Objective To explore the effect of fast track rehabilitation in patients with gastric cancer during perioperative period. Methods Eighty patients were randomly divided into conventional method group （n=40） and fast track rehabilitation group （n=40）, and to compare the levels of total lymphocyte count （TLC） , C-reaction protein （CRP），IgG， IgM， IgA， CD3＋， CD4＋， CD8＋， and CD4＋/CD8＋ in serum on the days of 1 d before operation and 1 and 3 d after operation，and to record the duration of fever，first ventilation time of flatus， postoperative hospital stay time，and the postoperative complications. Results The first ventilation time after operation was advanced in patients of fast track rehabilitation group， and the postoperative fever time and hospital stay time after operation of patients was shorter in fast track rehabilitation group than that in conventional method group （P＜0.05）. The incidence difference of complications in two groups had not statistic significance （P＞0.05）. The TLC on 1 d after operation were lower than that on 1 d before operation in two groups, and the CRP values of 1 d after operation were higher than that of 1 d before operation in two groups （P＜0.01）. Compared with 1 d before operation, the CRP value on 3 day after operation in fast track rehabilitation group was lower than that in conventional method group, and the levels of IgG, IgM， IgA， CD3＋， CD4＋， CD8＋， and CD4＋/CD8＋ were higher than that in conventional group （P＜0.05）. Conclusions Fast track surgery applied to patients with gastric cancer during perioperative period is safe and efficient， which can mitigate the immunologic impairment of patients and accelerate postoperative rehabilitation．
Objective To study the effect of preoperative urination training combined with restrictive fluid therapy with enhanced recovery after surgery (ERAS) on postoperative urination in total knee arthroplasty (TKA) patients. Methods A total of 150 patients who were conducted the unilateral TKA from March to May 2018 were divided into two groups, the trial group and the control group, with 75 patients in each group. The patients in the control group did not undergo urination training before surgery and were given liberal intravenous fluid therapy on the day of surgery; while the patients in the trial group received urination training before surgery and were given restrictive fluid therapy on the day of surgery. The pre-, intra-, and post-operative infusion volume and the total infusion volume on the day of surgery of the two groups were recorded; and the urination situation, urination time for the first time and the hospital days in the two groups were compared. Results The total infusion volume on the day of surgery in the trial group and the control group was (1 581.40±277.54) and (2 395.00±257.40) mL, respectively. After operation, in the trial group, there were 73 patients with smooth urinating, 2 with smooth urinating after inducing method, and none with urethral catheterization; in the control group, there were 66 patients with smooth urinating, 3 with smooth urinating after inducing method, and 6 with urethral catheterization. The urination time for the first time after operation in the trial group and the control group was (1.85±0.91) and (2.93±1.48) hours after back to the ward, respectively. These differences between the two groups were statistically significant (P<0.05). The hospital stay in the trial group and the control group was (5.86±2.48) and (6.28±1.60) days, respectively, and the difference between the two groups was not statistically significant (P>0.05). Conclusions Preoperative urination training combined with restrictive fluid therapy (the total infusion volume controls in about 1 500 mL on the day of surgery) in the TKA patients after ERAS is good for postoperation urination. It also can reduce the rate of postoperative urinary retention, and enhance rehabilitation.
Objective To analyze the progress of evaluation indexes for enhanced recovery after surgery (ERAS) model at home and abroad, and to propose suggestions for constructing systematic evaluation model of ERAS. Methods Atfirst checked the Chinese and English databases, including Medline, Embase, Sciencedirect, ACP Journal Club, BioMed Central, the Cochrane Central Register of Controlled Trials (CENTRAL), Science Citation Index Expanded, Cochrane Library, NHS Economic Evaluation Database, CNKI, VIP, and Wanfang databases (retrieval time was from January 1997 to December 2017), and then filtered the literatures, excluded duplicate documents, a total of 1 020 English literatures and 786 Chinese literatures were enrolled eventually to make an review. Results The literatures showed that, at present, there was no comprehensive and systematic evaluation index system about ERAS at home and abroad. The existing evaluation indexes mainly included the following deficiencies: localization and fragmentation of evaluation indicators, lack of evaluation indicators of ERAS organizational framework and process management, as well as lack of standardized operational definition of evaluation indicators. Conclusions The evaluation indexes of ERAS at home and abroad do not constitute a systematic evaluation index system according to scientific principles, which will restrict the standardization of accelerated surgical rehabilitation in our country. To establish a multidimensional and comprehensive quality evaluation index system based on multi-evaluation of hospital, patient, social, and medical management institutions, which covers ERAS organizational structure, process management, and clinical outcomes, is a necessary condition for the development of ERAS model.
ObjectiveTo explore the effect of a new rehabilitation intervention model based on International Classification of Functioning, Disability and Healthy (ICF) concept in perioperative treatment on patients with adolescent idiopathic scoliosis (AIS).MethodsFrom June 2017 to January 2019, AIS patients with Cobb angle below 80° were randomly divided into experimental group and control group by the method of randomized block design. The patients in the control group received routine perioperative rehabilitation intervention, while the patients in the experimental group received rehabilitation mode intervention based on ICF concept. The therapeutic effect of the two groups including functional and activity dimensions was observed.ResultsA total of 40 patients were included, with 20 in each group. Two patients withdrew the control group. On the fourth day after surgery, the total score of Modified Barthel Index (50.55±8.87 vs. 18.99±5.63; t=13.264, P<0.001) and Scoliosis Research Society-22 (SRS-22) (3.68±0.13 vs. 3.27±0.11; t=10.355, P<0.001) in the experimental group were all better than those in the control group. In the SRS-22 scores, statistically significant differences in comparison of function (2.79±0.29 vs. 1.90±0.48; t=6.884, P<0.001), and self image (3.91±0.27 vs. 3.38±0.32; t=5.539, P<0.001) between the two groups were found. There was no statistically significant difference in pain indicators and muscle strength between the two groups in the two postoperative evaluations (P>0.05). ConclusionsThe treatment based on the concept of ICF can improve the daily living ability in the short term with the safe and acceptable premise. The concept of stimulating patient autonomy, improving patient independence, and promoting social treatment, may improve the overall state of the patients.
The concept of "enhanced recovery after surgery (ERAS)" has been well known by care providers. Implementation of the ERAS principles requires minimally invasive surgical technology in conjunction with multidisciplinary teamwork. Only if these two aspects of peri-operative care regime optimization and "all-in-one model in medical" care were linked up associatelly, ERAS could be realized. Thoracoscopic surgery was a milestone in thoracic surgery. The successful application of such a recovery program requires the foundation of pain and risk free ward in perioperative period and improving quality of life post discharge. This review summarizes the peri-operative regimen care optimization regarding the utility of ERAS in the VATS lobectomy of patients with lung cancer. The first one is preoperative evaluation issues. It involves conditioning the patient and implementing a pre-operative exercise and a physical therapy regimen. The second one is operative and individual anesthetic maneuvers and the selective use of tube in the post-operative period. The third one is the foundation of pain and risk free ward:what are methods optimum of post operative management? The fourth one is medical management of patient's outcomes and the ERAS regimen continuing optimum. The fifth one is the importance of function of multi-departmental coordination in ERAS.
Objective To analyze the nurses' current view and perceptions of enhanced recovery after surgery (ERAS) by a questionnaire and to promote the clinical application of ERAS. Methods We conducted a questionnaire study for nurses who attended the First West China Forum on Chest ERAS in Chengdu during September 26-27, 2016 and 259 questionnaires were collected for descriptive analysis. Results (1) The application status of ERAS: There were 13.5% responders whose hospital took a wait-an-see attitude, while the others' hospital took different actions for ERAS; 85.7% of nurses believed that ERAS in all surgeries should be used; 58.7% of nurses believed that the concept of ERAS was more in theory than in the practice; 40.2% of nurses thought that all patients were suitable for the application of ERAS; (2) 81.9% of nurses believed that the evaluation criteria of ERAS should be a combination of the average hospital stay, patients’ comprehensive feelings and social satisfaction; (3) 70.7% of nurses thought that the combination of subjects integration, surgery orientation and surgeon-nurse teamwork was the best model of ERAS; 44.8% of nurses thought the hospital administration was the best way to promote ERAS applications; (4) 69.1% of responders believed that immature plan, no consensus and norms and insecurity for doctors were the reasons for poor compliance of ERAS; 79.5% of nurses thought that the ERAS meeting should include the publicity of norms and consensus, analysis and implementation of projects and the status and progress of ERAS. Conclusion ERAS concept has been recognized by most nurses. Multidisciplinary collaboration and hospital promotion is the best way to achieve clinical applications.
ObjectiveTo analyze the current situation of enhanced recovery after surgery (ERAS) application in colorectal surgery in China, and summarize the existing problems.MethodsAfter the questionnaire was developed, members of the Chinese Society of Colorectal Cancer were selected as respondents and results were collected by online questionnaire. All the respondents volunteered to visit the homepage of the questionnaire through the link address. After completing the questionnaire, they were saved and submitted.ResultsA total of 120 questionnaires were sent out and finally 107 respondents completed the electronic questionnaire survey. Among them, 73 (68.2%) routinely carried out ERAS programmes and 34 (31.8%) didn’t carry out ERAS programmes. Among the 11 ERAS programmes, most surgeons carried out 3–7 ERAS programmes, among which 4 ERAS programmes was the most (25 surgeons, 23.4%). The survey results for different ERAS programmes showed that only 4 out of 11 ERAS programmes had implemented more than half of the respondents. Respondents with older than 45 years old were more inclined not to undergo mechanical bowel preparation before surgery (P<0.001) and were more likely early postoperative oral intake (P=0.008), respondents with more than 1 000 hospital beds were more likely to select preoperative oral carbohydrate (P=0.012) and postoperative multimodal analgesia (P<0.001), respondents with more than 200 cases of colorectal surgery per year were more inclinedto take oral carbohydrate before surgery (P=0.018), and respondents whose rate of minimally invasive surgery was higher than 50% were more inclined to choose multimode analgesia (P=0.047). On the contrary, the respondents in the tumor hospitals recommended shortening the length of postoperative hospital stay and recommending early discharge (P=0.014). Hospitals that routinely performed ERAS (P<0.001), preoperative oral carbohydrate (P<0.001), without preoperative gastric tube (P=0.019), early postoperative drinking water (P=0.012), and early postoperative oral feeding (P=0.038) were associated with a shorter average postoperative hospital stay.ConclusionERAS has not been popularized in the field of colorectal surgery in China, and there are differences between different doctors and between different hospitals, which still need to be promoted continuously.
Objective To investigate the opinions of operating room nurse (ORN) on enhanced recovery after surgery (ERAS). Methods A questionnaire survey was performed among 215 ORNs in West China Hospital. There were 10 males and 205 females at age of 33.4±8.84 years. Results A total of 154 ORNs (71.6%) thought that we already had very good ERAS theory but we still needed more practice. Thirty-four ORNs(15.8%) thought that the application of ERAS was poor in our clinic comparing to other countries.A percentage of 84.2% (181/215) ORNs thought the criteria to judge whether the ERAS succeed or not should be average days of hospitalization, patients' feeling, and experience and social satisfactions. Besides, 78.1% (168/215) ORNs selected team building as the key point of ERAS success. There were 91.2% (196/215) ORNs who believed expert consensus and ERAS guide should be worked out and propagandized through academic forum or conference in order to popularize the ERAS. Conclusion The theory of ERAS has already been accepted by almost all the clinicians and team building is the best way to make ERAS work well.
ObjectiveTo investigate the prevalence of early mobilization and it’s influencing factors in colorectal cancer patients who underwent enhanced recovery after surgery (ERAS) pathway. MethodsThe geneal data and perioperative data were collected through questionnaire survey and accessing to the hospital information system. The situation of early mobilization was investigated by bedside inquiry. Logistic regression was used to analyze the influencing factors of early mobilization in the patients with colorectal cancer. ResultsIn this study, 300 patients with colorectal cancer underwent ERAS were selected. Within 24 h after operation, 47 patients got out of bed, the early mobilization rate was 15.7%. Logistic regression results showed that the patients without preoperative complications (OR=2.726, P=0.019) and without preoperative nutritional risk (OR=3.621, P=0.013), and with operation time <3 h (OR=2.246, P=0.032) increased the probability of early mobilization, and preoperative low albumin decreased the probability of early mobilization (OR=0.364, P=0.007). ConclusionsEarly mobilization rate of patients with colorectal cancer in ERAS mode is low. Preoperative complications, preoperative albumin level, preoperative NRS2002 score, and operation time were important influencing factors. Active treatment of preoperative complications and improvement of preoperative nutritional status could make patients bear follow-up stress process with better physical condition, which helps to promote early mobilization.