Rapid rehabilitation technique with integrated traditional Chinese and Western medicine promotes postoperative gastrointestinal function recovery

Table 1 Detailed contents of fast track surgery

Serial number	Measures	Treatment group (fast track surgery)	Control group
		Preoperation
1	Mission	Explaining the process of rapid rehabilitation surgery to relieve patient tension: (1) Communicating with the patient prior to the operation to reduce the fear of the unfamiliar environment; (2) Explaining the preparation and cooperation prior to and after the operation, how to get out of bed for exercising as soon as possible after operation, and how to restore early drinking and eating; (3) Informing the patient regarding the time of discharge from the hospital after the operation; and (4) Performing all necessary psychological nursing to relieve anxiety in the patients prior to operation	Appropriate care for the psychological problems of the patients, health management for the disease, and adequate sleep
2	Fasting, water prohibition	Fasting 6 h, water prohibition 4 h	Overnight water prohibition and fasting prior to the operation
3	Basic disease control and support therapy	Routine treatment	Routine treatment
4	Intestinal preparation	Cleansing of intestines at 18:00 one night prior to the operation	Cleansing of intestines at 18:00 one night prior to the operation at night
		Intraoperation
5	Anesthesia	General anesthesia for endotracheal intubation	General anesthesia for endotracheal intubation
6	Intraoperative heat preservation	Stabilization of the heat (i.e., use of a heated quilt to maintain the body temperature and warm distilled water to wash the wound)	Normal temperature treatment in the operation room
7	Drainage tube	Unconventional placement	Conventional placement
8	Gastric tube	Unconventional placement	Conventional placement
		Postoperation
9	Restrictive rehydration	Limiting the amount of infusion, especially the intake of salt, in principle not parenteral nutrition	Conventional rehydration
10	Analgesia	Intravenous analgesia and avoidance of morphine and opioid drugs. Reference scheme: PCIA scheme 1: sulfentanyl 50–80 μg + kyffin 200 mg, initial dose: sulfentanyl 5 μg + kyffin 50 mg; PCIA scheme 2: sulfentanyl 50 μg + dezocine 30–40 mg, initial dose: sulfentanyl 5 μg + dezocine 5 mg	Intravenous analgesia and avoidance of morphine and opioid drugs. Reference scheme: PCIA scheme 1: sulfentanyl 50–80 μg + kyffin 200 mg, initial dose: sulfentanyl 5 μg + kyffin 50 mg; PCIA scheme 2: sulfentanyl 50 μg + dezocine 30–40 mg, initial dose: sulfentanyl 5 μg + dezocine 5 mg
11	Early feeding	Early enteral nutrition, initiation of liquid diet on the first day after the operation, if no discomfort; gradual recovery of semi flow diet and general diet	A full-flow diet after the anal exhaust; recovery of half-flow diet after defecation; restoration of general diet 7 d after the operation
12	Early activity	Initiation of activities on the first day after the operation	Gradual initiation of activities based on the patient’s will and recovery
13	Catheter	Removal of catheter on the first day after the operation, in the absence of prostatic hyperplasia or another urinary tract obstruction	Catheter was removed in the second day after the operation if it is not prostatic presence of hyperplasia or another urinary tract obstruction
14	Drainage tube	Removal of the tube if the drainage is < 50 mL	Regular placement for 5 to 7 d
15	Gastric tube	Removal on the second day after the operation	Routine placement until exhaust and defecation
16	Antibiotic	Use according to the principles for the clinical application of antimicrobial agents established by the Ministry of Health	Use according to the principles for the clinical application of antimicrobial agents established by the Ministry of Health
17	Medication	Conventional treatment + Yikou-Sizi powder hot compress. No use of gastrointestinal motility medicine, Chinese medicine decoction, or Chinese patent medicine. No enema treatment performed within 3 d after operation. No use of parenteral nutrition in principle	Conventional treatment, No use of gastrointestinal motility medicine, Chinese medicine decoction, or Chinese patent medicine. No enema treatment performed within 3 d after operation. No use of parenteral nutrition in principle

PCIA: Patient controlled intravenous analgesia.

Table 2 Sex composition in the two groups (%) (Intent-to-treat population)

		Control group (n = 51)		Treatment group (n = 60)		χ2	P value
		n	%	n	%
Sex	Male (n = 61)	28	51.9	33	57.9	0.409	0.522
	Female (n = 50)	26	48.1	24	42.1

Table 3 Age, time of anesthesia, time of operation, and amount of intraoperative blood loss in the two groups (mean ± SD)

	Control group (n = 54)	Treatment group (n = 57)	Z	P value
Age (yr)	58.28 ± 10.28	58.96 ± 10.95	0.387	0.699
Time of anesthesia (h)	4.71 ± 0.78	4.42 ± 1.07	1.317	0.188
Time of operation (h)	3.75 ± 0.76	3.57 ± 0.85	0.980	0.327
Intraoperative bleeding (mL)	81.93 ± 60.46	81.3 ± 47.31	0.546	0.585

Table 4 Comparison of time to initial exhaust in the two groups after surgery (mean ± SD)

	Number of patients	Time to initial exhaust after surgery (h)	Z	P value
Treatment group	57	51.54 ± 23.66	1.791	0.073
Control group	54	62.24 ± 25.95

Table 5 Comparison of time to initial defecation in the two groups after surgery (mean ± SD)

	Number of patients	Time to first defecation after surgery (h)	Z	P value
Treatment group	57	87.16 ± 32.09	2.746	0.006a
Control group	54	109.79 ± 40.25

^aP < 0.05.

Table 6 Comparison of time to initial recovery of bowel sounds recorded in the two groups after surgery (mean ± SD)

	Number of patients	Time to initial postoperative recovery of bowel sound (h)	Z	P value
Treatment group	57	61.17 ± 26.75	3.263	0.001a
Control group	54	79.19 ± 33.35

^aP < 0.05.

Table 7 Comparison of total hospitalization expenses in the two groups (mean ± SD)

	Number of patients	Total hospitalization expenses (yuan)	t	P value
Treatment group	57	62283.45 ± 12413.90	0.099	0.921
Control group	54	62059.42 ± 11350.51

Table 8 Complications recorded in the two groups

Category	Treatment group (57 patients)	Control group (54 patients)
Postoperative anastomotic fistula	0	0
Postoperative ileus	0	1
Postoperative abdominal infection	0	1
Postoperative infection of incisional incision	1	1
Postoperative pulmonary infection	0	0
Postoperative urinary tract infection	0	1
Postoperative deep venous thrombosis	0	0
Other postoperative complications	0	0
Total	1	4