Construction And Application Study Of Early Enteral Nutrition Scheme After Endoscopic Radical Esophageal Cancer Surgery Based On ERAS Concept

ObjectivesAn early enteral nutrition program suitable for patients after laparoscopic radical resection of esophageal cancer was constructed guided by the concept of ERAS and based on evidence-based.Using quasi-experimental research to carry out effect evaluation of the program and clinical application and provide a set of standardized early enteral nutrition implementation program for patients after laparoscopic radical resection of esophageal cancer.MethodsPart 1:Preliminary construction of early enteral nutrition program after laparoscopic radical resection of esophageal cancer.According to the literature analysis method and evidence-based nursing,search domestic and foreign literatures related to the implementation of early enteral nutrition for patients after radical resection of esophageal cancer,screen and evaluate the quality of the literature,summarize high-level evidence,and guide the concept of ERAS to formulate laparoscopic radical resection of esophageal cancer The first draft of the implementation plan of post-early enteral nutrition,and after the expert meeting and the pre-experiment,the first draft of the plan was optimized and trimmed,and finally the implementation plan suitable for the experiment was formed.Part 2:Application of early enteral nutrition program after laparoscopic radical resection of esophageal cancer.Using a quasi-experimental study and convenient sampling method,72 patients who plan to undergo endoscopic esophagectomy for esophageal cancer were selected and numbered based on the determined surgical time.Odd numbers were used as the control group,and even numbers were used as the intervention group.The blood biochemical major nutritional indicators（prealbumin,total protein,albumin）,inflammatory index C-reactive protein and Immune index（CD₄⁺/CD₈⁺）;Compare the incidence of complications such as anastomotic leakage,pulmonary infection,and wound infection between the two groups;compare the days of hospitalization,the first exhaust and defecation time after operation between the two groups;evaluation of the application effect of early enteral nutrition program.SPSS 26.0 was used for statistical analysis of the data,measurement data were represented by“（?）SS”or P₅₀(P₂₅,P₇₅),and t test or rank sum test was used for comparison,and count data were represented by“n%”,andX² was used for comparison test or Fisher’s exact test,the test level α=0.05.Results1.Construction of early enteral nutrition program for patients undergoing laparoscopic radical resection of esophagus cancer.After literature screening and analysis,a total of 6 guidelines,5 randomized controlled trials,2 systematic reviews,and 3 consensus articles were included,and the evidence summary of 16literatures was carried out.A total of 17 pieces of relevant evidence were included,including 10 pieces of A-level evidence and 7 B-level pieces of recommended evidence.Four intervention topics were summarized,and the first draft of early enteral nutrition program after laparoscopic radical resection of esophageal cancer was constructed.After the intervention plan was perfected through the pre-experiment and the expert meeting,the 5-day intervention was finally determined to start 6 hours after the operation.The intervention plan included the timing of enteral nutrition,the method of enteral nutrition,specific measures of enteral nutrition,and outcome indicators.2.Application of early enteral nutrition program after laparoscopic radical resection of esophageal cancer.A total of 72 patients with esophageal cancer were enrolled,and 6 patients were lost.The data collection of 66 patients was completed,including 33 patients in the intervention group and 33 patients in the control group.（1）Comparison of baseline data:differences in gender,age,pathology,BMI,lymph node metastasis,tumor location,tumor maximum diameter,comorbidities,smoking,drinking,nutritional indicators,immune indicators,and inflammatory indicators between the preoperative control group and the intervention group There was no statistical significance（P>0.05）,indicating that the baseline data between the two groups were consistent and comparable.（2）Comparison of nutritional indicators after intervention:The detected values of nutritional indicators in the intervention group were higher than those in the control group on the 1st,3rd,and 5th days after operation.And the differences in the detection values between the two groups on the 3rd and 5th day after operation were statistically significant（P<0.05）.（3）Comparison of postoperative inflammatory indicators:Compared with preoperative,the detection values of postoperative inflammatory indicators in the two groups were higher;postoperatively,the inflammatory indicators in the intervention group were lower than those in the control group on days 1,3,and 5,and the difference was statistically significant（P<0.05）.（4）Postoperative immune index comparison:Compared with preoperative,the postoperative immune index detection values in the two groups were lower;but the immune index values of the intervention group at various time points after operation were better than those of the control group,and the difference between the two groups was statistically significant（P<0.05）.（5）Comparison of post-intervention complications:the overall complication rate in the intervention group（9.1%）was significantly lower than that in the control group（57.6%）,and the difference was statistically significant（X²=17.455,P<0.05）.（6）Comparison of recovery data after intervention:the first exhaust gas,defecation time and postoperative hospitalization days in the intervention group were shorter than those in the control group,and the differences were statistically significant（P<0.05）.Conclusions1.Early enteral nutrition program after laparoscopic radical resection of esophageal cancer can improve postoperative nutritional level,reduce postoperative inflammatory response,and improve postoperative immunity.2.The early enteral nutrition program after laparoscopic radical resection of esophageal cancer can reduce the occurrence of postoperative complications,shorten the first postoperative exhaust gas,defecation and hospitalization time,and provide nursing staff with early care for patients with laparoscopic esophageal cancer.Enteral nutrition practice provides a reference.