| Objective: To construct a clinical nursing pathway(CNP)for enhanced recovery after surgery(ERAS)in hepatectomy based on the concept of ERAS,and to explore the effectiveness and availability of the CNP by applying it to patients undergoing hepatectomy.Methods: Firstly,the CNP of ERAS in hepatectomy was constructed.The preliminary CNP of ERAS in hepatectomy was developed via case review,literature review and group meeting,and then Delphi questionnaires was sent to experts to complete the CNP.The statistical analysis was processed using Excel 2016 and SPSS 22.0 software.General information of experts included gender,age,educational background,professional and technical title,position and working years.Degree of experts' positivity and authority,concentration of opinions and coordination were analyzed.According to the result of Delphi questionnaires,CNP was modified,then we had a last CNP edition,and finally the CNP was applied to clinical practice.Prospectively included patients who underwent hepatic resection in the Department of General Surgery of a grade three hospital from March 2019 to December 2019.Patients undergoing liver resection surgery from March 2019 to July 2019 were included in control group,from August 2019 to December 2019 were distributed to ERAS group.We collected basic information of patients,and compare the postoperative thirsty score,pain score,time to first passage of exhaust and stool,complications,length of hospital stay and hospitalization costs of two groups.Results: A total of 57 items of nursing ordered items were produced via case review,and 13 ERAS nursing items of non-ordered nursing were supplemented through literature review.Combined with case review and literature review,the standard hospitalization time was set as 10 days,and the operative time was the fourth day of hospitalization,and the first round of expert consultation questionnaire was preliminarily formulated.Lately,we made a questionnaire to consult specialist.The authority of expert consulted was 0.78,which ensured the content validity of CNP;In the first round of consultation,a total of 15 experts put forwarded opinions,positive coefficient of expert was 93.75%,the rate of experts consent for each item ranging from 20% to 100%.The consent rate of items was 70% or higher would be included to conduct the second round of expert consultation.Then we had a final version of nursing path.The importance of each entry assignment means range from 3.53 to 4.87,the variation coefficient from 0.07 to 0.22,the coordination coefficient of the specialist's opinion was 0.465,P< 0.001,so consistency was high.The clinical application of CNP was listed as follows: in terms of comfort,62 patients were included in our research,each group had 31 patients.Compared to control group,postoperative 24 h pain score(2.61±1.12 vs 3.26±1.12,P=0.03),preoperative 2h thirst score(5.97±1.43 vs 6.84±1.53,P= 0.02)and postoperative 2h thirst score(5.94±1.79 vs 7.23±1.15,P= <0.001)of ERAS group were lower.As for gastrointestinal function recovery,the time to first passage of exhaust(2.35±0.84 vs 3.19±0.98,P=<0.001)and time to first passage of stool(3.00±0.73 vs 3.68±0.94,P=<0.001)of the ERAS group was shorter than control group.As far as length of hospitalization was concerned,the median length of hospitalization in the ERAS group was 2 days less than control group(7 vs 9,P=0.02).In terms of total hospital expenses,there was no statistically difference between two groups,but regarding to western medicine(0.71 vs 0.89,P=0.01)and consumables(0.45 vs 0.20,P=0.02),the cost of the ERAS group was lower than control group.Conclusion: The CNP of ERAS for hepatectomy had a high content validity and coordination,if which was applied to the clinic practice,postoperative gastrointestinal function recovery would be promote.Besides,CNP also could improve patients' comfort,reduce abdominal distension,shorten the length of hospital stay. |
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