Table 1 The diagnosis and treatment measures of the ERAS group and the control group

Psychological care

The application of multi-mode, individualised plan and targeted health education after operation. In order to reduce unnecessary contact during the epidemic, after the patient regains consciousness after the operation, the patient and relatives can be met regularly through the mobile terminal video connection

Routine postoperative health education. Face-to-face bedside visits are prohibited due to lockdown management requirements during the pandemic. Unusual video meeting

Pipeline management

Endotracheal intubation and follow-up respiratory support

Comprehensive assessment of the condition, in the absence of serious postoperative complications and clear indications for mechanical ventilation, the SBT process of disconnection from invasive mechanical ventilation and removal of orotracheal intubation was completed within 24 h to achieve off-line extubation. Immediately after weaning and extubation, transnasal high-flow oxygen therapy was administered

Comprehensive assessment of the condition, in the case of patients with no deterioration of liver function and clear infection after surgery, the SBT process is completed. Ordinary nasal cannula or nebulised mask oxygen therapy was given after weaning and extubation

Gastric tube

Fully assess the patient’s level of consciousness, nutritional needs, gastrointestinal integrity and function. If the patient’s consciousness recovered well and there was no absolute indication for gastrointestinal decompression, the nasogastric tube was removed on the second postoperative day. If the evaluation found that there was a need for continued retention of the gastric tube, the tube was not removed

Assess the patient’s level of consciousness, nutritional needs, gastrointestinal integrity and function and remove the nasogastric tube after the patient’s consciousness is restored, the anus is exhausted, and there are no other absolute indications for retaining gastrointestinal decompression

Urinary catheter

The urinary catheter was removed 24 h after surgery. In the early stage, the urine was collected in a fresh-keeping bag, and in the later stage, the patient collected urine in a urinal by himself

The patient can remove the catheter after getting out of bed

Nutritional support

When and how

Early nutritional support was initiated within 24 h after surgery when hemodynamically stable. Enteral nutrition or other food is given first through a nasogastric tube (when the tube is not removed) or by mouth. If there are counter-indications for enteral nutrition (abdominal compartment syndrome, severe diarrhoea, hemodynamic instability, or other dramatic changes), reduce the dose of nutritional enteral nutrition or discontinue enteral nutrition. Please consult the nutrition department, and according to the nutritional needs of patients, appropriate intravenous nutritional supplements are given to avoid nutritional deficiencies or excessive nutrition

Complete parenteral nutrition was given in the early stage, and after the gastrointestinal function recovered, partial enteral nutrition was started, and intravenous nutrition support was gradually withdrawn. If there are counter-indications for enteral nutrition (abdominal compartment syndrome, severe diarrhoea, hemodynamic instability, or other dramatic changes), reduce the dose of nutritional enteral nutrition or discontinue enteral nutrition

Nasogastric tube feeding parameters

The initial feeding speed is 20 ml/h, and the dosage is gradually increased; the temperature of the nutrient solution is 40 °C; the target feeding amount is 30 kcal/kg/day

Oral feeding process

Liquid food–semi-liquid food–normal diet

Early activity

After returning to the ICU after the operation, if there is no special need, the upper body is immediately raised by 30°. When the patient regains consciousness but has not yet been released from the ventilator, assist the patient to turn over on the bed and give training such as fisting, arm raising, ankle pumping and lower limb pedalling. After the patient is released from the ventilator, assist the patient to gradually increase the range of exercise, including standing at the bedside, getting out of bed and sitting, and walking with assistance

Regular activities in the ICU, including turning over once every 2 h, physical therapy on the chest, maintaining the functional position of both lower extremities 2 times a day, limb massage, activities, etc

Pain relief

Evaluation method

The visual analogue scale and numerical rating scale were used to evaluate the pain intensity of patients at rest and during exercise, and the treatment effect was also evaluated

The visual analogue scale and numerical rating scale were used to evaluate the pain intensity of patients at rest and during exercise, and the treatment effect was also evaluated

Analgesic mode

Intravenous analgesia pump, used immediately after surgery, for a duration of 48 h. Other strong opioid analgesics can be given if the tracheal tube is not removed and dehumidified

Analgesic pump, used immediately after surgery for a duration of 48 h. Other strong opioid analgesics can be given if the tracheal tube is not removed and dehumidified

Administer weak opioids + NSAIDs 2–5 days after the operation with analgesia pump

Sequential analgesia with NSAIDs