Effects of enhanced recovery after surgery on postoperative recovery, psychological state of patients with laparoscopic gastrointestinal surgery / 中国中西医结合急救杂志

ABSTRACT

Objective To explore the effects of enhanced recovery after surgery (ERAS) on postoperative recovery, psychological state and complications of patients with laparoscopic gastrointestinal surgery. Methods Ninety-eight patients with laparoscopic gastrointestinal surgery admitted to Huzhou Central Hospital from January 2016 to December 2017 were enrolled and they were divided into two groups (49 cases in each group) according to difference in nursing. During peri-operative period, the routine nursing group was given routine nursing; while the ERAS nursing group received the nursing of ERAS. The postoperative recovery, inflammatory response and nutritional status, complications, psychological state and nursing satisfaction were compared between the two groups. Results Compared with the routine nursing group, the gastrointestinal tract exhaust time, common food intake time, incision healing time, ambulation time and hospital stay were significantly shorter in ERAS nursing group [gastrointestinal tract exhaust time (days) 2.43±1.02 vs. 3.46±1.15, common food intake time (days) 4.24±1.36 vs. 6.23±1.52, incision healing time (days) 7.62±1.54 vs. 9.63±1.63, ambulation time (days) 8.80±2.32 vs. 11.24±2.02, hospital stay (days)10.23±2.12 vs.14.56±2.37, all P < 0.05]. After operation, the high-sensitivity C-reactive protein (hs-CRP) in the two groups was increased first and then decreased, and the levels of transferrin (TRF) and prealbumin (PA) were decreased first and then increased, and the differences were statistically significant at different time points within-groups (P < 0.05), and the changes of indexes in the 5 days after operation in the ERAS nursing group were more significant than those in the routine nursing group [hs-CRP (mg/L) 27.4±6.2 vs. 35.6±9.1, TRF (g/L) 1.89±0.05 vs. 1.81±0.06, PA (mg/L)340±20 vs. 280±20, all P < 0.05]. The postoperative incidences of nausea and vomiting and sore throat in ERAS nursing group were significantly lower than those in routine nursing group [nausea and vomiting 32.65% (16/49) vs. 67.35% (33/49), sore throat 12.24% (6/49) vs. 51.02% (25/49), both P < 0.05], and there were no significant differences in postoperative incidences of abdominal distension, incision infection, pulmonary infection and anastomotic leakage between the two groups [abdominal distension 4.08% (2/49) vs. 6.12% (3/49), incision infection 4.08% (2/49) vs. 6.12% (3/49), pulmonary infection 2.04% (1/49) vs. 6.12% (3/49), anastomotic leakage 2.04% (1/49) vs. 4.08% (2/49), all P >0.05]. The scores of self-rating anxiety scale (SAS) at discharge in the two groups were lower than those before operation, and the degree of decrease in ERAS nursing group was greater than that in routine nursing group (39.21±4.64 vs. 46.56±4.53, P < 0.05). The nursing satisfaction rate in ERAS nursing group was significantly higher than that in routine nursing group [95.92% (47/49) vs. 77.55% (38/49), P < 0.05]. Conclusion ERAS for laparoscopic gastrointestinal surgery not only can promote the recovery of gastrointestinal function, improve the nutritional status and reduce inflammatory response and postoperative complications, but also can relieve anxiety, shorten hospital stay and elevate nursing satisfaction, therefore it is worthy to promote and apply in clinical nursing.