3.1 Baseline data
The baseline data of 90 patients with lung cancer surgery from July 2020 to July 2022 were analyzed,and they were randomly divided into ERAS group and routine group.This article has been reviewed and approved by the ethics committee of our hospital.Inclusion criteria:(1)meet the diagnostic criteria for lung cancer[13];(2)Complete clinical data,informed about the research,and signed the consent form;(3)No other malignant diseases;(4)Cardiopulmonary and other important functions are normal;(5)No coagulation dysfunction.Exclusion criteria:(1)abnormal neurological function,unable to communicate normally;(2)combined with other infectious diseases;(3)poor compliance and inactive cooperation;(4)unable to participate in the whole study.
3.2 Methods
The routine group received routine intervention,The research subjects were given health education before admission,fasted food and water for 12 hours before surgery,practiced pursed-lip breathing and balloon blowing training;After the operation,take the medicine for analgesia according to the doctor's instructions.1 day after the operation,get out of bed and observe whether there is gas leakage in the closed chest drainage bottle,the effusion is bloodless,purulent and the lungs are fully recruited,and the pleural drainage fluid is 24 hours later.The amount does not exceed 10ml,extubation.
The ERAS group was given ERAS combined with psychological intervention.(1)Preoperative:Provide knowledge education to the research subjects,including disease-related and ERAS-related,to improve patient acceptance.At the same time,psychological intervention was given to the research subjects,maintaining an enthusiastic and friendly attitude to communicate with patients,to understand the preoperative psychological state and needs of patients,to relieve their tension,In addition,individualized psychological assistance is provided to each research subject to inform the influence and harm of negative emotions on postoperative operation;Instruct relatives,friends and family members to strengthen care and love for the patient,and arrange visitation time reasonably to ensure that the patient's preoperative psychological state is good.Preoperative airway training,pulmonary function,respiratory muscle and stair climbing training should also be performed on patients to increase intra-alveolar pressure during exhalation,avoid premature closure of small airways,and reduce complications.(2)Intraoperative:The surgical operation should be careful and gentle,to reduce the compression of the lung tissue,and to keep the central venous pressure of the research subject below 5 mmHg.(3)After operation:within 24 hours after operation,monitor the vital indicators of the patient at all times,resume water intake and liquid food after 6 hours,and eat normally after 24 hours;Analgesic drugs(5 mg Tylenine,3 times/d)can be given in advance 24 hours after the operation.If the patient has adverse reactions such as nausea,vomiting and dizziness to the analgesic drugs,other analgesic drugs should be replaced in time.Psychological intervention should also be performed on the research subjects after surgery,so as to understand the patients'demands in a timely manner,answer their doubts,and reduce the psychological burden of the patients;Communicate with patients often,soothe their emotions,and enhance their compliance and recovery confidence.6 hours after anesthesia,the patient needs to assist the patient to perform a small amount of activities,such as bending the knees on the bed,activities of the limbs,etc.After the vital signs are stable,get out of bed exercise training as appropriate,first sit to the side of the bed for about 5 minutes,if there is no dizziness,chest tightness,etc.,you can get out of bed and stand for about 3 minutes.After the patient is fully adapted,you can walk around the bed.Follow-up based on the patient's own Adjust the amount of exercise.
3.3 Observation indicators
(1)To analyze the postoperative recovery of the research subjects,observe and record the first postoperative exhaust time,postoperative first getting out of bed,chest tube drainage time and hospitalization time of the research subjects at all times[14].
(2)Analyze the psychological status of the subjects before and after the intervention,and evaluate the anxiety and depression of the subjects according to the Hamilton Anxiety Scale(HAMA)[15]and the Hamilton Depression Scale(HAMD)[16];HAMA has a total of 14 items,with a full score of 0 to 56.A total score of 29 or more indicates severe anxiety,21 to 28 indicates obvious anxiety,and 14 to 20 indicates clear anxiety;<14 indicates no anxiety;HAMD has a total of 24 items,with a full score of 0–52 points,≥8 points indicate depression,and < 8 points indicate no depression.
(3)The pain condition of the research subjects at different times was analyzed,and the pain visual analogue scale(VAS)was used to evaluate the pain.The higher the score,the more severe the pain[17].
(4)The Spirostik pulmonary function tester from Geratherm,Germany was used to detect the pulmonary function of patients[18],It mainly includes:forced expiratory volume in first second(FEV1),forced vital capacity(FVC),the percentage of FEV1 in FVC(FEV1/FVC%).
(5)To analyze the quality of life of the research subjects,and to evaluate by Nottingham Health Profile(NHP),It includes 6 categories of energy,pain,emotion,sleep,social interaction,and body,with a total of 38 items.The higher the score,the worse the quality of life of the research subjects[19].
(6)To analyze the complications of the research subjects,including wound infection,pulmonary infection,arrhythmia,thoracic paralysis,intestinal paralysis and atelectasis[20].
(7)Analyze the satisfaction rate of the research objects,and use the self-made satisfaction scale of the hospital for evaluation.The full score is 100 points,above 80 points are very satisfied,60 ~ 79 points are satisfied,below 60 points are dissatisfied,total satisfaction rate=(very satisfied + satisfied)/total×100%[21].
3.4 Statistical methods
Data processing uses SPSS 26.0 software,Measurement data are expressed as mean ± standard deviation(‾x ± s),independent samples t test is used for data between groups,and F test is used for multiple groups;Enumeration data are expressed as percentage(%),x²test;Repeated measures analysis of variance was used to compare each time period between groups,and spherical test was performed;P < 0.05,the difference was statistically significant.