Study On The Effects Of Enhanced Recovery After Surgery Nursing On Anxiety And Sleep In Elderly Patients Undergoing Esophagectomy

Background: The number of elderly patients with esophageal cancer is increasing as society ages.At present,surgical resection is comprehensive treatment for non-advanced esophageal cancer.As a traumatic operation,there are many injuries in patients after surgery both physical and mental condition,especially anxiety and sleep disorder in the elderly.Anxiety and sleep disorders increase perioperative risks and postoperative complications.Therefore,it is necessary to alleviate the anxiety and sleep disorders of patients during perioperative period.Enhanced recovery after surgery(ERAS),which obtain exact clinical effects,has been widely used in esophageal cancer surgery.Studies have confirmed that ERAS can improve mental health and sleep quality in patients with colorectal cancer,pulmonary bulla and orthopedic diseases.From the perspective of clinical benefits and promotion of multidisciplinary cooperation,it is necessary to explore the effect of ERAS interventions to alleviate anxiety and improve sleep quality in elderly patients undergoing esophagectomyObjective: To explore the clinical nursing effect of Enhanced Recovery After Surgery(ERAS)for esophageal cancer surgery in elderly Patients,and its impact on anxiety status and postoperative sleep quality.Methods: From December 2017 to November 2018,94 caces of esophageal cancer elderly patients treated by Minimally invasive radical esophagectomy(MIE)were included in this study.By block randomization,the every 10 patients were randomized into two groups.The control group contained 49 patients that received conventional perioperative nursing,while the treatment group contained 45 patients that were treated with care of ERAS.Patients’ general information,anus exhausting time,postoperative hospital stay and hospitalization expenses were recorded by means of general data questionnaire.On the 1st day before surgery and the 7th day after surgery,Pittsburgh Sleep Quality Index(PSQI)and Self-Rating Anxiety Scale(SAS)were used to evaluate the sleep quality and anxiety status of the two groups.The Numerical Recrating Scale(NRS)was used to evaluate the patient pain in morning of 3th,5th,7th day post-operative,whether it disturbed the patient’s sleep.Results:1.There was no significant difference in general date of age,sex,and pathological stage between the two groups(P>0.05).2.Compared to the control group,the treatment group had significantly shorter anus exhausting time(2.73±0.96 d vs.3.14±0.98 d,P=0.044),shorter postoperative length of stay(median: 8d vs.10 d,P<0.001),lower the hospitalization expense(6.06±0.46 ten thousand RMB vs.7.02±1.33 ten thousand RMB,P < 0.001),and lower pulmonary complications(22.4% vs.44.9%,P=0.031).3.Compared to the comparison group,the treatment group experienced lower score of SAS both before surgery(median: 37 sores vs.40 sores,P=0.005)and after surgery(median: 43 sores vs.48 sores,P<0.001);The treatment group experienced less anxiety increase(median: 6 sores vs.7sores,P< 0.001).There is no significant Anxiety rate difference between the two group before surgery(2.2%vs.12.2%,P=0.145),but the treatment group experienced lower incidence of anxiety after surgery(8.9 % vs.42.9%,P<0.001).4.Before the surgery,there is no significant difference between two groups in score of PSQI(median:5 sores vs.6sores,P=0.117),and the treatment groups had lower score of PSQI in the dimension of sleep time(P<0.05).After the surgery,the treatment groups had lower score of PSQI than the comparison group(median: 9sores vs.12 sores,P<0.001),as well as in the dimension of subjective sleep quality,sleep latency,sleep time,sleep efficiency and daytime dysfunction(P<0.05).Conclusion: The application nursing of ERAS can alleviate the perioperative anxiety of the elderly patients with esophageal cancer,improve their postoperative sleep quality and accelerate their recovery.