|
|
|
| Application effect of enhanced recovery after surgery nursing on postoperative delirium and cognitive dysfunction in elderly patients with biliary tract |
| ZHANG Xiaodan WENG Linshu WU Beilei YU Haibo |
| Department of Hepatobiliary Surgery, Wenzhou Central Hospital, Zhejiang Province, Wenzhou 325000, China |
|
|
|
|
Abstract Objective To explore application effect of enhanced recovery after surgery （ERAS） nursing on postoperative delirium and cognitive dysfunction in elderly patients with biliary tract. Methods A total of sixty patients with biliary tract surgery admitted to the Department of Hepatobiliary Surgery of Wenzhou Central Hospital, Zhejiang Province from July 2022 to December 2022 were included, they were divided into control group and ERAS group by random number table method, with 30 cases in each group. The control group received general surgery basic nursing, ERAS group received ERAS mode nursing program on the basis of the control group. The incidence of postoperative delirium, cognitive function score, and postoperative adverse reactions were observed. Results After surgery, postoperative delirium incidence in ERAS group was lower than that in control group, and delirium duration in ERAS group was shorter than that in control group, and the differences were statistically significant (P＜0.05). The overall analysis showed that there were statistical significances in comparison between groups, comparison at time points and interaction of mini-mental state examination (MMSE) between the two groups (P＜0.05). Intra-group comparison showed that when the MMSE scores of the two groups were lower at 1, 3, and 7 days after surgery, the MMSE scores at 3 and 7 days after surgery were higher than those at 1 day after surgery, the MMSE scores at 1 and 3 months after surgery were higher than those at 3 days after surgery, and the MMSE scores at 1 and 3 months after surgery were higher than those at 7 days after surgery, the differences were statistically significant (P＜0.05). MMSE scores at 1, 3 and 7 days after operation in ERAS group were higher than those in control group, the differences were statistically significant (P＜0.05). The incidence of nausea and vomiting, urinary retention, sleep disorders and hypotension in ERAS group was lower than that in control group, and the duration of postoperative hospitalization was shorter, the differences were statistically significant (P＜0.05). Conclusion Compared with the conventional nursing scheme, the nursing ERAS can effectively reduce the occurrence of postoperative delirium, shorten the duration of delirium, reduce postoperative cognitive dysfunction and promote the recovery of cognitive function in elderly patients with biliary tract surgery, and is worthy of clinical promotion and application.
|
|
|
|
|
|
[1] Daiello LA，Racine AM，Yun Gou R，et al. Postoperative Delirium and Postoperative Cognitive Dysfunction：Overlap and Divergence [J]. Anesthesiology，2019，131（3）：477-491.
[2] Chen CC，Li HC，Liang JT，et al. Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery：A Cluster Randomized Clinical Trial [J]. JAMA Surg，2017，152（9）：827-834.
[3] Huang H，Li H，Zhang X，et al. Association of postoperative delirium with cognitive outcomes：A meta-analysis [J]. J Clin Anesth，2021，75：110496.
[4] Duprey MS，Devlin JW，Griffith JL，et al. Association Between Perioperative Medication Use and Postoperative Delirium and Cognition in Older Adults Undergoing Elective Noncardiac Surgery [J]. Anesth Analg，2022，134（6）：1154-1163.
[5] O’Gara BP，Mueller A，Gasangwa DVI，et al. Prevention of Early Postoperative Decline：A Randomized，Controlled Feas- ibility Trial of Perioperative Cognitive Training [J]. Anesth Analg，2020，130（3）：586-595.
[6] 方汉萍，李蓉蓉，蔡纯，等.加速康复外科护理专业组管理模式构建及应用研究[J].护理学杂志，2019，34（20）：5-8.
[7] 曹晖，陈亚进，顾小萍，等.中国加速康复外科临床实践指南（2021版）[J].中国实用外科杂志，2021，41（9）：961- 992.
[8] 杨军英，魏民，郑炜，等.重症监护病房患者的睡眠状况及其影响因素分析探讨[J].世界睡眠医学杂志，2020，7（3）：383-384.
[9] Hooper VD. SAMBA Consensus Guidelines for the Management of Postoperative Nausea and Vomiting：An Executive Summary for Perianesthesia Nurses [J]. J Perianesth Nurs，2015，30（5）：377-382.
[10] Jia X，Wang Z，Huang F，et al. A comparison of the Mini- Mental State Examination （MMSE） with the Montreal Cog- nitive Assessment （MoCA） for mild cognitive impairment screening in Chinese middle-aged and older population：a cross-sectional study [J]. BMC Psychiatry，2021，21（1）：485.
[11] Oh ES，Fong TG，Hshieh TT，et al. Delirium in Older Per- sons：Advances in Diagnosis and Treatment [J]. JAMA，2017， 318（12）：1161-1174.
[12] 陈凛，陈亚进，董海龙，等.加速康复外科中国专家共识及路径管理指南（2018版）[J].中国实用外科杂志，2018， 38（1）：1-20.
[13] 王嫒芬，周英萍，赵鲁文，等.加速康复外科理念在妇科恶性肿瘤围手术期应用的Meta分析[J].中国临床研究，2022，35（9）：1241-1248.
[14] 徐国志，彭艺，陈龙，等.ERAS下腹腔镜辅助右半结肠癌扩大根治术的临床研究[J].中华普外科手术学杂志（电子版），2021，15（2）：195-198.
[15] Ban KA，Berian JR，Ko CY. Does Implementation of Enhan- ced Recovery after Surgery （ERAS） Protocols in Colorectal Surgery Improve Patient Outcomes?[J]. Clin Colon Rectal Surg，2019，32（2）：109-113.
[16] To■a?觭 HK，Y?覦lmaz E. Effects of preoperative individualized audiovisual education on anxiety and comfort in patients undergoing laparoscopic cholecystectomy：randomised contr- olled study [J]. Patient Educ Couns，2021，104（3）：603-610.
[17] Wang YW，Huang XQ，Liu ZL. The Effect of Preoperative Health Education，Delivered as Animation Videos，on Postoperative Anxiety and Pain in Femoral Fractures [J]. Front Psychol，2022，13：881799.
[18] 任杰，许臣，蔡连军，等.加速康复外科理念联合腹腔镜手术在急腹症治疗中的应用[J].中国医刊，2021，56（4）：404-407.
[19] 袁琳，王静，朱红艳，等.加速康复外科在妇科微创手术围术期应用的临床研究[J].中华妇幼临床医学杂志（电子版），2020，16（6）：733-738.
[20] Noba L，Rodgers S，Chandler C，et al. Enhanced Recovery After Surgery （ERAS） Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery：a Systematic Review and Meta-Analysis [J]. J Gastrointest Surg，2020，24（4）：918-932.
[21] Kotekar N，Shenkar A，Nagaraj R. Postoperative cognitive dysfunction-current preventive strategies [J]. Clin Interv Aging，2018，13：2267-2273.
[22] 赵凤阳，黄叶莉，邱宝安.程序化综合护理预防老年肝胆外科患者术后谵妄的研究[J].上海护理，2020，20（3）：44-47.
[23] Hughes CG，Boncyk CS，Culley DJ，et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Delirium Prevention [J]. Anesth Analg，2020，130（6）：1572-1590.
[24] Safavynia SA，Goldstein PA，Evered LA. Mitigation of peri- operative neurocognitive disorders：A holistic approach [J]. Front Aging Neurosci，2022，14：949148.
[25] Kerolus MG，Yerneni K，Witiw CD，et al. Enhanced Recovery After Surgery Pathway for Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion Decreases Length of Stay and Opioid Consumption [J]. Neurosurgery，2021，88（3）：648-657. |
|
|
|
