Multimedia Journal of Metaverse in MEDICINE

We selected 62 patients who underwent ERCP surgery at our hospital between January 2017 and December 2019 as study subjects. Based on the nursing approach, the patients were divided into two groups: the experimental group (31 patients), who received ERAS-based perioperative care, and the control group (31 patients), who received conventional care. All patients met the following inclusion and exclusion criteria:

Inclusion criteria:
1. All patients were diagnosed with common bile duct stones combined with gallbladder stones through imaging techniques such as CT and MRI;
2. No severe cardiopulmonary complications, ASA classification I or II;
3. No history of upper gastrointestinal surgery;
4. Complete clinical data and signed informed consent.

Exclusion criteria:
1. Common bile duct stones larger than 2.5 cm in diameter;
2. Clear bile duct stricture or malformation;
3. Patients with malignant tumors or coagulopathy;
4. Mental disorders preventing cooperation.

The control group received conventional perioperative nursing, mainly including monitoring of the condition, medication guidance, etc.
The experimental group received perioperative nursing interventions based on the ERAS concept, with specific measures as follows:

(1) Preoperative Nursing:
a. Psychological Care: Patients often have negative perceptions of their condition and lack understanding, leading to varying degrees of anxiety and depression. Timely psychological counseling was provided, along with ERAS-related education to improve patient cooperation.
b. Preoperative Preparation: On the night before surgery, patients were given 1000 mL of 10% glucose solution, and on the morning of surgery, 500 mL of 10% glucose solution. Patients were instructed to fast for 4-6 hours before surgery and refrain from drinking for 2 hours, while also receiving bowel care to prevent intra-abdominal infection during surgery.
(2) Intraoperative Nursing:
The patient’s position was adjusted, and appropriate temperature and humidity were set before and during surgery. Measures were taken to maintain warmth and manage the nasobiliary tube and catheter to prevent infection and abdominal distension.
(3) Postoperative Nursing:
a. Encouraging the patient to get out of bed 6 hours after surgery, with pain management based on pain scores.
b. If there was no obvious biliary infection, antibiotics were given 30 minutes before surgery and stopped 24 hours postoperatively.
c. A cholangiogram was performed 24 hours after surgery, with the tube removed the following day.
d. Fluid intake was controlled at 2000 mL within the physiological requirement, with an infusion rate of 250 mL/h. Additionally, dietary and rehabilitation training guidance was provided.

Evaluation Indicators
a. Clinical indicators such as intraoperative blood loss, time of first flatus, first defecation, time of first out-of-bed activity, first meal, nasobiliary tube placement, hospital stay, and hospital costs were recorded.
b. Complications such as postoperative white blood cell count, serum amylase, cholangitis, pancreatitis, and bleeding were observed within 24 hours post-surgery.

Statistical Methods
Continuous variables were expressed as mean ± standard deviation, and categorical variables as percentages. The t-test was used to compare differences in continuous variables between the experimental and control groups, while the Chi-square test or Fisher’s test was used to compare categorical variables. Statistical analyses were performed using SPSS version 24 (Chicago, IL, USA), with a two-sided P value < 0.05 considered statistically significant.