Application Of Nursing Intervention Of Fast Track Surgery In Elderly Patients Undergoing Laparoscopic Colorectal Surgery

Background:Elderly patients with colorectal cancer are more prone to intraoperative hypotension,hypoglycemia,heart failure,postoperative pulmonary infection,wound infection.They are affected by a combination of physiological function decreased and concomitant with one or more other diseases(coronary heart disease,hypertension,diabetes,chronic obstructive pulmonary disease).Fast track surgery program have been proposed by domestic and foreign researcherstocontrolthefactorsthataffectpostoperative rehabilitation.Nursing intervention is an important part of the concept of FTS.The intervention is still relatively little reported,and the views held by are also different in elderly patients with laparoscopic colorectal cancer,at home and abroad.Objectives:FTS Nursing intervention and traditional perioperative nursing program are compared in elderly patients undergoing laparoscopic colorectal cancer surgery.The superiority of two perioperative nursing programs will be explored.The aim is to reduce the perioperative risk and the postoperative organ dysfunction,shorten the total length of hospital stay,decrease the hospital costs and save medical resources.The standardized FTS care program will be explored in the elderly patients with colorectal cancer to provide a scientific basis.Methods:From January 2015 to October 2016,100 old patients who underwent elective laparoscopic colorectal surgery were enrolled in this study.Each patient met the inclusion criteria.The patients were divided into FTS nursing group(50 cases)and traditional nursing group(50 cases)by random number table method.There were no significant differences in age,sex,body mass index,tumor stage and tumor location between the two groups(P>0.05).The two groups were implemented different care measures.Health education,preoperative bowel preparation,preoperative diet,indwelling gastric tube and urinary catheter,intraoperative care,postoperative early activity,early postoperative eating and postoperative analgesia was included.Stress indicators(C-reactive protein levels),operation-related indexes(operation duration,intraoperative blood loss),postoperative recovery indexes(bowel movement recovery time,first defecation time,first into the fluid time,postoperative hospital stay),the incidence of postoperative complications(anastomotic fistula,intestinal obstruction,pulmonary infection,urinary retention,urinary tract infection,incision infection and incision bleeding),economic indicators(total cost of hospitalization,total length of stay)were recorded and compared.Data were collected by Excel.SPSS 22.0 were used for statistical analysis.The metrical data of normal distribution were expressed as X~—±S,the comparison between groups was made by t test,and the CRP was analyzed with repeated measures of variance.Data were expressed as median(interquartile spacing)which were not in accordance with the normal distribution.Wilcoxon rank sum test was used for comparison between groups.The count data were expressed as frequency and percentage,and the rates were compared by?~2 test.P<0.05 for the difference was statistically significant.Results:96 old patients with colorectal cancer were eventually included in the study.During the study,there were no deaths.FTS care group were included 48cases and removed 2 cases.Because one patient refused surgery and automatic discharge,the other one had multiple metastases,the tumor invasion of the right ureter,small intestine and uterus.The traditional nursing group included 48 cases and excluded 2 cases,exclusion reasons for palliative surgery(Hartman surgery)and sigmoid colostomy.1.There was no statistical difference in the operation method,intraoperative blood loss and operation duration between the two groups(P>0.05).2.The comparison of CRP levels between the two groupsThere was no statistically significant difference between CRP level on FTS nursing group(3.2±4.1)mg/L and the traditional nursing group(5.4±6.6)mg/L at one day prior to surgery,P>0.05.On the first day after surgery,CRP levels were significantly increased in both groups,but FTS care group(55.3±23.6)mg/L increased less than the traditional care group(33.9±14.6)mg/L,the difference was statistically significant(P<0.05).On the fifth day after operation,the levels of CRP were decreased in both groups,but still higher than the level of one day before operation.FTS nursing group(17.7±10.1)mg/L was less than the traditional care group(33.9±14.6)mg/L,the difference was statistically significant(P<0.05).There was a time-and-group interaction in CRP changes.3.The comparison of postoperative recovery indexes between two groupsThe postoperative recovery time of the FTS nursing group was earlier than that of the traditional nursing group.The first postoperative anal exhaust time was(95.5±31.1)h and(109.5±33.5)h.The first defecation time was(134.0±48.7)h and(154.0±47.7)h.The time of the first influent was(119.0±52.9)h and(144.5±57.8)h.The postoperative hospital stay was(269.5±48.3)h and(295.0±72.2)h.The difference was statistically significant(P<0.05).4.The comparison of two groups on postoperative complicationsThere were 3 cases of complication in the FTS nursing group,2 cases of pulmonary infection,1 case of incision bleeding.But no patient suffered from anastomotic fistula,intestinal obstruction,urinary tract infection,urinary retention and incision infection.There were 12 cases of traditional nursing group complications,1 case of postoperative anastomotic fistula,1 case of intestinal obstruction,1 case of urinary tract infection,1 case of urinary retention,2 cases of wound infection,5 cases of pulmonary infection and 1case of wound bleeding.There was significant difference in the total complication rate(P<0.05).5.Comparison of hospitalization cost and hospitalization time between two groups of patientsThe total cost of hospitalization in FTS nursing group(41876±7718)yuan was lower than that in traditional nursing group(47005±10603)yuan,the difference is statistically significant(P<0.05).There was no statistically significant difference in the total hospitalization time between FTS nursing group and traditional nursing group.Conclusion:Application of nursing intervention of fast track surgery is safe and effective,which can accelerate the recovery of bowel movement,lighten the postoperative stress response,reduce the postoperative hospital stay and the total cost of hospitalization,and do not increase the incidence of postoperative complications in elderly patients with colorectal cancer after laparoscopic surgery.