Application Of The Concept Of Fast-track Surgery Combined With Clinical Nursing Pathway In Patients With VATS Monolingual Lobectomy

Objective To investigate the effect of rapid rehabilitation nursing in perioperative period of patients with thoracoscopic pulmonary lobectomy,to provide standardized nursing behavior for patients with rapid rehabilitation of thoracoscopic pulmonary lobectomy,promote postoperative recovery,reduce surgical complications and improve patient satisfaction...Methods This study collected 660 patients undergoing thoracoscopic pulmonary lobectomy in a thoracic hospital from January 1,2016 to December 31,2017.Experimental study was adopted,among which 285 patients from January 1,2016 to December 31,2016 were control group,and routine nursing was given during perioperative period;From January 1,2017 to December 31,2017,375 patients were intervention groups.The time of patients in the two groups to get out of bed for the first time,exhaust for the first time,defecate for the first time and cough up the first mouthful of old blood sputum was compared.And postoperative 24 h,48 h,72 h three point pain and chest tightness score,the chest drainage tube indwelling time,hospitalization time and total hospitalization expenses,the sleep time,sleep duration within 72 hours after,patients satisfaction of nursing work and common postoperative complications(bronchial stump fistula,lung infection,atelectasis,pulmonary embolism,pleural hemorrhage,arrhythmia,lower extremity deep vein thrombosis,infection of incision),etc.General statistical description was used for the data,and the measurement data were presented as mean ± standard deviation in line with normal distribution,while median and interquartile interval were presented as non-normal distribution.The time,pain,chest tightness level,length of indwelling time of thoracic drainage tube,length of surgical incision healing and suture removal,total hospital expenses of the patients in the two groups after the first postoperative discharge,anal exhaust,defecation,and coughing up the first old blood sputum were compared.The results were consistent with the normal distribution by using two independent samples t-test,and inconsistent with the normal distribution by using rank sum test.Rank sum test was used to compare nursing job satisfaction between the two groups.Results The two groups were comparable in gender,age,pathological type,education level and operation time.Compared with the control group,the time of getting out of bed for the first time in the intervention group was(14.36 ± 3.45)H lower than that in the control group(21.34 ± 1.98)H;the time of defecation for the first time was(3.80± 2.10)d lower than that in the control group(3.10 ± 1.80)d;the time of coughing up the first old blood sputum and the time of keeping the chest catheter were lower than that in the control group;the time of suture removal for the surgical incision healing in the intervention group was(7.85±1.46)d lower than that in the control group(9.40±1.27)d,the total cost of hospitalization was(1.31 ± 0.26)yuan lower than that of the control group(1.94 ± 0.44);the score of facial expression pain scale of patients in the intervention group was lower than that of the control group at 24 and 48 hours after operation;the score of chest distress of patients in the intervention group at 24 and 72 hours after operation was higher than that of the control group,the difference was statistically significant;the patients in the two groups were in bronchial stump fistula,pulmonary embolism,lower extremity deep vein thrombosis,incision There was no significant difference in the complications of oral infection,but there was significant difference in the aspects of pulmonary infection,atelectasis,thoracic hemorrhage and arrhythmia;the nursing satisfaction score of the intervention group(98.52 ± 1.23)was better than that of the control group(97.65 ± 1.89),and the difference was statistically significant.Conclusion Thoracoscope lung resection fast rehabilitation nursing path has effectiveness and feasibility in clinical application,can promote patients postoperative rehabilitation,shorten the postoperative bed time,extubation time,alleviate postoperative discomfort,clinical pain control effect is good,reduce the postoperative complications,shorten the length of surgical incision healing and suture removal,reduce hospitalization costs,increase the exchange of nurses and patients,improve the patients' medical experience,rapid rehabilitation nursing for thoracoscope lobe resection provides the beneficial reference.Rapid rehabilitation surgery concept combined with clinical nursing pathway promotes the thoracoscope single lung resection in patients with the recovery of physiological function,promote the patient's postoperative early to bed,early to defecate and produce the first bite pulmonary blood in phlegm,reducing the chest tube indwelling time and surgical incision healing and suture removal time and the total cost of a hospital,at the same time,effectively alleviate the 24 h,48 h postoperatively in patients with two point pain level,beneficial to the patient's sleep.At the same time,it reduces the occurrence of postoperative complications and improves the patients' satisfaction with nursing work.