Study On The Application Of ERAS In The Perioperative Period Of Colorectal Cancer

Background:Colorectal cancer（CRC）is a relatively common and serious malignant tumor disease that threatens human life and health.Nowadays,with the transformation of people’s life and diet,coupled with the improvement of people’s health awareness,diagnosis and treatment level,the rate of the disease diagnosis has increased significantly^[1].CRC is based on the principle of surgical resection,radiotherapy,chemotherapy,neoadjuvant,and gene,immunity and targeting as supplementary treatment principles.In order to prevent the occurrence of recurrence,metastasis and complications,improve the recovery and survival rate,and improve the prognosis,the concept of“enhanced recovery after surgery”（ERAS）or“Fast-Track Surgery”（FTS）is on the stage.Its definition is:the application of optimized,multidisciplinary collaborative perioperative treatment methods to reduce the stress response caused by social,psychological,pre-and post-operative care and operational measures can achieve a management model that reduces the incidence of postoperative complications,shortens the length of hospital stay,and saves medical costs and resources.ERAS has formulated a series of related treatment measures before and after surgery.It mainly includes preoperative instruction and education,avoiding excessive fasting and taking carbohydrates at 6h and 2h before surgery,unroutine mechanical bowel preparation（MBP）,preventive use of antibiotics,and multiple modes Analgesia（Multi-model analgesia,MMA）,intraoperative warmth,perioperative fluid management（restrictive fluid replenishment measures）,minimally invasive techniques,surgery as much as possible to choose a smaller incision,leaving no routine placement of gastric tube,drainage tube and Urinary catheters and other pipes or patient conditions need to be removed early after surgery（within 24 to 72 hours）,the best pain control,early postoperative oral eating,early getting out of bed,etc^[2],to prevent postoperative nausea and vomiting(postoperative nausea and vomiting（PONV）and paralytic intestinal obstruction（Post-operative ileus,POI）.Objective:Exploring the effect of ERAS in the perioperative period of CRC.Method:A collection of 80 patients diagnosed with CRC and undergoing laparoscopic surgery admitted to the Department of Gastrointestinal Hernia and Anorectal Department of Yan’an University Affiliated Hospital from October 2018 to January 2021.Use the random number table method to randomly divide into two groups,among them,40 patients were treated with the concept of ERAS in the perioperative period（observation group）,and 40 patients were treated with the concept of traditional perioperative care（control group）.The patients in the two groups were diagnosed with medical history,physical examination,laboratory,imaging,endoscopy,pathology and other examination methods,and the surgical evaluation was perfected.Implement corresponding perioperative measures to collect and compare general data,surgical indicators,changes in inflammatory indicators before and after surgery,recovery of body functions,length of stay,complications,and postoperative pain scores.The data were analyzed and processed by SPSS 25.0 statistical analysis,and the measurement data conforming to the normal distribution:mean±standard deviation X?±S,independent sample T test;count data 2 test.The null hypothesis of P value≥0.05 is established,and the difference is not statistically significant;otherwise,the null hypothesis is rejected,and the difference is statistically significant.Result:General data comparison:age,sex ratio,BMI,tumor location,TNM staging,intraoperative blood loss,operation time,number of lymph nodes dissected P>0.05,there was no statistical difference.In the comparison of surgical incision length between the two groups:the observation group（5.20±1.10）was significantly smaller than the control group（9.75±3.01）,T=8.99,P<0.01,the difference was significant.Comparison of surgical indicators:there was no difference in the comparison of WBC,CRP P>0.05 before surgery;white blood cells（T=3.96,P<0.05）,CRP（T=8.92,P<0.05）the comparison is statistically significant.Postoperative recovery:time to get out of bed for the first time（T=5.55,P<0.05）,time to first meal（T=9.18,P<0.05）,time to first exhaust and defecation（T=3.73,P<0.05）,removal The time of abdominal drainage tube（T=5.10,P<0.05）,the time to remove the catheter（T=3.45,P<0.05）,and the length of hospital stay（T=5.00,P<0.05）were all statistically significant.There were 2 cases（5%）in the observation group and 5 cases（12.5%）in the control group.The comparison value of x²=1.41,P>0.05,the difference was not statistically significant.On the 1st day after operation,the pain in the observation group was lighter（1.98±0.77）,which was lower than the control group（4.05±1.13）,P<0.01;on the 3rd day after operation,the observation group（0.63±0.74）and the control group（2.15±1.05）,In this comparison,P<0.01,the difference is statistically significant.In conclusion:There were no differences in general information,surgical conditions（except incision length）,white blood cells and CRP 1 day before surgery.On the 3rd day after operation,WBC and CRP indicators were different from those of the control group.From the aspect of inflammation,it indicated that ERAS treatment caused less stress response to patients.The ERAS group did not increase the incidence of postoperative complications on the basis of reducing the length of the surgical incision,reducing the postoperative VAS pain score,shortening the patient’s early getting out of bed and eating,anal exhaust and defecation,removal of related ducts and hospitalization time.That is,the application of ERAS concept nursing not only does not increase the incidence of postoperative complications,but also reduces the incidence of stress response in many aspects,improves patient comfort,promotes postoperative recovery,and shortens the number of days in hospital.Feasible,more high-quality,safe and effective perioperative treatment.