| [Objective]To construct the Standard Operating Procedure for Coordination of Laparoscopic Sleeve gastrectomy Based on Node Control for obese patients and explore its application effect in the clinical practice of operating room nursing.In order to standardize the coordination process of laparoscopic sleeve gastrectomy,improve the efficiency of surgical coordination,reduce the safety risk of perioperative nursing,and improve the satisfaction of surgical patients and surgeons.It provides theoretical basis for continuous quality improvement of operating room nursing.[Methods]Domestic and foreign literatures related to weight loss and metabolism surgery and surgical cooperation were systematically searched,the quality evaluation and content extraction of the selected literatures were carried out.In addition the first draft of Standardized Operating Procedures for Laparoscopic Sleeve gastrectomy based on Nodecontrol was formulated based on clinical practice experience.Using the expert group meeting,through the discussion and modification of 6 experts,finally determined the standardized operation procedure scheme.In this randomized controlled experiment,40 patients who underwent Bariatric and metabolic surgery in the bariatric and metabolic surgery department of Changzhou Second People’s Hospital affiliated to Nanjing Medical University from July to August 2022 were selected and divided into experimental group(n=20)and control group(n=20)according to the method of random number table.All patients were operated by the same surgical team.The control group was given perioperative routine nursing for surgical cooperation,and the intervention group was given perioperative nursing cooperation by the research team according to the "Standardized Operating Procedures for Coordination of Laparoscopic sleeve gastrectomy based on Nodal Control".Test records were recorded before surgery,1 day and 3 days after surgery,respectively,and the differences of hospital stay,hospital cost,operation time,preoperative preparation time,patient satisfaction,surgeon satisfaction,and related metabolic risk factor indexes were compared between the two groups.[Results]The Standardized Operation Procedure for Coordination of laparoscopic sleeve gastrectomy based on Node control was constructed,which included 5 first-level items,10 second-level items,30 third-level items and 52 fourth-level items,including preoperative visit,preoperative node index,intraoperative node index,postoperative node index and postoperative return visit.The nurse cooperated with the node punch table for node control.The average length of hospitalization was 5.0±0.8 days in the intervention group and 6.4±1.1 days in the control group.The average length of hospitalization in the intervention group was significantly reduced compared with the control group(P<0.001).The median and interquartile distance of hospitalization expenses in the intervention group was 47087.1(46204.1-48282.2)yuan,and the median and interquartile distance of hospitalization expenses in the control group was 51175.5(48668.2-53339.6)yuan.The hospitalization expenses in the intervention group were significantly decreased compared with the control group(P<0.001).In the intervention group,the median and interquartile distance between the satisfaction of operating room nurses and their families was 92.5(91.5-95.0)points,while in the control group,the median and interquartile distance between the satisfaction of operating room nurses and their families was 85.0(85.0-86.0)points.The satisfaction of operating room nurses in the intervention group was significantly higher than that in the control group(P<0.001).The median and interquartile distance between the satisfaction of the surgeons to the visiting nurses in the intervention group was 92.0(91.0-93.0)points,and the median and interquartile distance between the surgery doctors and the visiting nurses in the control group was 85.0(84.0-86.0)points.Compared with the control group,the satisfaction of surgeons to itinerant nurses in the intervention group was significantly higher(P<0.001).The median and interquartile distance between the satisfaction of surgeons to instrument nurses was 93.0(92.0-93.0)points in the intervention group,and 83.0(82.5-84.0)points between the median.Compared with the control group,the satisfaction of surgeons on instrument nurses in the intervention group increased significantly(P<0.001).The median interval between the intervention group and the control group was 90.0(80.0-102.5)min,while the median interval between the control group and the control group was 100.0(100.0-125.0)min.There was no statistically significant difference between the two groups in the operation time(P=0.067).Compared with the preoperative systolic blood pressure,the systolic blood pressure of the intervention group decreased by 8.8mmHg(6.5%)and that of the control group by 1.3mmHg(1.0%)on the first day after surgery,with a difference of 7.5mmHg between the two groups(95%CI:-18.8-3.9,P=0.188).Three days after surgery,systolic blood pressure decreased by an average of 8.9mmHg(6.6%)in the intervention group and 3.3mmHg(2.6%)in the control group,with a difference of 5.6mmHg(95%CI:-16.0-4.8,P=0.281).Compared with the preoperative results,the diastolic blood pressure decreased by 4.0mmHg(6.5%)in the intervention group and 0.4mmHg(0.5%)in the control group at 3 days after surgery,with a difference of 3.6mmHg(95%CI:-13.5-6.3,P=0.470).The diastolic blood pressure decreased by 5.1mmHg(6.2%)in the intervention group and 1.5mmHg(1.9%)in the control group at 3 days after surgery,and the difference between the two groups was 3.6mmHg(95%CI:-12.3-5.1,P=0.408).Compared with the preoperative results,the fasting blood glucose of the intervention group was increased by 0.1mmol/L(1.6%)on average and that of the control group was increased by 0.4mmol/L(6.8%)on average one day after surgery.The difference of the increase of blood glucose between the two groups was 0.3mmol/L(95%CI:-1.6-1.0,P=0.646).Three days after operation,the fasting blood glucose in the intervention group decreased by 1.4mmol/L(21.9%)on average,and that in the control group decreased by 1.0mmol/L(14.2%)on average,and the difference between the two groups was 0.4mmol/L(95%CI:-1.5-0.8,P=0.495).[Conclusion]The application of "Node control based LSG operation with standard operating procedure" can significantly reduce the length of hospital stay of laparoscopic sleeve gastrectomy patients,reduce the hospitalization cost of surgical patients,and improve the satisfaction of surgical patients and surgeons.The implementation of "Node control based LSG operation with standard operating procedure" can improve the effect of coordination of surgery,and standardize the procedure of coordination of surgery. |
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