Before surgery, the patient physiologically responds to stress. The central nervous system mediates this process, producing stress hormones and inflammatory mediators [11], and strengthens effective communication with patients before surgery. It can be written and spoken. The above agreement provides individualized counseling to patients and psychologically prepares them for what they are doing, thereby reducing the anxiety and fear of patients, improving recovery, improving patient compliance with the plan, and promoting eating. Early exercise, pain control and respiratory function, reduce the occurrence of complications [8] [12]; for elderly patients, often combined with chronic diseases, to actively treat diseases that affect the recovery of patients, such as hypertension, diabetes, blood pressure Achieve a stable state with blood glucose before surgery, and actively improve nutrition for malnourished patients, so that the patient’s body reaches an optimal state before surgery.

For elderly patients with gastric cancer, often combined with malnutrition, is the main clinical problem of gastrointestinal malignant tumors, malnutrition in hospitalized patients reached 50% - 60%, up to 71% in cancer patients [13]; malnutrition led to hospitalization Prolonged time, increased postoperative complications, slow recovery of postoperative bowel function, high readmission rate, high postoperative mortality; evidence [14], preoperative nutritional status is a key determinant of optimal outcome in gastrointestinal surgery avoid preoperative fasting before surgery, optimize preoperative nutrition, oral nutritional supplements and immunonutrient preparations; Sonvi research shows [15], preoperative oral immunonutrition preparations, postoperative complications are lower, it is recommended that all preoperative The patient underwent 5 to 7 days of on-site immunonutrition [16].

Inadequate mechanical bowel preparation before surgery has been shown to cause dehydration and imbalance of fluids and electrolytes, especially in elderly patients. Mechanical bowel preparation is to remove solid excretion from the large intestine and reduce the amount of bacteria. Liquefaction of feces increases the risk of surgical spillage [8]; there is no need to fast for one night before surgery. The current guidelines recommended by the American Society of Anesthesiologists [17], fasting solid foods 8 hours before surgery, 2 hours before the ban According to the Cochrane study [18], the risk and incidence of inhalation were not increased compared with traditional requirements; prolonged fasting (>12 h) resulted in hypovolemia, increased metabolic stress and insulin resistance, insulin resistance It is a key factor for long-term rehabilitation and increased morbidity; a data suggest that [19], decreased insulin sensitivity, will lead to increased complication rate, postoperative hyperglycemia, increased risk of postoperative infection by 30%; 2 - 3 day before surgery Drinking 300 - 400 ml of carbohydrates a day can not only reduce pre-operative thirst, hunger, anxiety and postoperative insulin resistance, but also reduce postoperative nitrogen and protein loss, better maintain capacity and muscle mass, and exhaust time. With hospitalizationShortening, however, for patients with diabetes and delayed gastric emptying, gastrointestinal motility disorders with the exception of patients [8].

The nasogastric tube is not routinely used. According to the Cochrane conclusion [18], the nasogastric tube is not routinely used, the pulmonary complications are significantly reduced, the early feeding is improved, and the hospital stay is shortened. The use of the nasogastric tube has a certain effect on the nasopharyngeal mucosa. The stimulation, which leads to increased complications in the pharynx and lungs, also exerts pressure on the patient’s psychology, and also has an effect on the patient’s early bed-out activities; a randomized trial [20], no patients who received the nasogastric tube, there was no difference in postoperative nausea, vomiting, and recovery of bowel function.

The anesthesia program will promote the recovery of gastrointestinal motility and is the key to speeding up recovery. For elderly patients, the anesthesia should be avoided too deeply, and the depth of anesthesia is bis < 45, not only to minimize the anesthetic, but also to prevent convulsions, promote rapid arousal and recovery [21]; anesthesia is a stress response that limits surgery to fluid balance and pain [22]; intraoperative intravenous anesthesia combined with epidural anesthesia, anesthesia induction and continuous anesthesia are generally selected for short-acting anesthetics (propofol, cis Lacurium, fentanyl, to reduce sympathetic nerve stimulation and postoperative anesthesia, combined anesthesia combined with general anesthesia onset, intraoperative anesthesia and epidural anesthesia can promote postoperative gastrointestinal function recovery, postoperative analgesia The advantages can not only achieve the desired anesthetic effect, but also accelerate the recovery of patients after surgery, inhibit the occurrence of postoperative intestinal paralysis, accelerate the recovery of gastrointestinal function, and provide conditions for early postoperative feeding [21].

The use of prophylactic antibiotics can reduce the incidence of postoperative infections; studies have shown [23] that prophylactic antibiotics are effective against possible anaerobic and aerobic infections, 30 minutes to 1 hour before skin incision Dosage can be administered repeatedly according to the half-life of the drug and the operation time during the operation.

The safety and efficacy of laparoscopic radical gastrectomy have been confirmed [24]; there is evidence [14] that laparoscopic surgery can reduce trauma, reduce intraoperative blood loss, and reduce surgical stress response compared with conventional laparotomy Postoperative pain and discomfort, postoperative intestinal adhesions, low incidence of intestinal obstruction, early recovery of bowel function, reduced hospital stay, and a high degree of synergy with eras.

Liquid management is an important part of eras. It can maintain normal blood volume by pre-operative, intraoperative and postoperative methods. Whether it is a large amount of infusion or a limited amount of infusion, it can significantly impair organ function and will increase postoperative complications (P < 0.05). Symptoms and prolonged hospital stay [25]; there is evidence [8], a large number of fluid replacement, delayed recovery of gastrointestinal function, wound healing and anastomotic healing, affecting tissue oxygenation, leading to prolonged hospital stay; intraoperative fluid management is maintained There is sufficient circulation at the end of the organ, low blood volume leads to hypoperfusion, increased risk of organ failure, high blood volume leads to peripheral and pulmonary edema, and the incidence of postoperative intestinal obstruction increases [18]; intraoperative fluid should be zero-balanced For the purpose of high-risk patients or large-scale abdominal surgery should be targeted to use liquid therapy, using objective parameters, according to hemodynamics, such as cardiac output, pulse pressure changes, etc., to make patients’ fluid recovery more accurate, reduce postoperative bowel Obstruction occurs, promote the recovery of bowel function, thereby reducing hospital stay [26]; postoperative, early oral fluid, limiting postoperative intravenous rehydration, can reduce hospital stay, reduce concurrency, Such as the occurrence of intestinal obstruction [8].

In gastric cancer surgery, due to anesthesia leading to abnormal body temperature regulation, a large number of infusions, and prolonged exposure to the wound, cold water flushing the abdominal cavity, often lead to hypothermia, especially in elderly patients [7]; According to studies [8], maintaining a normal body temperature can reduce wound infections and heart complications. bleeding and blood transfusion requirements, shorten postoperative recovery time; it is recommended to use room temperature at 24˚C, through the upper body forced air heating, insulation blanket, heated intravenous infusion, warm water to wash the abdominal cavity and other measures to make the patient’s body temperature Keep at around 36˚C to avoid complications and improve intraoperative and postoperative safety [27].

Abdominal drainage tube should not be used routinely. Abdominal drainage tube does not reduce the incidence of complications, but increases the risk of infection and postoperative fistula [28]; a rct experiment shows [29], two groups in wound infection and there was no significant difference in postoperative pus. The incidence of postoperative complications and hospitalization time were lower in the non-drainage group; if it was in some special cases, such as anastomotic blood supply, cancerous ascites, weak constitution, nutritional status If the difference is poor, the drainage tube should be placed according to the intraoperative condition. The amount and nature of the drainage fluid should be closely observed after operation, and the tube should be extubated as soon as possible to reduce the tube stimulation and complications.