Objective To explore the clinical efficacy of nursing measures based on the concept of enhanced recovery after surgery (ERAS) for patients undergoing day surgery of inguinal hernia repair. Methods A total of 120 patients scheduled for day surgery of inguinal hernia repair between January and June 2015 were randomized into ERAS group (n=60) and control group (n=60). Patients in the ERAS group received nursing optimized by the idea of ERAS during the perioperative period, while those in the control group received traditional routine nursing intervention. Postoperative visual analogue scale (VAS) scores, adverse responses, early ambulation, influence of pain on patients’ sleep, satisfaction of the patients and prolonged hospital stay rate were analyzed and compared between the two groups. Results VAS scores during hours 0-2, 2-4, 4-8, and 8-12 in the ERAS group were significantly lower than those in the control group (P < 0.05). Between hour 12 and 24, the VAS sco res were not significantly different between the two groups of patients (P > 0.05). Early postoperative ambulation, influence of pain on the sleep, and patients’ satisfaction on pain control and nursing care in the ERAS group were all significantly better than those in the control group (P <0.05). Conclusion Based on the concept of ERAS nursing intervention model, we can effectively reduce postoperative complications after inguinal hernia repair, accelerate patients’ postoperative rehabilitation, and increase patients’ satisfaction.
ObjectiveTo establish a systematic, scientific, and sensitive index system to provide a scientific basis for quality evaluation and comprehensive quality management of day surgery nursing.MethodsThe databases of Wanfang, China National Knowledge Infrastructure, CQVIP, PubMed, and Web of Science were searched. The retrieval time was from the establishment of the databases to 15th July, 2019. Based on the “structure-process-outcome” management model, Delphi method was used to conduct two rounds of expert consultation for nursing experts related to day surgery in five tertiary hospitals. The results of the consultation were sorted out and the consensus of experts was obtained, so as to determine the quality-sensitive indicators of day surgery nursing.ResultsA total of 20 nursing experts participated in the questionnaire survey. The final evaluation indicators determined by expert correspondence included 1 structural indicator, 9 process indicators, and 4 outcome indicators.ConclusionsThe construction of quality evaluation standard of day surgery nursing not only embodies the connotation of nursing management of day surgery, but also puts forward clear requirements and quality standards for specialized nursing management. It has high reliability, scientificity, and strong operability, which can effectively improve the quality of nursing management and service level of day surgery.
Objective To analyze the clinical effect of individualized pain nursing intervention on the pain relieving after ambulatory laparoscopic cholecystectomy (LC) . Methods From March to June 2017, a total of 180 ambulatory LC patients were selected and randomly asigned into the control group and the intervention group with 90 cases in each group. Parecoxib sodium (40 mg) was preoperatively administrated half an hour before the surgery to the patients in both of the two groups. The patients in the control group were treated with routine nursing intervention, while the ones in the intervention group were given individualized pain nursing interventions, including regular pain assessment, preoperative pain health guidance, enhanced education for pain related knowledge, and following the nursing theory of enhanced recovery after surgery. Visual Analogue Scale (VAS) was used to measure the degree of postoperative pain, and the data of dormant pain were collected. Results There was no significant difference between the two groups in VAS one hour after the operation (P>0.05); the VAS scores 2, 6 and 12 hours after the operation gradually decreased in the two groups (P<0.05), and the scores of patients in the intervention group were much lower than those in the control group (P<0.05). The time of pain relieving in the intervention group and the control group was (3.25±1.72) and (5.39±2.06) hours, respectively, and the difference was statistically significant (P<0.05). The incidence of dormant pain in the intervention group (12.2%) was lower than that in the control group (33.3%), and the difference was statistically significant (P<0.05). Conclusion Individualized pain nursing interventions can effectively alleviate the postoperative pain and improve the quality of sleep in ambulatory LC patients.
ObjectiveTo evaluate the application value of three-dimensional visualization (3DV) technique in the reconstruction of complex abdominal incisional hernia. MethodsThe clinical data of the patients with complex abdominal incisional hernia admitted to the West China Hospital of Sichuan University from September 2021 to September 2022 were collected. The area of abdominal wall defects was analyzed by Medraw software and reconstructed using 3DV technique, then the classifying and partition of abdominal wall defects were performed, the hernia sac/ intraabdominal volume ratio was calculated, patch size was estimated, and intraabdominal pressure values at 24 h and 48 h after surgery as well as operation time, complications were recorded. ResultsA total of 48 patients with complex abdominal incisional hernia were enrolled, including 30 cases of midline abdominal incisional hernia and 18 cases of other sites. There were 13 cases of moderate hernia, 19 cases of large hernia, and 16 cases of huge hernia. The abdominal wall defect area measured by 3DV technique for the 48 patients was (92.11±60.25) cm2, the hernia sac / intraabdominal volume ratio was (7.7±5.2)%, and the actual defect area measured intraoperatively was (89.20±57.38) cm2. Pearson correlation analysis showed a positive correlation between the preoperative 3DV measurement and intraoperative measurement (r=0.959, P<0.001). The operation time was (73.5±8.2) min, postoperative anal exhaust time (31.66±15.32) h, intraabdominal pressures at 24 h and 48 h postoperatively were (13.50±2.12) mmHg and (11.39±1.42) mmHg, respectively. The patient’s hospitalization time was (7.12±1.21) d. Among the 48 patients, 7 cases (14.58%) experienced complications after surgery, recovered smoothly after conservative treatment and no unplanned reoperation was required. All patients were followed up for 18–32 months with a median time of 26 months, and no long-term hernia recurrence was observed. ConclusionFrom the analysis results of this study, it can be seen that the application of 3DV technique to evaluate complex abdominal wall defects can assist hernia surgeons to make a correct choice and has a better safety and effect.
Since its establishment in 2009, adhering to the concept of patient-centered service, the Day Surgery Center of West China Hospital of Sichuan University has been improving the management model constantly, and perfecting the service process gradually, to ensure the medical quality and safety of the hospital, and optimize the utilization of medical resources. In view of the management of day surgery, the hospital has formulated a sound patient access system, surgeon access principle, standardized appointment process and contingency plans, and made changes in patient admission process, responsibilities of surgeons, and nursing care comparing with the traditional hospital operation. The purpose of this paper is to introduce the management model of day surgery in West China Hospital of Sichuan University, discuss the clinical application of centralized and decentralized management in combination with the actual situation, and explore the model of day surgery with high applicability and more consistent with our national conditions.