Study On The Establishment And Application Of Precise Diet In Early Postoperative UBE Patients Under General Anesthesia

Purpose1.Under the guidance of Enhanced recovery after surgery(ERAS),domestic and foreign literatures related to early postoperative diet management after general anesthesia were systematically searched.To establish early precise feeding and drinking regimen in patients with Unilateral biportal endoscopy(UBE)after surgery(taking degenerative lumbar spinal stenosis and lumbar disc herniation as examples)under general anesthesia.2.The early diet management path after the operation of general anesthesia UBE was formed and applied in clinic,and further improved according to the results,providing a basis for the diet nursing practice of minimally invasive surgery in clinical spine surgery.Method1.Construction of early precision diet after general anesthesia UBE:1 Systematic literature review : Databases such as CNKI,Wanfang Data,Pub Med,Sinomed,and Web of Science were searched to screen literature related to diet management after orthopedic general anesthesia.Quality evaluation and content extraction were carried out on the literature after screening,and the framework content of early precise diet program for patients after general anesthesia UBE was preliminarily formulated.2 A postoperative diet management group for general anesthesia UBE was formed,and the members of the group discussed and formed the first draft of the early postoperative precision diet plan for general anesthesia UBE.3 Delphi expert letter inquiry:After two rounds of correspondence from 15 experts,the final draft of early precision diet after UBE general anesthesia was determined.2.Non-concurrent randomized controlled trials were used : A total of 104 patients with UBE under general anesthesia from the spinal surgery department of a Grade-III hospital in Yancheng City,Jiangsu Province from January 2021 to October2022 were selected as the study objects,with bimonthly patients as the experimental group and one-month patients as the control group.This study was approved by the Ethics Committee of our Hospital.The time difference of the first intake,the first intake of semi-fluid diet,the first intake of normal diet,the number of nausea and vomiting,the degree of abdominal distension,thirst and hunger,oral comfort,pain and anxiety were compared between the two groups within 24 hours after surgery.Result1.Establishment of precise personalized diet after general anesthesia UBE(1)Literature search results:A total of 1364 literatures were retrieved.By reading titles and abstracts,articles unrelated to the research were excluded,as well as duplicate literatures and basic research,conference abstracts,letter notices,and old guidelines.The full text or literatures with only abstracts and discussion drafts could not be obtained through multiple approaches.After reading the full text,a total of 15 relevant literatures were obtained.After evaluating and analyzing the quality of the literatures,a framework of early precision diet program after general anesthesia UBE operation with 17 items was initially formed.(2)After discussion by the UBE postoperative diet management team,the first draft of the early postoperative precision diet program of general anesthesia UBE was determined,which included 10 items.(3)Expert consultation results : Delphi method was used for expert consultation on the draft plan.After two rounds of correspondence consultation with15 experts,the final draft of early postoperative precision diet plan of general anesthesia UBE was determined,including 10 items.The positive coefficient of experts in two rounds was 100%,the authority coefficient was 0.90,the coordination degree of experts in the first round was 0.200,and the coefficient of variation(CV)was as follows: 0.052～0.610;The coordination degree of experts in the second round was 0.280,coefficient of variation(CV)was 0.000-0.210.2.Comparison of precision diet program group(experimental group)and conventional diet program group(control group)6h after surgery:(1)Pearson Chi-square test was used to compare the frequency of vomiting and the occurrence of abdominal distension within 24 h between the two groups,and there was no significant difference(P>0.05).(2)The thirst and hunger at 3h and 6h after operation were scored by correlation grade scores,and the difference was statistically significant(P<0.001).(3)Repeated measure analysis of variance was used to compare the scores of oral comfort,anxiety and pain between the two groups at 1h,2h,3h,4h,5h and 6h.The results showed that there were significant differences in oral comfort between the two groups from 2h onwards(P<0.001);The difference in anxiety score began 2h after patients returned to the ward,and the difference in pain score began 3h after patients returned to the ward,and the differences were statistically significant(P<0.001).(4)After returning to the ward for 2h,the oral comfort level of the two groups was negatively correlated with anxiety(R=-0.314,P<0.01),and with the increase of time,the correlation between the two became stronger and stronger: R=-0.641 at 3h after surgery,R=-0.791 at 4h after surgery,R=-0.890 at 5h after surgery,and R=-0.931 at 6h after surgery,namely,with the increase of patients’ oral comfort,patients’ anxiety score decreased.(5)There was also a certain correlation between the pain and anxiety of the two groups of patients.From 3h after returning to the ward,the anxiety and pain of the patients began to have a positive and weak correlation,and the correlation gradually increased(P<0.05).The R values of 3-6 hours were 0.211,0.285,0.290,0.306,respectively.The pain of the patients also decreased gradually.ConclusionIn this study,precise diet management scheme was established in the early postoperative period of general anesthesia UBE,which could relieve thirst and hunger,improve oral comfort,and reduce postoperative anxiety and pain of patients in the early postoperative period without increasing postoperative gastrointestinal discomfort of patients.