MAP of TO time point were significantly higher than that of T1 and T2 time points in both groups(P<0.05).The HR and MAP of N group were significantly lower than that of C group at T1 and T2 time points(P<0.05).There was no significant difference in SpO2 between the two groups(P>0.05).4.3 Patient's delirium evaluationThe 60 patients included in each group were divided into three groups,20 to 39 years old sub-group,40 to 59 years old sub-group,and 60 to 80 years old sub-group.The results showed that the Nu-DESC scores and the incidence of deliriumin patients aged 60-80 years in group C and N were significantly higher than those in the same group of 20-39 years old sub-group and 40-59 years old sub-group(P<0.05).The incidence of Nu-DESC score and deliriumof 60-80 years old patients in N group was significantly lower than that in group C(P<0.05).In group C,patients aged 60-80 years old need thirty limbs immobilization with the help of 1-2 nursing staff,this number was 36%higher than that of the 22 limbs immobilization in group N,and the incidence of delirium was 10.2%higher than that of group N.4.4 Comparison of patients' recovery status and complicationsCompared with group C,extubation time and PACU retention time were significantly lower in group N(P<0.05).The incidence of nausea,vomiting,respiratory and cardiovascular related complications in group N was significantly lower than that in group C(P<0.05).There were no severe pain,chills/hypothermia,and unplanned transfers to the ICU in either group.4.5 Comparison of neuroendocrine factors in patientsCompared with T1 and T2 time points in the group C,plasma concentrations of norepinephrine,epinephrine,cortisol,and glucagon in group N were significantly lower at the corresponding time points(P<0.05).Compared with the corresponding time points in group C,concentration of the above four indicators in the N group was significantly lower at the T1 and T2 time points,the difference was statistically significant(P<0.05).4.6 Comparison of nursing workload and patient satisfactionThe NAS scores in group N were significantly lower than those in group C(P<0.05).The satisfaction level of patients in group N was significantly higher than that in group C(P<0.05).5.ConclusionIn conclusion,intraoperative Narcotrend monitoring effectively reduced the incidence of adverse events during PACU,reduced stress response and the incidence of POD in elderly patients,reduced nursing workload,and improved PACU nursing quality. |
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