24 February 2023 : Clinical Research
Effects of Nursing Care Using a Fast-Track Surgery Approach in 49 Patients with Early-Stage Hepatocellular Carcinoma Undergoing First-Line Treatment with Radiofrequency Ablation: A Retrospective Study
Shuqi Zhang1ABDE, Yanting Yang1BD, Wen Liu1AC, Bijin Yuan1CD, Chunyan Tao1AB, Guangjian Dou1ACEFG*DOI: 10.12659/MSM.939044
Med Sci Monit 2023; 29:e939044
Table 1 Comparison of nursing measures between the 2 groups.
| Nursing measures | 2021 group | 2020 group |
|---|---|---|
| Health education | Inform the fast recovery process about the preoperative fasting time, understand the surgical method and process, preoperative pulmonary function exercise, early postoperative activities, and expected discharge time | Only inform patients about relevant surgical precautions |
| Psychological care | We accurately assessed the psychological state of patients of different ages and different family situations, and carried out pertinent psychological counseling | There was no aspect of psychological care involved |
| Bowel preparation | No intestinal preparation was required and 200–500 ml carbohydrate was given orally 2 hours before surgery | Fasting the night before surgery |
| Intraoperative care | During the operation, a warm blanket was used to keep patients warm, fluid infusion was limited, attention was paid to oxygen inhalation and oxygen saturation maintenance, blood pressure was maintained, and liver perfusion was ensured. After the operation, ropivacaine was injected into the skin around the puncture site for infiltration | Routine rehydration without special measures |
| Pain care | Non-steroidal analgesic drugs were given regularly and quantitatively, and the analgesic effect was known to the patients in time, and the reasons for poor analgesic effect were examined and dealt with. The pain assessment process was standardized and evaluated every 6 hours after surgery | Temporary analgesics are given when the patient was in pain |
| Early nutrition | After surgery, chewing gum was used to stimulate saliva secretion and gastrointestinal motility, and a liquid diet could be given 6–8 hours after bowel sounds, without waiting for flatus | Change to a liquid diet after first flatus and defecation |
| Early activity | After waking up, patients were guided to move their limbs and turn over in bed to prevent the formation of deep vein thrombosis. At 6 h after the operation, patients were helped to get out of bed in the mode of “supine for 30 seconds – sitting up for 30 seconds – standing for 30 seconds” to prevent postural hypotension. With help from nursing staff, the activity time and activity amount were gradually increased with the patient’s recovery | Based on the patient’s own subjective wishes, the nurse guides the activities |
| Postoperative medication | Prophylactic antibiotics were administered for 24 hours, hemostatic drugs were administered once after surgery, fluid replacement was limited according to dietary conditions, and sodium bicarbonate was used to alkalize urine to reduce the damage to renal function caused by surgical stress | Antibiotics are routinely applied for 1–2 days, and antibiotics were upgraded according to body temperature and test indicators |
| Postoperative monitoring | Postoperative blood routine, liver and kidney function, electrolytes, etc. were checked; vital signs were assessed every 60 minutes, and continuous monitoring was performed for 6 hours. After that, the measurement interval could be extended as prescribed by the doctor, and monitoring was stopped at 12 hours. After returning to the ward, we checked the bedside B-ultrasound for 2 hours. Re-examination was performed within 24 hours, and patients with no obvious abnormalities could be discharged | Routine level I nursing monitoring for 3 days |