| ObjectiveTo formulate isolation techniques in laparoscopic malignant tumor surgery,using Bundled care strategy.To evaluate the effect of isolation techniques after laparoscopic malignant tumor surgery,using Bundled care strategy.Methods1.To initially form(isolation technique)items on Bundled care,in term of the principles and procedures of inquiry nursing,a multidisciplinary team was established to search the relevant literature on the application of surgical isolation techniques in laparoscopic malignant tumor surgery,and the selected guidelines,consensus,literature,experimental research and other results were independently evaluated by using the grading standard of evidence level and recommendation level of 《Joanna Briggs Institute grading standards for evidence and recommendation(2010)》.Through consulting experts,clinical research and localized evidence review of clinical experts applying FAME principle,the isolation technique items on Bundled care strategy of laparoscopic malignant tumor surgery were formed after modification.2.Taking experimental research method,the surgical isolation techniques on Bundled care strategy were implemented in laparoscopic malignant tumor surgery,and its clinical effect was evaluated.Random sampling was used to select 109 patients as the research object,who underwent laparoscopic malignant tumor surgery in a Class A tertiary hospital of Inner Mongolia Autonomous Region(July 2020-March 2021),and the sample was divided into experimental group and control group.The experimental group implemented Bundled care strategy while the control group continued with usual nursing method,and the following indexes were compared between these two groups: 1)general information,2)incidence of surgical site infection,3)PCT value within 72 hours after surgery,4)postoperative tumor cell implantation and metastasis rate,5)CEA value and CA1996 value of tumor marker index,6)implementation rate of laparoscopic surgical isolation techniques.3.Data were analyzed using Spss24.0 statistical software,the measurement data conform to normal distribution and homogeneity of variance,and the data are listed as means ± standard deviation;Use frequency and composition ratio of counting data to describe;Chi square test was used for the counting data,and the measurement data obeyed the normal distribution.Two independent sample t-test was used,which did not conform to the normal distribution.Rank sum test was used,and repeated measurement analysis of variance was used for repeated measurement data.P < 0.05 was statistically significant.Results1.By transforming the evidence into the Bundled care strategy of laparoscopic malignant tumor surgical isolation techniques and changing the obstacle factors of clinical application,the implementation of surgical isolation techniques on Bundled care strategy in13 aspects and 35 items,such as preoperative evaluation,preoperative preparation,intraoperative cooperation and post-operative treatment,was formulated,and the assessment standard was formulated at the same time.2.Comparing the general data between the experimental group and the control group,there was no significant difference between the two groups in gender,age,educational level,payment method,medical diagnosis,tumor stage,organizational credit type,and other general data(P > 0.05),the two groups were comparable.3.Comparison of surgical site infection data between the two groups: the incidence of surgical site infection in the experimental group was 5.9%,while that in the control group was 15.7%.The incidence of surgical site infection in the experimental group was significantly lower than that in the control group(P < 0.05);Within 72 hours after operation,the PCT value of the experimental group was significantly lower than that of the control group(P < 0.05).4.On postoperative tumor cell implantation and metastasis rate,there was no significant difference between the two groups in surgical incision implantation and metastasis,puncture needle path implantation and metastasis,and abdominal cavity implantation and metastasis(P > 0.05),the postoperative implant transfer rate in the experimental group was 5.8% and that in the control group was 15.7%,which was significantly lower than that in the control group(P < 0.05).5.Comparison of tumor markers: the values of CEA and CA199 in the control group decreased,one month,three months,six months after operation,significantly increased higher than the preoperative level nine months after operation,and comparatively decreased twelve months after operation,while those in experimental group decreased at all time points.Compared with the control group,the postoperative CEA value and CA199 value of the experimental group decreased significantly and significantly lower than that of the control group(P < 0.05)6.The implementation rates of the first,2nd and3 rd surgical isolation techniques in both group were above 90%,and there was no significant difference(P > 0.05);for comparison,the implementation rates of the 4th-10 th surgical isolation techniques were above 90% of the experimental group,though only 4 rates were above 70% of the control group,the implementation rates of the experimental group were significantly higher than that of the control group,and the difference was statistically significant(P < 0.05).Conclusion1.Based on the method of inquiry and confirmation,this study formulated laparoscopic surgical isolation techniques on Bundled care strategy,formulated the assessment standard of laparoscopic surgical isolation techniques,provided scientific processes and norms for the implementation of laparoscopic malignant tumor surgery,and improved the implementation rate and standardization of this operation,so as to improve the quality of surgical nursing.2.The application of surgical isolation techniques on Bundled care strategy in laparoscopic malignant tumor surgery may help to reduce the incidence and risk of surgical site infection,as well as to reduce the rate of postoperative implantation and metastasis of tumor patients,and the risk of postoperative tumor cell implantation and metastasis. |
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