Pre-rehabilitation management method for laparoscopic sleeve gastrectomy patient

Abstract

The invention relates to the technical field of pre-rehabilitation management methods, and discloses a pre-rehabilitation management method for a laparoscopic sleeve gastrectomy patient, which comprises the following steps: selecting proper subjects, the total number of the subjects is 120, and the subjects are divided into two groups according to a random number table method, namely 60 control groups and 60 observation groups; carrying out endoscopic sleeve gastrectomy on all patients in a selected period, carrying out conventional nursing on a control group, and carrying out preoperative pre-rehabilitation nursing on patients in an observation group; according to the pre-rehabilitation management method for the laparoscopic sleeve gastrectomy patient, preoperative pre-rehabilitation means that targeted and effective rehabilitation management is given to the patient from the time when a surgeon and the patient jointly decide an operation to the day before the operation according to the rehabilitation characteristics of diseases, the physiological environment and the body function reserve of the patient are improved, the patient can better tolerate the operation, and the patient can be better protected. The device is an important way for realizing rapid postoperative rehabilitation of a patient and is an extension of preoperative preparatory work.

Description

Technical Field

[0001] The present invention relates to the technical field of pre-rehabilitation management methods, and specifically to a pre-rehabilitation management method for patients undergoing laparoscopic sleeve gastrectomy. Background Art

[0002] By implementing preoperative pre-rehabilitation care for patients undergoing elective laparoscopic sleeve gastrectomy (LSG), the application effect of pre-rehabilitation care in LSG patients was explored. A pre-rehabilitation care intervention group was established, literature was reviewed, and preoperative pre-rehabilitation care intervention measures including exercise guidance, nutritional guidance, and psychological guidance were formulated and implemented. By observing the general conditions of the two groups of patients after surgery and the occurrence of postoperative complications, the postoperative weight and BMI values, and key laboratory indicators, the impact of the intervention on the nutritional status, psychological status, and satisfaction with nursing services of the patients before and after the intervention was evaluated, providing a strong theoretical basis and practical guidance for the application of pre-rehabilitation care in LSG patients.

[0003] Obesity is a disease state characterized by abnormal or excessive fat accumulation that threatens human health. With the rapid development of social economy and the change of lifestyle, obesity has become a global public health problem affecting health. In 2023, the proportion of overweight people in China was 34.8%, and the proportion of obese people was 14.1%. China has become the country with the largest number of obese people in the world. There has never been a healthy fat person. Obesity is a risk factor for various non-communicable chronic diseases such as hypertension, coronary atherosclerotic heart disease, type 2 diabetes, fatty liver, and obstructive sleep apnea. Bariatric surgery has become the most long-term and effective method for treating obesity at present. However, the surgery has certain trauma and can cause damage to some muscle and nerve functions. The stress response brought by the trauma to the patient, combined with the postoperative dietary changes, leads to psychological fluctuations in the patient, which directly affect the rehabilitation quality and even the surgical effect. There are invention reports that adopting a scientific and reasonable nursing method to carry out nursing intervention on patients can improve the preoperative physiological and psychological reserve ability of patients, improve cardiopulmonary function and nutritional status, relieve negative emotions, enable them to better withstand the surgical stress response, reduce the probability of postoperative complications and readmission, shorten the hospital stay, save medical costs, and promote the early recovery of patients after surgery. Therefore, there is an urgent need for a pre-rehabilitation management method for patients undergoing laparoscopic sleeve gastrectomy to solve the above technical problems. Summary of the Invention

[0004] The purpose of the present invention is to provide a pre-rehabilitation management method for patients undergoing laparoscopic sleeve gastrectomy to solve the problems raised in the above background art.

[0005] To achieve the above purpose, the present invention provides the following technical solutions: A pre-rehabilitation management method for patients undergoing laparoscopic sleeve gastrectomy, the pre-rehabilitation management method comprising the following steps: Step 1: Select appropriate subjects, with a total of 120 subjects. They are divided into two groups according to the random number table method, with 60 subjects in the control group and 60 subjects in the observation group. All patients are scheduled to undergo laparoscopic sleeve gastrectomy. The control group is given routine care, while the patients in the observation group are given pre-operative pre-rehabilitation care; Step 2: Establish a pre-rehabilitation nursing intervention team, consult the literature, formulate pre-operative pre-rehabilitation nursing intervention measures for patients undergoing laparoscopic sleeve gastrectomy, organize relevant personnel to learn pre-rehabilitation nursing knowledge; conduct one-on-one pre-rehabilitation consultation and guidance, answer questions before surgery, supervise the implementation of nursing measures, evaluate the implementation effect, collect data, and conduct statistical analysis; Step 3: Psychological intervention. Encourage patients to express their feelings, teach patients to apply relaxation training, music therapy, etc. to relieve negative emotions, and provide videos for patients to watch and train at home by a psychologist; patients should receive at least one experience sharing from patients who have successfully lost weight after previous LSG surgery before surgery, to gain personal experience and increase patients' self-confidence; for patients at risk of anxiety and depression, provide psychological counseling by a psychologist and give drug treatment if necessary; Step 4: Exercise guidance. Under the guidance of the pre-rehabilitation nursing intervention team, it is achieved through various modes such as follow-up videos, telemedicine, and mobile WeChat, and whole-body adaptability training is carried out; Step 5: Lifestyle intervention: Change bad eating and living habits, optimize the diet structure before surgery, mainly high-protein and high-vitamin, adhere to small and frequent meals to reduce the stomach capacity and adapt to the diet state of a small stomach capacity after surgery; Step 6: Before the intervention, explain, guide, and demonstrate the intervention content to the patients and their families, and check the completion quality of the patients after learning. Then, record the completion of each measure by punching in the WeChat mini-program every day, and jointly check and supervise by doctors, responsible nurses, and family members. If any missed items are found, they should be made up in time to ensure the compliance of the patients and the reliability of the results; Step 7: Observation indicators. The anxiety and depression scores of the patients in the two groups are statistically analyzed on the day before the nursing intervention, as well as the patients' weight and BMI values. And on the day of the patients' discharge and 1 month after surgery, the anxiety and depression scores, the patients' weight and BMI values are statistically analyzed again; Step 8: Use the Hospital Anxiety and Depression Scale for scoring. Special personnel are responsible for guiding the patients to conduct self-evaluation on the 1st day before the intervention and on the day of discharge; Step 9: For the patients' weight and BMI values, the responsible nurse uses a special ultrasonic physical examination machine for measurement and registration and statistics; Step 10: Statistically analyze fasting blood glucose and glycated hemoglobin based on the laboratory test indicators on the day of the patient's admission, the first day after surgery, and one month after surgery. Finally, on the day of discharge, a dedicated person is responsible for guiding the patients of both groups to conduct the evaluation.

[0006] Preferably, the general physical adaptation training includes recommending moderate-intensity aerobic training and resistance exercises, such as fast walking, jogging, cycling, swimming, aerobics, and push-ups, for at least 40 minutes per day when the patient can tolerate it; guidance on respiratory function exercise: diaphragmatic breathing 5 times / hour, 3 times / day; practicing blowing balloons 10 times / day, instructing the patient to blow up a small balloon with one breath forcefully, and then continue to blow slowly for more than 5 seconds, limited by not bursting the balloon.

[0007] Preferably, in Step 5, optimize the dietary structure before surgery, mainly with high protein and high vitamins, adhere to small and frequent meals, and adapt to the dietary state of a small stomach capacity after surgery. Arrange six meals a day. The three main meals in the morning, middle, and evening can be mainly porridge, meat, eggs, and vegetables. In addition, the three additional meals can be at 10:00, 15:00, and 20:00, mainly with milk, fruits, and soup. According to the recommendations of the Nutrition and Metabolism Society, the energy intake of surgical patients is 35 - 40 kcal / (kg / d), and the protein is 1.5 - 2.0 g / (kg / d). At the same time, optimize the dietary structure, ensure 6 - 8 hours of sleep per day, and use medications for assistance if necessary.

[0008] Preferably, the Hospital Anxiety and Depression Scale is a self-rating scale widely used for the assessment and screening of anxiety and depression in patients with various diseases in general hospitals. It consists of 14 items and is composed of 2 subscales. 7 items are used to evaluate anxiety (HADS-A), and 7 items are used to evaluate depression (HADS-D). Each item uses a Likert 4-point scale (0 - 3 points), and the scoring range of each subscale is 0 - 21 points. Patients with a score ≥ 9 are suspected of having anxiety and depression. A dedicated person is responsible for guiding the patients to conduct self-evaluation on the day before the intervention and the day of discharge respectively.

[0009] Preferably, in Step 9, calculate the percentage of excess body weight reduction EBMIL% according to the BMI value; EBMIL% = [(preoperative BMI - postoperative BMI) / (preoperative BMI - ideal BMI)] × 100%. The weight loss effect of LSG treatment is determined according to EBMIL%. An EBMIL% higher than 50% is judged as effective, between 30% - 50% is judged as insufficient, and lower than 30% is judged as failed. The postoperative EBMIL% of the observation group is significantly higher than that of the control group.

[0010] Preferably, when statistically analyzing fasting blood glucose and glycated hemoglobin based on the laboratory test indexes on the day of the patient's admission, the first day after surgery, and one month after surgery in step ten, obesity complications such as type 2 diabetes, hypertension, hyperuricemia, hyperlipidemia, obstructive sleep apnea, polycystic ovary syndrome, etc. are alleviated and cured. The determination of diabetes remission: FBG < 7.0 mmol / L and HbA1c < 6.5% are considered as diabetes remission. Without taking medicine, when measuring blood pressure values, the systolic blood pressure is between 90 - 130 mmHg and the diastolic blood pressure is between 60 - 90 mmHg, which is defined as hypertension remission.

[0011] Compared with the prior art, the present invention has the following beneficial effects: The pre - rehabilitation management method for patients undergoing laparoscopic sleeve gastrectomy. Pre - operative pre - rehabilitation refers to, according to the rehabilitation characteristics of the disease, from the time when the surgeon and the patient jointly decide on the surgery to the day before surgery, giving the patient targeted and effective rehabilitation management to improve their physiological environment and reserve of body functions, so as to better tolerate the surgery. It is an important way to achieve rapid postoperative rehabilitation of patients and an extension of preoperative preparation work. Specific embodiments

[0012] The following further details the present application with reference to embodiments. It can be understood that the specific embodiments described herein are only used to explain the related invention, rather than limiting the invention. Additionally, it should be noted that for the convenience of description, only the parts related to the invention are shown. Please refer to a pre - rehabilitation management method for patients undergoing laparoscopic sleeve gastrectomy. This pre - rehabilitation management method includes the following steps: Step 1: Select appropriate subjects. The total number of subjects is 120 cases, which are divided into two groups by the random number table method, with 60 cases in the control group and 60 cases in the observation group. All patients are scheduled to undergo laparoscopic sleeve gastrectomy. The control group is given routine care, while the patients in the observation group are given pre - operative pre - rehabilitation care. Step 2: Establish a pre - rehabilitation nursing intervention group. Consult the literature, formulate pre - operative pre - rehabilitation nursing intervention measures for patients undergoing laparoscopic sleeve gastrectomy, organize relevant personnel to study pre - rehabilitation nursing knowledge; provide one - on - one pre - operative pre - rehabilitation consultation, counseling, and answer questions, supervise the implementation of nursing measures, evaluate the implementation effect, collect data, and conduct statistical analysis. Step 3: Psychological intervention. Encourage patients to express their feelings, teach patients to apply relaxation training, music therapy, etc. to soothe bad emotions, and provide videos for patients to watch and train at home by a psychologist; patients should receive at least one sharing of the experience of successful weight loss after previous LSG surgery before surgery to gain personal experience and increase patients' self - confidence; for patients at risk of anxiety and depression, provide psychological counseling by a psychologist and give drug treatment if necessary. Step 4. Exercise guidance: Under the guidance of the pre-rehabilitation nursing intervention team, it is achieved through various modes such as follow-up videos, telemedicine, and mobile WeChat, and whole-body adaptability training is carried out; Step 5. Lifestyle intervention: Change bad eating and living habits, optimize the diet structure before surgery, mainly with high protein and high vitamins, adhere to small and frequent meals to reduce the stomach capacity and adapt to the diet state of a small stomach capacity after surgery; Step 6. Before the intervention, explain, guide, and demonstrate the intervention content to the patients and their families, and check the completion quality of the patients after learning. Then, record the completion of various measures by punching in the WeChat mini-program every day. It is jointly checked and supervised by doctors, responsible nurses, and family members. If any missed items are found, they should be made up in time to ensure the compliance of the patients and the reliability of the results; Step 7. Observation indicators: The anxiety and depression scores, body weight, and BMI values of the two groups of patients are statistically analyzed on the day before the nursing intervention. And on the day of the patients' discharge and 1 month after the surgery, the anxiety and depression scores, body weight, and BMI values are statistically analyzed again; Step 8. Use the Hospital Anxiety and Depression Scale for scoring. Special personnel are responsible for guiding the patients to conduct self-evaluation on the 1st day before the intervention and the day of discharge; Step 9. Regarding the body weight and BMI values of the patients, the responsible nurse uses a dedicated ultrasonic physical examination machine for measurement and registration and statistics; Step 10. According to the laboratory indicators of the patients on the day of admission, the 1st day after the surgery, and 1 month after the surgery, the fasting blood glucose and glycated hemoglobin are statistically analyzed. Finally, on the day of discharge, special personnel are responsible for guiding the patients to conduct the evaluation.

[0013] Among them, the whole-body adaptability training includes recommending moderate-intensity aerobic training and resistance exercises such as brisk walking, jogging, cycling, swimming, aerobics, and push-ups for at least 40 minutes per day when the patient can tolerate it; Breathing function exercise guidance: Abdominal breathing 5 times / h, 3 times / d; Practice blowing balloons 10 times / d. Instruct the patient to blow up a small balloon with a single breath, and then continue to blow slowly for more than 5 s, limited to not bursting the balloon.

[0014] Among them, in Step 5, the diet structure is optimized before surgery, mainly with high protein and high vitamins, adhere to small and frequent meals, and adapt to the diet state of a small stomach capacity after surgery. Six meals are arranged every day. The three main meals of breakfast, lunch, and dinner can be mainly porridge, meat, eggs, and vegetables. In addition, the three additional meals can be at 10:00, 15:00, and 20:00, mainly with milk, fruits, and soup. According to the recommendations of the Nutrition and Metabolism Society, the energy intake of surgical patients is 35 - 40 kcal / (kg / d), and the protein is 1.5 - 2.0 g / (kg / d). At the same time, optimize the diet structure, ensure 6 - 8 hours of sleep every day, and use drugs for assistance if necessary.

[0015] Among them, the Hospital Anxiety and Depression Scale (HADS) is a self-rating scale widely used for the assessment and screening of anxiety and depression in patients with various diseases in general hospitals. It consists of 14 items and is composed of 2 subscales. 7 items are used to assess anxiety (HADS-A), and 7 items are used to assess depression (HADS-D). Each item uses a Likert 4-point scale (0-3 points). The scoring range of each subscale is 0-21 points. Patients with a score of ≥9 are considered suspected cases of anxiety and depression. Special personnel are responsible for guiding the patients to conduct self-ratings on the day before the intervention and on the day of discharge respectively.

[0016] Among them, in Step 9, the percentage of excess body weight loss (EBMIL%) is calculated based on the BMI value; EBMIL% = [(preoperative BMI - postoperative BMI) / (preoperative BMI - ideal BMI)] × 100%. The weight loss effect of LSG treatment is determined according to EBMIL%. An EBMIL% higher than 50% is considered effective, between 30% and 50% is considered insufficient, and lower than 30% is considered a failure. The EBMIL% of the observation group after surgery was significantly higher than that of the control group.

[0017] Among them, in Step 10, when statistically analyzing fasting blood glucose and glycated hemoglobin based on the laboratory test indexes on the day of admission, the first day after surgery, and 1 month after surgery, obesity-related complications such as type 2 diabetes, hypertension, hyperuricemia, hyperlipidemia, obstructive sleep apnea, polycystic ovary syndrome, etc. were relieved and cured. The criteria for diabetes remission: FBG < 7.0 mmol / L and HbA1c < 6.5% are considered diabetes remission. Without taking medications, when measuring blood pressure values, a systolic blood pressure between 90-130 mmHg and a diastolic blood pressure between 60-90 mmHg are defined as hypertension remission.

[0018] Working principle and usage process of the present invention: General situation of the technological development at home and abroad and literature basis of the present invention: Abroad, prehabilitation interventions mainly focus on exercise, nutritional support, psychological intervention, smoking cessation, and alcohol abstinence; most domestic inventions implement the "triple prehabilitation management model" that focuses on the three intervention themes of psychological intervention, nutritional support, and exercise. The prehabilitation strategy has changed the traditional nursing concept, but the invention of preoperative prehabilitation is still in its infancy. In recent years, foreign scholars have gradually applied the prehabilitation strategy to the preoperative rehabilitation of bariatric metabolism surgery, while domestic inventions are still in their infancy. In a small-sample invention of preoperative prehabilitation intervention for bariatric metabolism surgery in the United States, two groups of patients received exercise intervention and physical and mental intervention respectively. The results showed that the scores of quality of life, anxiety, and depression of the two groups of patients were significantly improved compared with those of the non-intervened patients. This invention intervention plan has reference significance for domestic preoperative prehabilitation intervention. Some domestic scholars have reported a review of the prehabilitation strategies adopted by LSG patients at home and abroad in recent years, including the concept, implementation time, and intervention measures of prehabilitation, such as exercise training, nutritional support, smoking cessation, psychological counseling, etc., providing a basis for optimizing the preoperative physiological and psychological reserves of patients and promoting their recovery. Some inventors interviewed bariatric surgical nurses to deeply understand their cognition, content, attitude, and implementation suggestions for preoperative prehabilitation nursing of LSG, and proposed that preoperative prehabilitation of LSG can start from psychological intervention, exercise, and lifestyle changes, which is consistent with the previous invention results. Currently, there is no clinical intervention invention report on preoperative prehabilitation of LSG in China, and further invention exploration is needed.

[0019] The prehabilitation management method for patients undergoing laparoscopic sleeve gastrectomy has the subject selection basis that this invention is a single-center, prospective, randomized, controlled intervention clinical invention. The control group uses conventional nursing intervention, and the observation group uses prehabilitation nursing intervention. In this invention, 120 patients scheduled to undergo LSG are expected to be included and randomly divided into a control group and an observation group.

[0020] Inclusion criteria: ① Meeting the obesity standard, with a body mass index (BMI) ≥ 35 kg / m2; ② Aged 18 - 50 years old; ③ Those who have failed in non-surgical weight loss attempts; ④ Those who meet the LSG surgical indications after evaluation; ⑤ Voluntarily participating in this invention and signing the informed consent form.

[0021] Exclusion criteria: ① Incomplete clinical data; ② Unable to strictly follow the doctor's advice for diet guidance; ③ Unable to complete the follow-up in the later stage; ④ Secondary obesity; ⑤ Having mental illness, cognitive impairment, and consciousness disorder; ⑥ Pregnancy within 1 year after surgery.

[0022] Test population: 120 patients who meet the subject criteria and are scheduled to undergo laparoscopic sleeve gastrectomy in our hospital from March 2025 to February 2026 are selected.

[0023] Sample size calculation: Refer to the literature, estimate the sample size, and determine that the total number of subjects to be enrolled in this project is 120 cases, with 60 cases in each of the control group and the observation group.

[0024] Specific invention content: ①Formulate and implement preoperative prehabilitation nursing intervention measures for patients undergoing laparoscopic sleeve gastrectomy; ②Explore the effects of prehabilitation nursing on the postoperative psychological status, general postoperative conditions, postoperative weight, BMI value, key laboratory indicators, and patient satisfaction with nursing services in patients undergoing laparoscopic sleeve gastrectomy.

[0025] The inclusion criteria are as follows: Inclusion criteria: ①Meet the obesity criteria, with a body mass index (BMI) ≥ 35 kg / m2; ②Aged 18 - 50 years old; ③Those who have failed in non-surgical weight loss attempts; ④Those who meet the LSG surgical indications after evaluation; ⑤Voluntarily participate in this invention and sign the informed consent form.

[0026] Exclusion criteria: ①Incomplete clinical data; ②Unable to strictly follow the doctor's advice for diet guidance; ③Unable to complete the follow-up in the later stage; ④Secondary obesity; ⑤Having mental illness, cognitive impairment, and consciousness disorder; ⑥Pregnancy within 1 year after surgery.

[0027] Grouping of subjects: The total number of cases in this invention is 120. They are divided into two groups by the random number table method, with 60 cases in the control group and 60 cases in the observation group.

[0028] Criteria for early withdrawal / termination of the trial by subjects: ①The subject requests to withdraw the informed consent form; ②The inventor considers it necessary to terminate the invention for the subject from a medical perspective.

[0029] All patients will undergo elective laparoscopic sleeve gastrectomy. The control group will receive routine care, while the patients in the observation group will receive preoperative prehabilitation nursing. At the same time, a prehabilitation nursing intervention group will be established. Refer to the literature, formulate preoperative prehabilitation nursing intervention measures for patients undergoing laparoscopic sleeve gastrectomy, organize relevant personnel to learn knowledge related to prehabilitation nursing, provide "one-on-one" preoperative prehabilitation consultation, counseling, and answer questions, supervise the implementation of nursing measures, evaluate the implementation effect, collect data, and conduct statistical analysis.

[0030] Conduct psychological intervention: Encourage patients to express their feelings, teach patients to apply relaxation training, music therapy, etc. to relieve negative emotions, and provide videos for patients to watch and train at home by a psychologist; Patients should receive at least one sharing of the experience of successful weight loss after LSG surgery in the past before surgery, to personally experience and increase the patient's self-confidence; For patients at risk of anxiety and depression, provide psychological counseling by a psychologist and give drug treatment if necessary.

[0031] Exercise guidance: Under the guidance of the pre-rehabilitation nursing intervention team, it is achieved with the help of follow-up training videos, telemedicine, mobile WeChat and other modes. Whole body adaptive training: If the patient can tolerate it, it is recommended to perform moderate-intensity aerobic training and resistance exercises (such as brisk walking, jogging, cycling, swimming, aerobics, push-ups, etc.), not less than 40 minutes a day. Stop exercising if you feel tired; respiratory function exercise guidance: abdominal breathing 5 times / h, 3 times / d; practice blowing balloons 10 times / d, ask the patient to blow up a small balloon with one breath, and then continue to blow slowly for more than 5 seconds, so as not to blow it up. Check in in the WeChat group every day, supervised by the members of the intervention team, the patient can share his experience, the intervention team will give evaluation, form interaction every day, and encourage the patient to persist in exercising. Through regular exercise, the patient's cardiopulmonary function and muscle reserve can be increased, weight can be reduced, cardiometabolic risk factors can be reduced, and overall physical fitness can be improved.

[0032] Lifestyle intervention: Change bad diet and living habits. Optimize the diet structure before surgery, mainly high protein and high vitamins, adhere to small and frequent meals to reduce stomach capacity and adapt to the diet state of small stomach capacity after surgery. Six meals can be arranged every day. Breakfast, lunch and dinner can be mainly porridge, meat, eggs and vegetables. Three additional meals can be at 10:00, 15:00 and 20:00, mainly milk, fruit and soup. According to the recommendation of the Nutrition and Metabolism Association, the energy intake of surgical patients is 35-40 kcal / (kg / d) and protein is 1.5-2.0 g / (kg / d). At the same time, optimize the diet structure, eat meals at regular times and quantitatively every day, reduce the intake of high-sugar and high-fat foods, and appropriately increase the intake of vegetables, fruits, coarse grains and high-quality protein (fish, chicken breast, milk, eggs, soybeans); smoking and drinking can increase the risk of postoperative anastomotic ulcers, infection, delayed wound healing and respiratory complications. Advise patients to quit smoking and drinking; do not stay up late, ensure 6-8 hours of sleep every day, and use medication when necessary. In the WeChat group every day, patients are required to report their diet and sleep conditions, and the intervention team will give timely feedback to help them develop good living habits and lay the foundation for long-term recovery after surgery.

[0033] In order to ensure the implementation of the intervention measures, the content of the intervention was explained, guided and demonstrated to the patients and their families before the intervention, and the quality of completion of the patients' learning was checked. Afterwards, the completion status of various measures was recorded by checking in on the WeChat mini program every day. The doctors, responsible nurses and family members jointly checked and supervised. If any missed items were found, they would be supplemented in time to ensure the patient's compliance and the reliability of the results.

[0034] Then observe the indicators: One day before the nursing intervention, the anxiety and depression scores, body weight, and BMI values of the patients in both groups were statistically analyzed. On the day of discharge and 1 month after the operation, the anxiety and depression scores, body weight, and BMI values of the patients were statistically analyzed again. The key laboratory data of the patients were statistically analyzed: on the day of admission, on the first day after the operation, and 1 month after the operation, the glucose metabolism indicators: fasting blood glucose (FBG) and glycated hemoglobin (HbA1c). The general conditions of the two groups of patients during the perioperative period were statistically analyzed and compared, including the time spent in the LSG operation process, the bleeding situation during the operation (expressed by the amount of bleeding), the first flatus time, the first time getting out of bed, the first time having liquid diet, the length of postoperative hospitalization, and the incidence of postoperative complications. The satisfaction of the patients with the nursing service was observed and statistically analyzed.

[0035] The scores were based on the Hospital Anxiety and Depression Scale (HADS). The HADS is a self-rating scale widely used for the assessment and screening of anxiety and depression in patients with various diseases in general hospitals. It has good reliability and validity. It consists of 14 items and is composed of 2 subscales. 7 items are used to assess anxiety (HADS-A), and 7 items are used to assess depression (HADS-D). Each item uses a Likert 4-point scale (0-3 points), and the scoring range of each subscale is 0-21 points. Patients with a score of ≥9 are suspected of having anxiety and depression. One day before the intervention and on the day of discharge, a dedicated person was responsible for guiding the patients to conduct self-ratings. Subsequently, for the body weight and BMI values of the patients, the responsible nurse used a dedicated ultrasonic physical examination machine for measurement and registration. According to the BMI value, the percentage of excess weight reduction EBMIL% was calculated. EBMIL% = [(preoperative BMI - postoperative BMI) / (preoperative BMI - ideal BMI)] × 100% (the ideal BMI was calculated as 25 kg / m2). The weight loss effect of LSG treatment was determined according to EBMIL%. An EBMIL% higher than 50% was determined to be effective, between 30% and 50% was determined to be insufficient, and lower than 30% was determined to be a failure. The postoperative EBMIL% of the observation group was significantly higher than that of the control group.

[0036] According to the laboratory indicators on the day of the patient's admission, the first day after surgery, and one month after surgery, such as fasting blood glucose (FBG) and glycated hemoglobin (HbA1c), statistical analysis was carried out. Obesity comorbidities such as type 2 diabetes, hypertension, hyperuricemia, hyperlipidemia, obstructive sleep apnea, polycystic ovary syndrome, etc. were relieved and cured. The criteria for diabetes remission were as follows: FBG < 7.0 mmol / L and HbA1c < 6.5% were defined as diabetes remission. Without taking medications, when measuring blood pressure, if the systolic blood pressure was between 90 - 130 mmHg and the diastolic blood pressure was between 60 - 90 mmHg, it was defined as hypertension remission. For other comorbidities, if they could be controlled with medications after surgery, it was considered an improvement.

[0037] The satisfaction of patients with nursing services was supplemented. It was evaluated using the Newcastle Nursing Satisfaction Scale, which had 19 items with a full score of 95 points. A score of 85 - 95 points was considered very satisfied, 70 - 84 points was considered relatively satisfied, and ≤ 69 points was considered dissatisfied. The nursing satisfaction was the sum of very satisfied and relatively satisfied. On the day of discharge, two groups of patients were specifically responsible for guiding the patients to conduct the evaluation.

[0038] At the same time, it should be noted that the overview of the data management method in the present invention: The data collected should be filled into the case report form according to the requirements of the protocol. At the end, the case report forms of all selected patients should be complete and signed.

[0039] Reporting and collection of adverse events and serious adverse events: The adverse events, the number of cases of trial dropouts, and the reasons were detailedly recorded.

[0040] Communication with the ethics committee and the superior drug regulatory department: Be supervised and communicated with by the ethics committee and the superior department at any time.

[0041] Internal analysis plan for data: The data statistics was completed by a data statistician using SPSS 26.0.

[0042] Regarding the compliance with ethical principles and relevant regulations, prior approval from the ethics committee will be obtained before the start of the present invention.

[0043] Before enrolling patients, their authorization consent and / or disclosure of personal and / or health data must be obtained. To protect the privacy of patients, the patient's age will be recorded on the CRF instead of the patient's date of birth, and the initials of the name will be recorded on the CRF.

[0044] At the same time, SPSS 26.0 statistical software was used for data processing. Count data was described by frequency and rate (%). The χ2 test or Fisher's exact probability method was used for between-group comparison. Measurement data was It was described by ±s. The independent samples t-test was used for comparison between the two groups, and the results were obtained. P < 0.05 was considered statistically significant. After all data entry and review were completed, professional statisticians promptly completed the statistical analysis work and issued a written statistical analysis report.

[0045] The content not described in detail in this specification belongs to the prior art well-known to those skilled in the art.

[0046] The above description is only a preferred embodiment of the present application and an explanation of the technical principles applied. Those skilled in the art should understand that the scope of the invention involved in the present application is not limited to the technical solutions formed by the specific combination of the above technical features, but should also cover other technical solutions formed by any combination of the above technical features or their equivalent features without departing from the inventive concept. For example, the technical solutions formed by mutually replacing the above features with the technical features (but not limited to) having similar functions disclosed in the present application.

Claims

1. A pre-rehabilitation management method for patients undergoing laparoscopic sleeve gastrectomy, characterized in that: The pre-rehabilitation management method includes the following steps: Step 1: Select appropriate subjects. The total number of subjects is 120 cases. They are divided into two groups according to the random number table method, with 60 cases in the control group and 60 cases in the observation group. All patients are scheduled for laparoscopic sleeve gastrectomy. The control group is given routine care, while the patients in the observation group are given pre-operative pre-rehabilitation care; Step 2: Establish a pre-rehabilitation nursing intervention group. Consult the literature, formulate pre-operative pre-rehabilitation nursing intervention measures for patients undergoing laparoscopic sleeve gastrectomy, and organize relevant personnel to study the relevant knowledge of pre-rehabilitation nursing; Provide one-on-one pre-rehabilitation consultation, counseling, and answer questions before surgery, supervise the implementation of nursing measures, evaluate the implementation effect, collect data, and conduct statistical analysis; Step 3: Psychological intervention. Encourage patients to express their feelings, teach patients to apply relaxation training, music therapy, etc. to relieve bad emotions, and provide videos for patients to watch and train at home by a psychologist; Patients should receive at least one experience sharing from patients who have successfully lost weight after previous LSG surgery before surgery, have a personal experience, and increase the patients' self-confidence; For patients at risk of anxiety and depression, provide psychological counseling by a psychologist and give drug treatment if necessary; Step 4: Exercise guidance. Under the guidance of the pre-rehabilitation nursing intervention group, it is achieved through various modes such as follow-up videos, telemedicine, and mobile WeChat, and whole-body adaptability training is carried out; Step 5: Lifestyle intervention: Change bad eating and living habits, optimize the diet structure before surgery, mainly high-protein and high-vitamin, adhere to small and frequent meals to reduce the stomach capacity and adapt to the diet state of a small stomach capacity after surgery; Step 6: Explain, guide, and demonstrate the intervention content to the patients and their families before the intervention, and check the completion quality of the patients after learning. Then, record the completion of each measure by punching in the WeChat mini-program every day, and jointly check and supervise by doctors, responsible nurses, and family members. If any missed items are found, make up for them in time to ensure the compliance of the patients and the reliability of the results; Step 7: Observation indicators. The anxiety and depression scores, body weight, and BMI values of the two groups of patients are statistically analyzed on the day before the nursing intervention. And on the day of the patients' discharge and 1 month after surgery, the anxiety and depression scores, body weight, and BMI values of the patients are statistically analyzed again; Step 8: Use the Hospital Anxiety and Depression Scale for scoring. Special personnel are responsible for guiding the patients to conduct self-evaluation on the 1st day before the intervention and on the day of discharge; Step 9: Regarding the body weight and BMI values of the patients, the responsible nurse uses a special ultrasonic physical examination machine for measurement and registers and statistics; Step 10: Statistically analyze the fasting blood glucose and glycosylated hemoglobin according to the laboratory indexes of the patients on the day of admission, the 1st day after surgery, and 1 month after surgery. Finally, on the day of the patients' discharge, special personnel are responsible for guiding the patients to conduct the evaluation.

2. The pre - rehabilitation management method for patients undergoing laparoscopic sleeve gastrectomy according to claim 1, wherein: The whole-body adaptability training includes recommending moderate-intensity aerobic training and resistance exercises, such as brisk walking, jogging, cycling, swimming, aerobics, and push-ups, for at least 40 minutes every day when the patients can tolerate it; Respiratory function exercise guidance: Abdominal breathing, 5 times / h, 3 times / d; Practice blowing balloons, 10 times / d. Instruct the patient to blow up a small balloon in one breath with force, and then continue to blow slowly for more than 5 s, limited by not bursting the balloon.

3. The prehabilitation management method for patients undergoing laparoscopic sleeve gastrectomy according to claim 1, characterized in that: In step five, optimize the diet structure before surgery, mainly with high protein and high vitamins, adhere to small and frequent meals to adapt to the diet state of a small stomach capacity after surgery. Arrange six meals a day. The three main meals in the morning, noon, and evening can be mainly porridge, meat, eggs, and vegetables. Additionally, the other three meals can be at 10:00, 15:00, and 20:00, mainly milk, fruits, and soup. According to the recommendations of the Nutrition and Metabolism Society, the energy intake for surgical patients is 35 - 40 kcal / (kg / d), and the protein is 1.5 - 2.0 g / (kg / d). At the same time, optimize the diet structure, ensure 6 - 8 h of sleep every day, and use medications for assistance if necessary.

4. A pre-rehabilitation management method for patients undergoing laparoscopic sleeve gastrectomy according to claim 1, characterized in that: The Hospital Anxiety and Depression Scale is a self - rating scale widely used for the assessment and screening of anxiety and depression in patients with various diseases in general hospitals. It consists of 14 items and is composed of 2 sub - scales. 7 items are used to assess anxiety (HADS - A), and 7 items are used to assess depression (HADS - D). Each item uses a Likert 4 - level scoring (0 - 3 points). The scoring range for each sub - scale is 0 - 21 points. Patients with a score of ≥9 are suspected of having anxiety and depression. Special personnel are responsible for guiding the patients to conduct self - assessment on the day before intervention and on the day of discharge.

5. A prehabilitation management method for patients undergoing laparoscopic sleeve gastrectomy according to claim 1, characterized in that: In step nine, calculate the percentage of excess body weight reduction EBMIL% according to the BMI value; EBMIL% = [(pre - operative BMI - post - operative BMI) / (pre - operative BMI - ideal BMI)]×100%. The weight loss effect of LSG treatment is determined according to EBMIL%. If EBMIL% is higher than 50%, it is judged as effective; if it is between 30% - 50%, it is judged as insufficient; if it is lower than 30%, it is judged as a failure. The EBMIL% of the observation group after surgery was significantly higher than that of the control group.

6. The prehabilitation management method for patients undergoing laparoscopic sleeve gastrectomy according to claim 1, characterized in that: In step ten, when statistically analyzing fasting blood glucose and glycated hemoglobin based on the laboratory indexes on the day of admission, the first day after surgery, and one month after surgery, obesity - related complications such as type 2 diabetes, hypertension, hyperuricemia, hyperlipidemia, obstructive sleep apnea, polycystic ovary syndrome, etc. are relieved and cured. The criteria for diabetes remission: FBG < 7.0 mmol / L and HbA1c < 6.5% are considered as diabetes remission. When measuring blood pressure values without taking medications, a systolic blood pressure between 90 - 130 mmHg and a diastolic blood pressure between 60 - 90 mmHg are defined as hypertension remission.