Application Of Optimized Plan For Accelerated Rehabilitation Surgery In Perioperative Period Of Laparoscopic Radical Cystectomy

Objective:To investigate the clinical effect and safety of the optimized program of accelerated rehabilitation surgery in the perioperative period of laparoscopic radical cystectomy.Methods:The clinical case data of patients undergoing radical cystectomy in the General Hospital of Ningxia Medical University from January 2018 to December 2020 were retrospectively collected.Patients who visited from January 2018 to June 2019 were treated with conventional rehabilitation treatment plan（control group）,and patients who visited from July 2019 to December 2020 were treated with ERAS optimization plan（experimental group）.There were 29 patients in the conventional rehabilitation treatment group,with an average age of（63.65±8.96）years old,including 25 males（86.2%）and 4 females（13.8%）;The ERAS optimization plan group included 27 study subjects,with an average age of 61.37±8.55 years old,including 22（81.5%）male patients and 5（18.5%）female patients.The SPSS 26.0statistical software was used to compare the perioperative clinical results of the data of the two groups.Results:Differences in age,gender,combined underlying diseases（hypertension,diabetes,coronary heart disease）,and smoking history between the conventional rehabilitation treatment group and the ERAS optimization plan group,body mass index（BMI）,number of preoperative resections of bladder tumors,and middle There were no statistically significant differences among neutrophils,lymphocytes,hemoglobin,platelets and albumin;The intraoperative crystal fluid（240（225-300）VS 2000（1500-2500））and colloidal fluid（1000（1000-1250）VS 500（0-1000））input in the conventional treatment group were more than those in the ERAS optimization plan group.The difference was statistically significant（P<0.05）.Operation time and intraoperative blood loss were not statistically different between the two groups(P_{operation time}=0.526,P_{intraoperative blood loss}=0.103).In the conventional rehabilitation treatment group,ureteral skin stoma,ileal bladder and orthotopic surgery The number of bladder surgery cases were 5（16.7%）,21（70.0%）and 4（13.3%）respectively,while the ERAS optimization plan group was 3（11.1%）,19（70.4%）and 5（18.5%）cases,The difference is not obvious between the two（P=0.758）In the ERAS optimization plan group,there were 4 cases,15 cases,8 cases,and 0 cases of normal,mild depression/anxiety,moderate depression/anxiety,and severe depression/anxiety,accounting for 14.81%,55.56%,29.63%and 0%of the total number of people in the group;The number of preoperative bladder tumor resections in the normal and mild depression/anxiety groups in the ERAS optimization plan group was more than that in the moderate and severe depression/anxiety groups,the difference was statistically significant（1.625±0.744 VS 0.789±0.976 P<0.05）,the postoperative hospital stay in the normal and mild depression/anxiety groups was less than that in the moderate and severe depression/anxiety groups,and the difference between the two is statistically significant（9.578±1.216 VS 12.875±3.482 P<0.05）.However,there was no significant difference in VAS pain score,postoperative ventilation time,liquid diet time,pathological grade,pathological stage,lymph node metastasis,ICU intensive care,and postoperative complications between the two groups at 6h after surgery（P>0.05）.Conclusion:The patient’s mental and psychological factors have a certain impact on the patient’s postoperative recovery.The pre-operative publicity should pay attention to the assessment of the patient’s mental and psychological pressure,and appropriate guidance should be given.Preventive analgesia combined with multi-modal analgesia can effectively reduce postoperative pain and improve postoperative satisfaction of patients.Houpu exhaust gas mixture has a certain promoting effect on the recovery of gastrointestinal function in patients after surgery;the optimized ERAS program in this study can effectively shorten the time and time of exhaustion after surgery without increasing the incidence of postoperative complications.Eating liquid diet time.