| ObjectiveThe purpose of this study was to explore the effect of using individual nutritional nursing intervention on rectal cancer patients after anterior resection.(1) to compare perioperative individual nutritional nursing intervention with routine nursing care for postoperative nutritional status of patients, exploring the effect of using individual nutritional nursing intervention on the nutritional status of patients;(2) to compare perioperative individual nutritional nursing intervention with routine nursing care for postoperative complications, postoperative time to flatus and defecation, time of taking out stitches after surgery and rooting out the sacral drainage tube, parenteral nutrition supplement and length of postoperative hospital stay, exploring the effect of using individual nutritional nursing intervention on postoperative complications and recovery time of patients;(3) to compare perioperative individual nutritional nursing intervention with routine nursing care for postoperative bowel function scoring differences of patients, exploring the effect of using individual nutritional nursing intervention on defecation function of patients.MethodsA quasi-experimental study was used in this study. A convenient sampling of56rectal cancer patients undergoing anterior resection in general surgery department of Tianjin Medical University General Hospital were enrolled from May2012to August2013. They were divided into experimental group and the control group according to admission time. The participants in the control group were given the routine perioperative nursing, while the participants in the experimental group were given the routine nursing care and an individualized nutritional care plan. It included: nutrition assessment within48hours after admission, making individualized nutrition plan according to different patients needed energy, providing health education materials to patients, explaining the importance of nutritional status and disease prognosis and knowledge related perioperative diet instruction, recording patients’nutritional support and daily diets and adjustment of the patient’s diet. We collected both group’s postoperative recovery condition to make the comparison, which including postoperative nutritional status (body weight, BMI, and serum protein level), complications, postoperative time to flatus and defecation, time of taking out stitches after surgery and rooting out the sacral drainage tube, parenteral nutrition supplement, length of postoperative hospital stay and the defecation function.SPSS11.5software was used to analyze the data. For categorical data, we used frequency, percentage to describe, while mean±standard deviation for the measurement data was used. When comparing two groups of patients, counting data was calculated by chi-square test or continuity correction; measurement data was first to do Kolmogorov-Smimov test for normal distribution. For normal distribution data, we used two independent sample t-tests or repeated measures analysis of variance; for non-normal distribution data and ranked data, we used nonparametric statistics and the Mann-Whitney U test.Results1According to inclusion and exclusion criteria, a total of56patients with rectal cancer was included into this research, and devided into the experimental group (28cases) and control group (28cases) respectively. Without lost to follow-up and deaths during the study,56patients were analyzed eventually for this research.2The mean weight of patients in the experimental group was61.68±8.53kg when admitted to hospital, the average weight decreased1.48±0.66kg after10days of surgery; while the mean weight of patients in the control group was65.80±8.48kg, the average weight decreased2.07±0.65kg after10days of surgery. The result of the two independent sample t-tests showed statistically significant differences between the two groups (P<0.05).3All the patients’BMI were dropped down after10days of surgery compared with preoperative assessment. The postoperative BMI of experimental group patients was22.11±2.37kg/m2, and the control group was23.34±2.24kg/m2. After two independent samples t tests, there was no statistically significant difference (P>0.05).4Repeated measures analysis of variance showed that the main effects of time on ALB, PALB, TRF were statistical significant (P<0.05). ALB, PALB, TRF were significant different with the time without considering intervention. The main effects of intervention on ALB, PALB, TRF were no statistically significant difference (P>0.05). They were significant interactions between time and intervention on PALB, TRF (P<0.05). All the patients had a trend of going down then rising in postoperative serum albumin and prealbumin levels, while transferrin showed a trend of gradual decline. Compared with the control group, albumin level of the experimental group patients increased obviously after7days of surgery (P<0.05); and transferring level of the control group decreased obviously after7days of surgery (P<0.05), the difference was statistically significant.5During both groups of patients,16cases of patients suffered from postoperative complications, and at least one or more complications (28.57%). Seven patients had postoperative anastomotic complications (12.5%), including4cases of anastomotic fistula,1case of anastomotic stenosis,2cases of anastomotic bleeding;4patients occurred incision complications (7.14%), including3case of incision infection,1case of incision dehiscence;6patients had pulmonary infection (10.71%), urinary retention in1(1.79%),5patients occurred urinary tract infection,(8.93%);1patient had ileus (1.79%). After chi-square test for the two groups of patients, there was no statistically significant difference in the incidence of postoperative complications (P>0.05).6The mean time of all patients for first time to flatus was2.73±0.84d, for the first time to defecation was6.36±1.17d; the mean time of taking out stitches after surgery was7±0.87d, for rooting out the sacral drainage tube was8.89±1.57d; the mean time of parenteral nutrition supplement was5.82±1.49d, for hospitalization time was16.64±5.82d. Experimental group patients had shorter time in first to flatus and defecation compared with the control group. Moreover, time of taking out stitches after surgery and rooting out the sacral drainage tube, parenteral nutrition supplement and length of postoperative hospital stay was shortened in experimental group patients, which showed statistically significant differences between the two groups (P<0.05).7Patients had better defecation function after surgery in the experimental group, 11patients were rated as excellent,13patients were rated as good,4patients were general.There were statistically significant differences between the two groups (P<0.05).Conclusion1The individual nutritional nursing intervention improved the nutrition status on postoperative patients with rectal cancer.2The individual nutritional nursing intervention can promote postoperative recovery time, including shortening postoperative flatus and defecation time, time of taking out stitches, rooting out the sacral drainage tube, parenteral nutrition supplement and length of postoperative hospital stay.3The individual nutritional nursing intervention can improve patients’ postoperative bowel function.4Based on this research, nurses should regard the nutritional status assessment as an important part in clinical basic nursing. An intervention of adaptive nutritional care should be provided timely in order to promote rehabilitation of patients with rectal cancer after surgery. |
PDF Full Text Request