| Objective To investigate the incidence and severity of postoperative fatigue in patients with gastric cancer at each postoperative stage,and analyze the factors influencing its occurrence and development.Based on the concept of accelerated rehabilitation surgery,comprehensive intervention measures for postoperative fatigue of patients with gastric cancer were put forward,and were divided into intervention group and control group for implementation,to evaluate the impact of nursing measures based on accelerated rehabilitation surgery on them.Methods This study was divided into two stages.The first stage: 159 patients with gastric cancer who were treated in a tertiary first class hospital in Jiangsu Province and underwent radical surgery for gastric cancer were conveniently selected for the evaluation of fatigue and related influencing factors at all stages of the operation,from March 2017 to August 2017.Self-made general situation questionnaire and fatigue visual analogue evaluation scale(VAS),)were used to input and analyze the data through excel and SPSS22.0 to obtain the status quo and influencing factors of postoperative fatigue in patients with gastric cancer.The second stage: 120 patients undergoing elective radical operation of gastric cancer in the general surgery department of a tertiary first class hospital in Jiangsu Province from September 2017 to August 2018 were conveniently selected.The patients were divided into intervention group and control group according to different wards,and the general surgical ward(1)was divided into intervention group and the general surgical ward(2)was divided into control group.The intervention group implemented perioperative comprehensive nursing measures based on the concept of enhanced recovery after surgery,while the control group implemented perioperative nursing measures based on traditional concepts.The fatigue visual analogue scale(VAS)and the peri-operative fatigue scale(ICFS)were used to evaluate the postoperative fatigue,pain visual analogue scale(VAS)to evaluate the postoperative pain score,and The number of pca pump compressions,postoperative hospitalization days,c-reactive protein level 3 days after surgery,and the incidence of complications were compared.Results 1.The incidence of fatigue was 100%,100%,97.5% and 87.4% in patients with gastric cancer at 3,7,14 and 30 days after surgery,respectively.The fatigue scores were 5.87±1.54,4.19 ±1.62,3.11 ±1.56 and 2.35± 1.49,respectively.2.Univariate analysis results showed that in the early postoperative period and recovery period,there were statistically significant differences in postoperative fatigue scores between different ages,different cardiopulmonary functions,different surgical methods,different nutritional status(BMI,preoperative albumin level,NRS2002 score,preoperative anemia)and different levels of anxiety and depression.In the long-term postoperative period,the difference in postoperative fatigue scores was statistically significant for different cardiopulmonary functions,different surgical methods,different nutritional status(BMI,preoperative albumin level,NRS2002 score,preoperative anemia)and different levels of anxiety and depression.3.Multivariate regression analysis showed that fatigue 1 day before surgery,surgical mode,fasting time,postoperative hospitalization days,cardiopulmonary function and anxiety were important influencing factors of early postoperative fatigue,which could explain 56.6% fatigue score.Fatigue 1 day before surgery,surgical mode,postoperative hospital stay and anxiety were important influencing factors of postoperative recovery fatigue,which could explain 41.2% fatigue score.Fatigue 1 day before surgery,surgical mode,postoperative hospital stay and depression were the important influencing factors of postoperative long-term fatigue,which could explain the fatigue score of 43.2%.4.After the implementation of nursing measures based on the concept of enhanced recovery after surgery and traditional nursing measures,the fatigue scores of the two groups of patients were statistically significant after 3 days,7 days,and 14 days(P<0.05),and the intervention group scored lower than the control group.There was no significant difference in fatigue score after 30 days(P>0.05).Repeated measures anova results showed that there were statistically significant differences in VAS scores and ICFS scores between the two groups in time effect,intergroup effect and interaction effect(P<0.05).There was no statistically significant difference in postoperative pain score,but statistical significance in the number of times of self-controlled analgesia pump presses(P>0.05).Postoperative hospitalization days in intervention group were less than that in the control group and 3 days after surgery c-reactive protein level was lower than that in the control group,differences were statistically significant(P<0.05),there was no statistically significant difference about the incidence of major complications(P>0.05).Conclusion 1 The incidence of POF in patients with gastric cancer was at a high level within 30 days after surgery.Fatigue one day before surgery,type of surgery,fasting time,postoperative hospital stay,cardiopulmonary function,anxiety and hemoglobin were the main factors affecting the occurrence of early postoperative fatigue.Early postoperative fatigue,fatigue one day before surgery,postoperative hospitalization days and age were the main influencing factors of postoperative recovery and long-term fatigue.2 The ERAS project can effectively relieve postoperative stress,early and convalescence fatigue of patients with gastric cancer,and shorten the length of hospitalization days,which is safe and effective,But is invalid for long-term(30 days after surgery)POF. |
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