The Effect of a Multi-stage Optimisation Strategy on Perioperative Thirst and Dry Mouth in Gastrointestinal Cancer Patients: A Quasi-experimental Study

The Effect of a Multi-stage Optimisation Strategy on Perioperative Thirst and Dry Mouth in Gastrointestinal Cancer Patients: A Quasi-experimental Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effect of a Multi-stage Optimisation Strategy on Perioperative Thirst and Dry Mouth in Gastrointestinal Cancer Patients: A Quasi-experimental Study jingrong Wang, Yujuan Peng, Rui Fan, Jian Hu, Tong Chen, Wen Shi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9038991/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objective: This study aimed to develop and evaluate a multi-stage optimisation strategy based on the thirst management model to alleviate perioperative thirst and dry mouth symptoms in patients with gastrointestinal cancer. Methods: A total of 132 patients undergoing gastrointestinal tumour surgery were enrolled and divided into an intervention group and a control group based on surgical duration, with 66 patients in each group. The intervention group received a multi-stage thirst management programme based on the Total Modular Management (TMM) approach; the control group received conventional perioperative thirst care. Thirst status, thirst intensity, and lip and tongue mucosal moisture levels were measured at six time points: preoperatively, and at 2 hours, 6 hours, 1 day, 3 days, and 5 days postoperatively. Results: A total of 132 gastrointestinal cancer patients were recruited (66 in each intervention and control group). The intervention group exhibited statistically significant reductions in thirst intensity and thirst-related discomfort scores at time points T1 to T4, alongside statistically significant improvements in oral mucosal moisture scores from T2 to T5. Conclusion: This clinical trial demonstrates that, compared with conventional nursing approaches, a multi-stage thirst management protocol based on the TMM model effectively reduces thirst intensity, alleviates thirst-related discomfort, and improves oral mucosal moisture levels. Trial and Protocol Registration This study underwent supplementary registration with the China Clinical Trial Registry on 9 March 2026, bearing the registration number ChiCTR2600120065. Thirst management Gastrointestinal cancer Perioperative care TMM model Symptom relief 1. Introduction The Chinese Cancer Centre's statistical report suggests that colorectal cancer and gastric cancer rank second and third, respectively, among malignant tumour incidence rates in China, with a combined incidence of 804,500 cases constituting 19.80% of all malignant tumour diagnoses [ 1 ]. Surgery remains the primary treatment for such tumours. However, perioperative factors—including strict fasting and fluid restrictions, surgical trauma, fluid loss, and postoperative intubation—frequently induce thirst in patients[ 2 ]. Thirst, characterised by a subjective, intense desire to drink water due to altered plasma osmolarity and reduced oral salivation, is considered one of the most distressing and painful symptoms experienced during the perioperative period[ 3 ]. Common manifestations include dry mouth, throat irritation, and an intense urge to drink[ 4 ]. To expedite patient recovery, the Chinese Clinical Practice Guidelines for Enhanced Recovery After Surgery (ERAS, 2021 Edition) recommend a 6-hour preoperative fasting period and 2-hour fluid restriction for patients without gastrointestinal motility disorders. Postoperative rehydration and refeeding should commence promptly to alleviate thirst[ 5 ]. However, awareness of enhanced recovery after surgery (ERAS) principles among nursing staff stands at merely 35.4%, while 50% of anaesthetists have not fully adopted relevant optimisation measures[ 6 ]. Furthermore, factors such as uncertainty in surgical scheduling, preoperative bowel preparation, intraoperative fluid loss, prolonged surgery duration, and various indwelling catheters all exacerbate thirst to varying degrees in perioperative gastrointestinal cancer patients22[ 7 – 8 ]. Thirst is prevalent and significantly impactful among perioperative patients. Nelson et al.[ 9 ]conducted a prospective analysis of 100 cancer patients, finding that the majority reported experiencing moderate to severe thirst and oral discomfort, with distress levels occasionally surpassing postoperative pain. One study indicated that the incidence of thirst in patients extubated from general anaesthesia reached 50.8% [ 10 ]. Chinese researchers Feng Yating et al.[ 11 ] investigated thirst prevalence among 183 gastrointestinal surgery patients under general anaesthesia, finding 41.5% experienced varying degrees of thirst[ 12 ]. Persistent severe thirst not only increases oxygen consumption and exacerbates metabolic burden on organs, but also induces negative emotions such as anxiety, irritability, and even delirium. This diminishes perioperative comfort, heightens complication risks, and ultimately impedes the patient's recovery process[ 13 , 14 ]. Despite the high incidence and significant risks associated with thirst in perioperative patients, it remains more readily overlooked by clinical healthcare professionals compared to conditions such as pain, vomiting, or agitation during the perioperative period [ 15 , 16 ] The reasons for this oversight are twofold. Firstly, healthcare professionals exhibit insufficient awareness of the negative implications of thirst. Surveys indicate that nurses consistently score low in understanding thirst's causes, assessment methods, patient impact, and intervention strategies, often perceiving thirst as a reversible symptom posing no threat to patient health[ 17 ]. Simultaneously, a Japanese cross-sectional study revealed that nurses primarily identified postoperative thirst through patient self-reports rather than objective assessments. They also predominantly relied on personal experience for nursing interventions (e.g., using mouth rinses in wards or moist gauze to moisten lips in operating theatres), lacking systematic evaluation and standardised intervention protocols [ 18 ]. Secondly, patients rarely proactively report thirst due to adherence to traditional fasting and fluid restriction protocols. Research indicates only 12% of patients actively express thirst, while 61.7% do not report it even when experiencing severe thirst, perceiving it as an inherent perioperative condition[ 19 ]. Consequently, healthcare professionals' awareness of thirst management in perioperative patients requires enhancement. With the advancement of enhanced recovery programmes, numerous studies have been conducted globally to develop targeted interventions for alleviating thirst symptoms. Oliveira et al. [ 20 ]demonstrated that carbohydrate solutions effectively reduce thirst intensity. Oztas et al. [ 21 ] showed that cold stimulation effectively alleviates thirst in perioperative patients. Garcia et al. [ 22 ]confirmed that peppermint chewing gum effectively quenches thirst. Chinese researcher Kong Xiangyi[ 23 ]found that patients' thirst levels significantly decreased after receiving 6 hours of acupoint massage. Chinese researchers Chang Xiaolan et al.[ 24 ] applied acupoint patches to patients on the morning of surgery, confirming that this method not only reduces thirst incidence but also significantly alleviates thirst severity. Whilst these interventions alleviate perioperative thirst discomfort, there remains a lack of tailored, multi-stage thirst management protocols for gastrointestinal cancer patients. Moreover, these strategies are often fragmented and evidence-based, primarily relying on empirical approaches such as lip balm application, without establishing an evidence-based consensus on thirst management. Consequently, there is an urgent need to develop a scientific, systematic, targeted, and actionable comprehensive thirst management protocol to guide clinical practice. The Thirst Management Model (TMM) was developed by the State University of Londrina, Brazil, based on symptom management theory and clinical experience, and applied to perioperative thirst management [ 25 ]. This model encompasses four key components: identifying and measuring perioperative thirst in patients, assessing the safety of thirst management interventions, and the clinical application of thirst relief strategies for perioperative patients. The model provides systematic scientific evidence and demonstrates significant outcomes, making it suitable for clinical practice. Concurrently, Garcia[ 26 ]has applied this model to burn patients, demonstrating its acceptability and feasibility within burn nursing teams. It provides nursing staff with safe, evidence-based guidance for managing thirst symptoms. This study aims to develop a perioperative thirst management protocol for gastrointestinal cancer patients based on the TMM model and to validate it clinically. Building upon these findings, we designed and implemented a nursing intervention programme guided by the thirst management model, providing a multi-stage optimised strategy to alleviate thirst symptoms in patients undergoing gastrointestinal tumour surgery. This clinical trial aims to evaluate the efficacy of this intervention in improving thirst and dry mouth in such patients. We hypothesize that patients receiving the multi-stage optimised strategy based on the thirst management model will experience greater improvement in thirst and dry mouth compared to those receiving standard care. 2 THE STUDY 2.1 Design We conducted a quasi-experimental study comprising two phases: (1) developing a perioperative thirst management protocol for gastrointestinal cancer patients based on the TMM model, and (2) validating the clinical efficacy of this management protocol. The study design and reporting adhered to the Trial Reporting in Clinical Trials (TREND) statement [ 27 ]. 2.2 Participants Participants were selected from 132 patients diagnosed with gastrointestinal tumours and experiencing thirst symptoms in the General Surgery Department of a Grade A tertiary hospital between August and December 2024. They were divided into a control group and an intervention group based on their surgical timing. Inclusion criteria: ① Patients with pathologically confirmed gastrointestinal tumours, meeting physical criteria for surgery, scheduled for general anaesthesia-assisted gastrointestinal surgery, and presenting with thirst symptoms; ② Age 18 ≤ age ≤ 80 years; ③ Patients were conscious and capable of normal communication; ④ Patients were able to complete the survey and sign an informed consent form. Exclusion criteria: ① Patients with Sjögren's syndrome or a history of long-term use of salivary gland secretion-inhibiting drugs; ② Patients undergoing palliative surgery; ③ Patients with comorbidities severely impacting quality of life, such as cardiac, cerebral, renal, or diabetic conditions; ④ Comatose patients, those with psychiatric disorders, or individuals unable to participate in the survey for other reasons. 2.3 Sample size This study aims to validate trends in thirst changes among perioperative gastrointestinal cancer patients, with the primary outcome being alterations in thirst severity scores. To detect a small effect size, referencing Statistical Power Analysis in Behavioural Science, an effect size f of 0.10 was adopted with α = 0.05 and power = 0.80, and inter-measurement correlation = 0.5. Using GPower software for repeated measures analysis, the calculated sample size was 109 cases. Accounting for a 20% dropout rate, this study requires a minimum sample size of 132 participants. 2.4 Intervention and Control Groups 2.4.1 Control Group The control group received standard perioperative care for gastrointestinal cancer patients, comprising: (1) Establishing trust: Nurses demonstrated a friendly and patient demeanour during communication, respecting patients' feelings and rights to foster trust; (2) Dietary care: The responsible nurse provided dietary education upon admission. Perioperative patients commenced the hospital's standard preoperative fasting protocol (no food or drink) from 22:00 the night before surgery. (3) Thirst management: On the first postoperative day back in the ward, the responsible nurse performed oral care at 8:00 and 18:00. From postoperative days 1 to 3, cotton swabs moistened with warm water were used to hydrate the oral cavity and lips every two hours. Following passage of flatus or on postoperative days 4–5, the responsible nurse will resume moistening the oral cavity and lips with a cotton swab dipped in warm water. Following each intervention, lip balm will be applied and chewing gum provided to alleviate thirst. This intervention will be performed hourly between 09:00–12:00 and 15:00–18:00. (4) Health Education: During the perioperative period, the responsible nurse provided health education to patients regarding disease-related knowledge and dietary guidance. 2.4.2 Intervention Group In addition to routine nursing care, participants in the intervention group received a multi-stage optimised strategy based on the thirst management model. The specific steps are as follows. (1) Formation of the Intervention Team The nurse-led intervention team comprised: − 3 physicians (1 general surgeon, 1 anaesthetist, 1 traditional Chinese medicine practitioner) − 2 head nurses (1 general surgery head nurse, 1 anaesthesia head nurse) − 3 responsible nurses − 2 postgraduate nursing students All nursing staff held bachelor's degrees or higher, possessed nurse professional titles or equivalent qualifications, and had over five years' clinical experience. Specific roles are as follows: the two head nurses serve as team leaders, responsible for coordination, planning, training, guidance, and supervision; the general surgeon and anaesthetist act as deputy leaders, overseeing intervention guidance and evaluation; the three charge nurses manage intervention implementation; TCM-related procedures are performed by the TCM physician; and the two nursing postgraduates undertake data collection and analysis. (2) Developing the Intervention Protocol The research team first compiled and synthesised high-quality evidence from literature on perioperative thirst management. This yielded 21 best-practice recommendations across four domains: thirst risk factor assessment, thirst severity evaluation and measurement, thirst relief strategies, and team collaboration. A preliminary intervention plan was drafted based on this evidence. Subsequently, 15 experts in relevant fields were invited to participate in a Delphi expert consultation. The response rates for the two rounds of questionnaires were 93.3% and 100%, respectively. The rates of expert recommendations were 60% and 26.66%, respectively, with an expert authority coefficient of 0.86 for both rounds. The coefficients of variation for the two rounds were 0.08–0.25 and 0.10–0.20, respectively, 0.10–0.20, and Kendall's coefficient of concordance was 0.336 and 0.559, respectively, demonstrating the scientific rigour and reliability of the protocol. The research team subsequently integrated expert feedback through multiple rounds of discussion and, incorporating findings from a small-scale feasibility assessment (sample size n = 15), continuously refined the intervention plan. This culminated in the finalisation of the definitive perioperative thirst management protocol for gastrointestinal cancer patients. (3) Implementation of Intervention Measures Building upon the perioperative thirst management protocol for gastrointestinal cancer patients, a multi-stage optimisation strategy based on the thirst management model was developed. This strategy encompasses intervention themes, content, timing, personnel, and specific measures (detailed in Table 1 ). Table 1 Multi-stage optimisation strategy based on the thirst management model Theme of intervention Intervention Content Intervention T Intervention Team Formation Formation includes Multidisciplinary team Admission Day 1 -Team formation with general surgery, anesthesiology, dietetics, oral and mucosal medicine, and Chinese medicine to work together Thirst Recognition Recognition Patient Potential risk of thirst Admission Day 1 -Identify risk factors by determining the patient's age, gender, BMI, and asking about the patient's smoking history, previous history of postoperative nausea and vomiting or dizziness, and the patient's psychological state -Use the Nutritional Risk Screening (NRS) 2002 to assess the patient's nutritional status during the Perioperative -Record perioperative body intake, excretion, and potassium levels. -Identify whether the patient is at risk for thirst based on the nurse's records, the patient's surgical procedure, anaesthesia medications, medications taken, and nutritional risk status. Thirst Strategies Preoperative Management The day before surgery Teach the patient how to use a numerical rating scale, inform the patient of the possibility of self-reporting, and teach the patient how to use an elephant trunk spray. -Individualized preoperative counseling on the type and amount of diet and avoidance of stimulants. -Introduce patients to perioperative treatment, operating room environment, surgical procedures, and successful cases to relieve patients' tension and anxiety. -Evaluate the t for the patient to receive the table for surgery, assess whether the patient is combined with delayed gastric emptying, abnormal gastrointestinal peristalsis, diabetes mellitus, emergency surgery and other factors, if not, drink 800ml of clear liquid containing 12.5% carbohydrate solution or glucose solution 10h before the operation, and abstain from food for 6h before the operation, and abstain from drinking for 2h before the operation. Surgery On the day of surgery -Score the patient's thirst and thirst discomfort on a numerical rating scale and a perioperative thirst discomfort scale. -Provide psychological care to patients to reduce their anxiety and tell them to promote salivary secretion and moisten the mouth to relieve thirst through psychological suggestion therapy. -Avoid taking medications that may cause vomiting and use antiemetic drugs as prescribed by the doctor. -Avoid preoperative mechanical bowel preparation. -Determine the patient's level of thirst by using the Oral Mucosal Wetting Scale. Intraoperative Management Use goal-directed fluid therapy to guide infusion and actively maintain zero fluid balance. Postoperative Management Postoperative 2h -Observe the degree of wetness of the oral mucosa to determine the degree of thirst. -Score the patient's thirst and thirst discomfort on a numerical rating scale and a perioperative thirst discomfort scale. -Ensure that the temperature in the ward is constant to minimize factors that aggravate the patient's thirst. Postoperative 6h -Observe the patient's oral cavity and predictively assess the trend of the patient's thirst. -Replenish fluids in a timely manner according to the patient's intake and output -Use the elephant trunk spray with 0–6℃ ice saline to spray the patient's palate, left and right cheeks, and tongue and face 3 times, 1.2 ml each time, the frequency of intervention is one hour, and apply lipstick on the patient's lips after spraying. Postoperative period Day 1–3 -Observe the patients' oral mucous membrane wetness to determine the patients' thirst level, and use the Adult Thirst Management Safety Assessment Scale to assess whether the patients are ready for the relevant interventions -Massage ShuiQuan, YuJi, and ShakZe points to relieve thirst by a TCM doctor twice a day at 9:00 am and 4:00 pm respectively -If passed the assessment, the patient was instructed to use an elephant trunk type spray to relieve thirst every 1 hour, on top of that, the patient was instructed to take a sitting or semi-recumbent position and to chew 1 piece of gum every 2 h for 10 min each t, if the assessment was not passed, after informing the doctor, the patient was assessed every 30 min, if not passed, the patient was given a continuous oxygen-driven nebulization using 15 ml of a 0.45% sodium chloride solution at 35–37°C Inhalation 20–30 min/ts, nebulized inhalation oxygen flow rate of 6–8 L/min, the mask for the mask-type medical nebulizer, assessment until passed -Provide psychological counseling to patients, encourage patients to express their emotions, and enhance their confidence in treatment. −24h after surgery, the patients' thirst and thirst discomfort were scored by the numerical rating scale and perioperative thirst discomfort scale. Postoperative Day 1–3 According to the doctor's instruction, use the sputum medicine with 0.9% sodium chloride solution, 15ml continuous oxygen-driven nebulized inhalation for 20−30min/ts, the oxygen flow rate of nebulized inhalation is 6−8L/min, and the frequency is once a day. Postoperative 4–5 days -Observe the degree of wetness of the oral mucosa to determine the degree of thirst of the patient, and dynamically adjust the rehydration measures according to the patient's intake and output. If the indication of drinking water is not reached, instruct the patient to take a sitting position or semi-recumbent position on the basis of the use of elephant trunk spray, and mouthwash to alleviate thirst every 2h, and chew 1 piece of gum every 2h for 10 minutes each t; if the indication of drinking water is reached, then drink small amounts of water according to the doctor's instructions. -Patients' thirst and thirst discomfort were scored on a numeric rating scale and a perioperative thirst discomfort scale. 2.6 Outcome Measures A custom-designed questionnaire was employed to collect patients' sociodemographic characteristics and baseline clinical data. This primarily included age, gender, hospital admission number, educational attainment, duration of surgery, preoperative fasting period, intraoperative fluid administration volume, and medication use.Study outcomes will be measured at the following time points: T0 (baseline), T1 (2 hours post-surgery), T2 (6 hours post-surgery), T3 (24 hours post-surgery), T4 (3 days post-surgery), and T5 (5 days post-surgery). 2.6.1 Numerical Scoring Scale for Thirst Severity This scale evolved from the visual analogue scale, quantifying patient thirst levels numerically via an 11-point horizontal line (0–10). Scores of 0 denote no thirst, 1–3 mild thirst, 4–7 moderate thirst, and 8–10 severe thirst. This scale is currently the only clinically available tool for grading thirst severity, demonstrating retest reliability coefficients of 0.65–0.85 [ 28 ]. 2.6.2 Perioperative Thirst Discomfort Scale This scale assesses patients' thirst discomfort during the perioperative period. Developed by Martins et al. in 2017[ 29 ], it was primarily compiled based on the Consensus Criteria for Bias Risk Assessment Checklist from methodological research. Chinese scholars Huang Chenshan et al.[ 30 ] conducted Chinese adaptation and reliability/validity testing. The scale demonstrated internal consistency (Cronbach's α) of 0.813, with reliability and validity coefficients of 0.93 and 0.95, respectively. It primarily inquires whether patients experience 'dry mouth, lips, or throat', desire to drink water, or discomfort characterised by 'thick saliva, coated tongue, or foul breath'. These seven aspects of discomfort are scored using a three-point Likert scale, where 0–2 points represent 'no related distress' to 'severe distress'. The minimum total score is 0, indicating no thirst-related discomfort, while the maximum score of 14 indicates extremely severe thirst discomfort. 2.6.3 Lip, Tongue, and Oral Mucosal Moisture Measurement Scale The Objective Oral Mucosa Scale (OOMS) assesses thirst indirectly through visual inspection of the patient's lips and oral mucosa by the attending nurse. This scale has undergone multiple validations both domestically and internationally[ 31 ]. It comprises four levels ranging from oral dryness and lip desquamation to complete moisture of the lips, tongue, and oral mucosa. The maximum score is 4 points (Level 1: lip desquamation and fissures, oral dryness with whitening), while the minimum is 1 point (Level 4: lips and oral mucosa fully moist). 2.7. Statistical analysis Statistical analysis was performed using SPSS 26.0 software. The count data were described using frequency (n) and percentage (%). Hypothesis testing employed Pearson's chi-square test, with Fisher's exact test used when chi-square conditions were not met. For continuous data, normally or approximately normally distributed variables were described using mean ± standard deviation (M ± SD), with hypothesis testing using t-tests or analysis of variance (ANOVA). Statistical descriptions for non-normally distributed variables were presented using median and interquartile range, with intergroup comparisons conducted using the rank-sum test. Generalised estimating equations were employed to analyse changes in thirst discomfort and thirst intensity at different time points, thereby controlling for confounding effects such as time. 2.8 Ethical Considerations This study has been approved by the Medical Ethics Committee of Tangdu Hospital, Fourth Military Medical University (Approval No. : K202405-02), dated 7 April 2024.The research team strictly adheres to the principles of the Declaration of Helsinki, fully safeguarding participants' privacy rights while respecting their autonomy and informed consent to participate. Researchers provided male participants with comprehensive project explanations and ample time to consider their participation decision, ensuring each individual's choice is fully respected. All participants signed informed consent forms, and their involvement in the study will not affect the implementation of their original treatment protocols. 3. Results This study initially enrolled 132 patients who met the inclusion criteria and signed informed consent forms. Participants were allocated to either the intervention group (66 patients) or the control group (66 patients) based on their admission date. All 132 participants completed baseline data collection and subsequent follow-up. 3.1. Homogeneity of study participants' characteristics The mean ages of the participants in the two groups were 57.98 ± 11.53 years and 62.59 ± 11.42 years, respectively. The majority of participants had an educational level of junior high school or above. The groups were also comparable in terms of clinical characteristics, including operation duration, anaesthesia duration, preoperative fasting and water deprivation duration, and intraoperative fluid balance. (Table 2 ). Table 2 Comparison of general characteristics between the two groups Item Control group (n = 66) Intervention group(n = 66) t/x 2 P Age (years) 57.98 ± 11.53 62.59 ± 11.42 −1.799 0.074 Education level Primary school or below 16 10 −0.461 0.646 Junior high school 22 28 High school 19 20 College degree or above 9 8 Marital status Married 62 63 0.434 0.665 Widowed 1 1 Divorced 3 2 Duration of surgery (h) 4.29 ± 1.56 3.93 ± 1.75 1.231 0.221 Duration of anaesthesia (h) 4.77 ± 1.55 4.54 ± 1.71 0.824 0.411 Preoperative fasting and water deprivation duration (h) 13.66 ± 3.59 13.97 ± 3.38 −0.507 0.613 Intraoperative fluid balance Positive balance 46 42 −0.829 0.409 Relative balance 16 18 Negative balance 4 6 Diuretics Y 19 22 0.561 0.576 N 47 44 Antihypertensive drugs Y 12 18 1.244 0.216 N 54 48 Proton pump inhibitors Y 21 27 1.082 0.281 N 45 39 Gland suppressants Y 19 24 0.925 0.357 N 47 42 3.2 Comparison of thirst degree scores between the two groups of patients 3.2.1 Intergroup comparison of perioperative thirst degree between the two groups of patients At baseline (T1), there was no statistical difference in thirst degree scores between the two groups (p > 0.05), indicating balanced grouping. As shown in Table 6 , at each postoperative time point (T1, T2, T3, T4, T5), the scores of the intervention group were significantly lower than those of the control group (all p < 0.05). (Table 4 ). The greatest intergroup difference was observed at the postoperative T3 time point, suggesting that the intervention had the most pronounced alleviating effect during the period of most severe thirst. Table 3: Intergroup comparison of thirst degree scores at each time point between the two groups of patients (N = 132) group time Control group Intervention group t P T0 4.236 ± 0.050 4.329 ± 0.025 -1.633 0.105 T1 5.402 ± 0.034 5.658 ± 0.022 -6.316 < 0.001 T2 7.038 ± 0.025 7.435 ± 0.038 -8.723 < 0.001 T3 6.432 ± 0.045 6.795 ± 0.044 -5.781 < 0.001 T4 5.338 ± 0.034 5.580 ± 0.071 -3.074 0.003 T5 3.576 ± 0.064 3.738 ± 0.037 -2.192 0.030 3.2.2 Within-group and between-group comparisons of changes in thirst degree scores To evaluate the dynamic changes induced by the intervention, we calculated the change values in scores from baseline (T1) to each postoperative time point (T2–T6) for each group and compared them (Table 4 ). Paired samples t-tests (within-group comparisons) revealed that the thirst degree scores of patients in both groups at all postoperative time points differed significantly from the baseline (all p < 0.001), indicating that thirst sensation underwent substantial dynamic changes after surgery. The key finding lies in the comparison of the magnitude of change between groups. Independent samples t-test results showed significant differences between the intervention group and the control group in the amount of change from T0 to T1, T2, and T3 (all p < 0.05). This indicates that the intervention not only reduced the absolute scores at each time point but, more importantly, significantly altered the trajectory of thirst degree evolution. For instance, from T1 to T3 (the peak period), the control group exhibited a substantial increase in scores (change value: 3.106), whereas the increase in the intervention group was significantly smaller (change value: 2.802). This demonstrates that the intervention effectively buffered the peak intensity of the symptom. Table 4: Comparison of within-group and between-group changes in thirst degree scores from baseline to each time point (N=132) Within-group paired t-test: all time points vs T0 for both groups (P＜0.05), 3.2.3 Analysis Results of the Generalized Estimating Equations Model After controlling for repeated measurement correlations and potential confounding factors using generalized estimating equations (GEE), the model parameter estimate values are shown in Table 5 . The main effect of the group did not reach a significant level (p > 0.05), suggesting that if the time factor is ignored, the average score difference between the two groups is not significant. However, the interaction term between group and time was statistically significant at time points T1, T2, and T3 (p < 0.05). These negative interaction term coefficients indicate that, compared to the control group, the intervention group had an additional, significant decrease in thirst degree scores at these time points. Among them, the interaction effect was greatest at the T2 time point (β = -0.305, Wald χ²=16.432, p < 0.001), further confirming that the intervention was most prominent in alleviating postoperative 6h thirst degree. Table 5 Generalized estimating equation analysis of the group‑by‑time interaction effect on thirst degree scores in the two groups (N = 132) Item β SE 95% CI Hypothesis Test Lower Limit Upper Limit Wald ² P (Intercept) 4.329 .0250 4.280 4.378 30060. 914 <0.001 Group (Ref: Control Group) Intervention Group -0.092 0.056 -0.203 0.018 2.707 0.100 Time (Ref: T0) T1 1.329 0.033 1.264 1.394 1603.922 <0.001 T2 3.106 0.046 3.015 3.197 4481.435 <0.001 T3 2.467 0.050 2.369 2.565 2425.611 <0.001 T4 1.252 0.071 1.113 1.391 311.473 <0.001 T5 -0.591 0.047 -0.682 -0.500 160.875 <0.001 GroupTime (Intervention group * T0 as reference) Intervention group* T1 -0.164 0.065 -0.292 -0.035 6.262 0.012 Intervention group* T2 -0.305 0.075 -0.452 -0.157 16.432 <0.001 Intervention group *T3 -0.271 0.081 -0.431 -0.112 11.112 0.001 Intervention group *T4 -0.150 0.095 -0.335 0.035 2.521 0.112 Intervention group* T5 -0.070 0.094 -0.254 0.115 0.549 0.459 3.3 Comparison of thirst discomfort scores between the two patient groups 3.3.1 Between-group comparison of thirst discomfort scores at each time point A total of 132 patients were enrolled in this study, with 66 in the intervention group and 66 in the control group. At baseline (T0), there was no statistical difference in thirst discomfort scores between the two groups (p > 0.05), indicating comparability. As shown in Table 1 , at the postoperative time points from T1 to T4, the scores in the intervention group were significantly lower than those in the control group (all p < 0.001). By the T5 time point, the difference between the two groups was no longer statistically significant (p = 0.469). Table 6 Between-group comparison of thirst discomfort scores for the two patient groups (N = 132) 时间点 Control GroupX ± S Intervention group‾X ± S t P T0 4.42 ± 1.665 4.83 ± 1.728 -1.381 0.169 T1 8.65 ± 1.839 6.63 ± 1.965 6.065 < 0.001 T2 11.90 ± 1.753 9.69 ± 1.915 6.907 < 0.001 T3 7.90 ± 1.905 6.54 ± 1.807 4.208 < 0.001 T4 5.39 ± 1.832 3.76 ± 1.765 5.202 < 0.001 T5 2.42 ± 1.409 2.27 ± 0.900 0.727 0.469 3.3.2 Comparison of within-group and between-group changes in thirst discomfort scores Note Between-group comparisons were performed using the independent samples t-test. To evaluate the dynamic changes induced by the intervention, we compared the change values in scores from baseline to each subsequent time point between the two groups. As shown in Table 7 , significant differences were observed between the intervention group and the control group in the magnitude of change from T0 to all other time points (all p < 0.05). This indicates that the intervention significantly altered the degree of thirst discomfort. For example, from T0 to T2, the control group's score increased by 7.48 points, whereas the intervention group's score increased by only 4.86 points, resulting in an intervention effect difference of 2.62 points (p < 0.001). Table 7 Comparison of within-group and between-group changes in thirst discomfort scores from baseline to each time point (N = 132) Time point Difference in the intervention group (n = 66) Difference in the control group (n = 66) t P T0 至 T1 2.17 ± 1.95 4.23 ± 1.50 -7.01 < 0..001 T0 至 T2 4.86 ± 1.80 7.48 ± 1.74 -5.54 < 0.001 T0 至 T3 1.71 ± 1.81 3.48 ± 1.91 -5.62 < 0.001 T0 至 T4 -1.07 ± 1.77 0.97 ± 1.83 -4.44 < 0.001 T0 至 T5 -2.56 ± 0.90 -2.00 ± 1.41 2.60 0.010 Within-group paired t-test: all time points vs T1: P<.001 3.3.3 Results of the Generalized Estimating Equation Model Analysis After controlling for repeated-measures correlations and potential confounding factors using Generalized Estimating Equations (GEE), the overall model test indicated that group (Wald χ² = 83.63, p < 0.001), time (Waldχ²= 2393.48, p < 0.001), and their interaction (Wald χ² = 127.39, p < 0.001) were all statistically significant. However, the parameter estimates revealed that the main effect of group was not significant after controlling for the time effect (β = -0.38, p = 0.14), suggesting a need to examine the specific differences at each time point. See Table 8 . Further analysis of the interaction effect parameters showed that, compared to the control group, the intervention group exhibited an additional, significant reduction in thirst discomfort scores at time points T1 to T4 (all interaction terms p < 0.001). Among these, the interaction effect was greatest at the T1 time point (β = -2.30, Waldχ²= 49.17, p < 0.001). This indicates that the intervention group demonstrated the most pronounced effect during the T1 phase, suggesting that the intervention's effect on alleviating thirst was most prominent 2 hours after surgery. In other words, the intervention was most effective in the short-term post-intervention, with its effect gradually diminishing over time, though it remained superior to that observed in the control group. Table 8 Generalized Estimating Equation Analysis of the Group-by-Time Interaction Effect on Thirst Discomfort Score (N = 132) Item β SE 95% CI Hypothesis Test Lower Limit Upper Limit Wald ² P (Intercept) 4.606 0.180 4.252 4.960 651.930 <0.001 Group (Ref: Control Group) Intervention Group -0.379 0.254 -0.877 0.119 2.221 0.136 Time (Ref: T0) T1 4.061 0.227 3.616 4.505 320.990 <0.001 T2 7.318 0.186 6.954 7.682 1551.968 <0.001 T3 3.455 0.229 3.006 3.903 227.637 <0.001 T4 1.136 0.216 0.712 1.560 27.604 <0.001 T5 -2.364 0.208 -2.772 -1.955 128.576 < 0.001 GroupTime (Intervention group * T0 as reference) Intervention group *T1 -2.303 0.328 -2.947 -1.659 49.170 <0.001 Intervention group* T2 -2.015 0.364 -2.728 -1.302 30.696 <0.001 Intervention group *T3 -1.894 0.337 -2.554 -1.233 31.590 <0.001 Intervention group* T4 -1.591 0.358 -2.292 -0.889 19.753 <0.001 Intervention group *T5 0.758 0.291 0.187 1.328 6.775 0.009 3.4 Comparison of oral mucosa moisture between the two groups The results in Table 9 show that there was no statistically significant between-group difference in oral mucosa moisture between the two groups of patients before surgery (p > 0.05). From 6 hours after surgery onwards, a significant difference in moisture scores emerged between the intervention group and the control group, which persisted until T5 (p < 0.05). Further observation of the oral mucosa moisture scores revealed that, starting from 6 hours post-surgery, the proportion of patients with higher moisture grades in the intervention group gradually increased. This indicates that the intervention effectively improved the postoperative oral mucosa moisture status of the patients, with the effect becoming apparent from 6 hours after surgery and lasting until 5 days post-surgery. Table 9: Comparison of oral mucosa moisture scores between the two groups time grade intervention group (n = 66) control group (n = 66) Z值 P值 T0 1 0 (0.0%) 0 (0.0%) -1.043 0.297 2 6 (9.1%) 9 (13.6%) 3 32 (48.5%) 34 (51.5%) 4 28 (42.4%) 23 (34.8%) T1 1 11 (16.7%) 13 (19.7%) -1.421 0.155 2 16 (24.2%) 23 (34.8%) 3 27 (40.9%) 22 (33.3%) 4 12 (18.2%) 8 (12.1%) T2 1 7 (10.6%) 15 (22.7%) -2.581 0.010 2 18 (27.3%) 24 (36.4%) 3 25 (37.9%) 18 (27.3%) 4 16 (24.2%) 9 (13.6%) T3 1 4 (6.1%) 7 (10.6%) -2.344 0.019 2 12 (18.2%) 17 (25.8%) 3 23 (34.8%) 28 (42.4%) 4 27 (40.9%) 14 (21.2%) T4 1 3 (4.5%) 7 (10.6%) -1.982 0.047 2 11 (16.7%) 16 (24.2%) 3 20 (30.3%) 18 (27.3%) 4 32 (48.5%) 25 (37.9%) T5 1 0 (0.0%) 2 (3.0%) -2.519 0.012 2 1 (1.5%) 3 (4.5%) 3 14 (21.2%) 23 (34.8%) 4 51 (77.3%) 38 (57.6%) 4. Discussion This study evaluated an intervention plan grounded in the thirst management model, designed to alleviate thirst and dry mouth in patients undergoing perioperative care for gastrointestinal tumours and thereby enhance their comfort. The findings demonstrated statistically significant reductions in both thirst degree and thirst discomfort, alongside a clinically meaningful decrease in dry mouth. These results suggest that the thirst management model–based intervention plan may serve as an effective adjunctive strategy for symptom management in clinical nursing practice. 4.1 The thirst management programme for patients undergoing perioperative care for gastrointestinal tumours reduced thirst severity during the perioperative period Gastrointestinal surgery presents unique complexities; to ensure patient safety and minimise the risk of complications such as anastomotic fistula, most healthcare professionals permit oral intake only after the return of flatus. This practice inevitably prolongs fasting duration and consequently exacerbates postoperative thirst[ 32 ]. In a qualitative study exploring thirst experiences among perioperative patients, participants described thirst as an intensely distressing sensation, with some even reporting feelings of despair and thoughts related to mortality [ 33 ]. Currently, clinical attention in China towards perioperative patients is predominantly focused on domains such as pain management, with relatively limited emphasis placed on thirst. The findings of this study indicate that there was no statistically significant difference in thirst degree between the two groups at baseline (T 0 ) (p > 0.05). However, at all postoperative time points, the thirst degree scores in the intervention group were significantly lower than those in the control group; the between-group difference was most pronounced at T₃ (p < 0.05). This may be attributable to the peak intensity of thirst experienced during this period, which is likely driven by factors including recovery from anaesthesia, prolonged fasting duration, and surgical stress. Furthermore, generalised estimating equation (GEE) analysis confirmed a statistically significant interaction effect between group and time at the three key time points—T₂, T₃, and T₄ (p < 0.05)—indicating that the intervention not only reduced the absolute level of thirst but also modified its temporal trajectory. These findings suggest that the intervention plan has clinical relevance in alleviating postoperative thirst symptoms, with particularly pronounced effects during the peak symptom phase. Consistent with both domestic and international research findings—including those reported by Chen L [ 34 , 35 ]—this pattern may be attributable to progressive stimulation of thirst induced by surgical stress and prolonged pre- and postoperative fasting, resulting in a gradual increase in thirst degree from the preoperative period to 6 hours after surgery. At the 6-hour postoperative time point, patients are generally able to actively cooperate with relevant clinical nursing interventions, which not only help mitigate anxiety and tension but also reduce thirst discomfort. 4.2 The thirst management program for patients undergoing perioperative care for gastrointestinal tumours reduces thirst discomfort throughout the perioperative period. According to multiple studies, the incidence of thirst during the initial postoperative period may reach as high as 78% [ 36 ]. Prolonged dehydration can adversely affect patients' cognition and psychological functioning [ 37 ]. Consequently, exploring effective thirst management programmes in clinical practice is of particular importance. Generalized estimating equation (GEE) analysis in this study revealed that, at 2 hours, 6 hours, day 1, and day 3 after surgery, the intervention group demonstrated significantly greater improvement in thirst discomfort compared with the control group (p < 0.05), with the most pronounced effect observed at 2 hours after surgery. These findings indicate that a systematic assessment and intervention approach can effectively alleviate thirst discomfort, especially during the early postoperative phase. This outcome is consistent with the clinical validation reported by Ma Xiaolan et al. [ 38 ], who implemented a perioperative thirst symptom management protocol. Further analysis showed that the intervention not only reduced the absolute level of thirst but also altered its temporal trajectory. Thirst discomfort in the control group peaked at six hours after surgery, whereas the intervention group exhibited a significantly lower peak value (9.69 ± 1.915) and earlier resolution. This improvement in the temporal trajectory of thirst discomfort may help reduce anxiety, agitation, and oral complications arising from severe thirst, thereby potentially facilitating early postoperative recovery and alleviating nursing workload. The underlying rationale is that the thirst management program for patients undergoing perioperative care for gastrointestinal tumours is a comprehensive, individualised approach. It entails a thorough assessment of each patient's condition using validated scales, followed by the implementation of tailored interventions. Such an individualised strategy is more effective in alleviating thirst discomfort throughout the perioperative period, consequently reducing patients' anxiety and distress and promoting faster recovery. Overall, the perioperative thirst management program reduced the severity of thirst discomfort in patients through individualised assessment and targeted interventions. This finding is consistent with those reported in existing studies [ 39 ] 4.3 The thirst management program for patients undergoing gastrointestinal tumour surgery improved moisture levels of the lips, tongue, and oral mucosa. In this study, the conventional nursing group (control group) exhibited consistently low mucosal moisture scores across all postoperative time points, which may be attributable to the routine practice of using cotton swabs dipped in warm water to moisten the oral cavity. This approach may accelerate evaporation of moisture and thereby exacerbate thirst[ 40 ]. In contrast, the intervention group undertook an objective assessment of each patient's thirst status before implementing individualised operational measures—including saline-filled elephant-trunk sprays, chewing sugar-free gum, applying lip balm, and rinsing with mouthwash—to enhance hydration of the lips, tongue, and oral mucosa. Clinical validation demonstrated that the intervention group achieved significantly higher oral mucosal moisture scores than the control group at multiple postoperative time points (p < 0.05), thereby effectively maintaining mucosal hydration. These improvements are likely mediated by increased salivary flow induced by chewing gum, cold stimulation, or exposure to acidic solutions. These findings are consistent with those reported in both domestic and international studies[ 15 , 41 ]. Furthermore, the lip balm, mouthwash, sugar-free chewing gum, and elephant-trunk spray bottles incorporated into the protocol are all low-cost and widely available, thereby avoiding any increase in healthcare expenditure. Consequently, this protocol demonstrates favourable cost-effectiveness and a degree of clinical applicability. 5. Limitations During the protocol development phase, the literature review was restricted to sources published in Chinese and English, which may have led to the omission of high-quality evidence available in other languages and thereby compromised the comprehensiveness of the protocol. In the clinical validation phase, the study was conducted at a single Class III Grade A hospital located in Xi’an City, Shaanxi Province, with a sample size of only 132 participants; such a small-scale, single-centre design inherently limits the generalisability of the findings. Furthermore, because patients undergoing perioperative care were all accommodated within the same ward in the participating department, it was not feasible to conduct a randomised controlled trial, and a quasi-experimental design was therefore adopted instead. Future research should build upon ongoing evidence updates and protocol refinements to implement multicentre, large-sample randomised controlled trials to rigorously evaluate the feasibility and effectiveness of this protocol. In addition, objective assessment of intervention outcomes could be enhanced through physiological monitoring techniques, including unstimulated whole salivary flow rate (UWSFR) and oral pH measurement. 6. Conclusions This study developed a perioperative thirst management protocol for gastrointestinal tumor patients through evidence synthesis, expert consultations, and pilot trials, which was clinically validated. The results demonstrated that the protocol effectively alleviated thirst symptoms, reduced discomfort levels, and improved oral mucosal moisture retention during perioperative care. The approach proved feasible, scientifically sound, and clinically effective, providing valuable guidance for healthcare professionals in managing patient thirst during gastrointestinal tumor surgeries. Declarations Conflicts of Interest The authors declare no conflicts of interest. Funding Statement This project received no external funding. Ethical Considerations This study has obtained approval from our hospital's Medical Ethics Committee (Approval No.: K202405-02) and has formally commenced recruitment of participants. The research team strictly adheres to the principles of the Declaration of Helsinki, fully safeguarding participants' privacy rights while respecting their autonomy and informed consent in participating in the study. 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DOI:10.3969/j.issn.1003-6350.2020.04.009 Nascimento LAD, Garcia AKA, Conchon MF, et al. Advances in the Management of Perioperative Patients' Thirst[J]. AORN J, 2020,111(2):165-179. DOI: 10.1002/aorn.12931 Garcia AKA, Conchon MF, Pierotti I, et al. Implementation of the thirst management model in the burn unit guided by knowledge translation[J]. Rev Gaucha Enferm,2023,43(9):e20220220. doi: 10.1590/1983-1447.2022.20220220.en. Schulz, K. F., Altman, D. G., & Moher, D.. CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomised trials[J]. BMJ, 2010,340, c332.doi: 10.4103/0976-500X.72352. Paice JA, Cohen FL. Validity of a verbally administered numeric rating scale to measure cancer pain intensity[J]. Cancer Nurs,1997;20(2):88-93. doi: 10.1097/00002820-199704000-00002. Martins PR, Fonseca LF, Rossetto EG. Developing and validating the Perioperative Thirst Discomfort Scale[J]. Rev Esc Enferm USP,2017,51:e03240. doi: 10.1590/S1980-220X2016029003240. 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Eur J Cardiovasc Nurs,2018 ,17(3):226-234. doi: 10.1177/1474515117728624. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 05 May, 2026 Reviewers agreed at journal 14 Apr, 2026 Reviewers agreed at journal 13 Apr, 2026 Reviewers invited by journal 13 Apr, 2026 Editor assigned by journal 11 Apr, 2026 Submission checks completed at journal 12 Mar, 2026 First submitted to journal 05 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9038991","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":623904903,"identity":"c85b2fac-d3be-4d64-ad05-0530bacb096b","order_by":0,"name":"jingrong Wang","email":"","orcid":"","institution":"The Second Affiliated Hospital of Air Force Medical University","correspondingAuthor":false,"prefix":"","firstName":"jingrong","middleName":"","lastName":"Wang","suffix":""},{"id":623904904,"identity":"a5b1c7a5-8fa3-4472-9461-8c6a2c2ebe15","order_by":1,"name":"Yujuan Peng","email":"","orcid":"","institution":"Hebei Vocational College of Resources and Environment","correspondingAuthor":false,"prefix":"","firstName":"Yujuan","middleName":"","lastName":"Peng","suffix":""},{"id":623904905,"identity":"b0feb96e-ca19-4cde-a3fd-efc738862246","order_by":2,"name":"Rui Fan","email":"","orcid":"","institution":"The Second Affiliated Hospital of Air Force Medical University","correspondingAuthor":false,"prefix":"","firstName":"Rui","middleName":"","lastName":"Fan","suffix":""},{"id":623904906,"identity":"261056d5-5396-4913-84b0-97c0bdc4a88c","order_by":3,"name":"Jian Hu","email":"","orcid":"","institution":"The Second Affiliated Hospital of Air Force Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jian","middleName":"","lastName":"Hu","suffix":""},{"id":623904907,"identity":"15d2ca14-b666-4a4a-b6c8-42da7a9dcd41","order_by":4,"name":"Tong Chen","email":"","orcid":"","institution":"The Second Affiliated Hospital of Air Force Medical University","correspondingAuthor":false,"prefix":"","firstName":"Tong","middleName":"","lastName":"Chen","suffix":""},{"id":623904908,"identity":"cde91a40-2a8c-4fe6-9a72-62c3248579c5","order_by":5,"name":"Wen Shi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIiWNgGAWjYDACCcYGEMnMz9584MCHH8RrsWGX7DmWeHBmD1FawGQav8GNHOPDHGxE6JCf3dwm8XHHYWmGGzkfDjPwMMjzix3Ar8XgzsE2yZlnDhsz9rzdcLjAgsFw5uwEAlokEttu87YdTmZmz91weAYPQ4LBbQJa5GcAtfxtO1zfxpDz4DAPGxFaGG4AtTC2pTHzcOQwEKfF4EZi+8/eNhtmCZ5jBsBAliDsF/kZ6Y8NfrZJMNsfb3784cMPG3l+aUIOQwMSpCkfBaNgFIyCUYAdAACgCkptjOJ6xgAAAABJRU5ErkJggg==","orcid":"","institution":"The Second Affiliated Hospital of Air Force Medical University","correspondingAuthor":true,"prefix":"","firstName":"Wen","middleName":"","lastName":"Shi","suffix":""}],"badges":[],"createdAt":"2026-03-05 10:24:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9038991/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9038991/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107868898,"identity":"c5ee9a95-5018-49f6-b988-489fe69c2d89","added_by":"auto","created_at":"2026-04-27 07:34:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":665196,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9038991/v1/62f00496-842e-49ae-b841-71e4fd3dc993.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effect of a Multi-stage Optimisation Strategy on Perioperative Thirst and Dry Mouth in Gastrointestinal Cancer Patients: A Quasi-experimental Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe Chinese Cancer Centre's statistical report suggests that colorectal cancer and gastric cancer rank second and third, respectively, among malignant tumour incidence rates in China, with a combined incidence of 804,500 cases constituting 19.80% of all malignant tumour diagnoses [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Surgery remains the primary treatment for such tumours. However, perioperative factors\u0026mdash;including strict fasting and fluid restrictions, surgical trauma, fluid loss, and postoperative intubation\u0026mdash;frequently induce thirst in patients[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Thirst, characterised by a subjective, intense desire to drink water due to altered plasma osmolarity and reduced oral salivation, is considered one of the most distressing and painful symptoms experienced during the perioperative period[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Common manifestations include dry mouth, throat irritation, and an intense urge to drink[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e To expedite patient recovery, the Chinese Clinical Practice Guidelines for Enhanced Recovery After Surgery (ERAS, 2021 Edition) recommend a 6-hour preoperative fasting period and 2-hour fluid restriction for patients without gastrointestinal motility disorders. Postoperative rehydration and refeeding should commence promptly to alleviate thirst[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, awareness of enhanced recovery after surgery (ERAS) principles among nursing staff stands at merely 35.4%, while 50% of anaesthetists have not fully adopted relevant optimisation measures[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Furthermore, factors such as uncertainty in surgical scheduling, preoperative bowel preparation, intraoperative fluid loss, prolonged surgery duration, and various indwelling catheters all exacerbate thirst to varying degrees in perioperative gastrointestinal cancer patients22[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThirst is prevalent and significantly impactful among perioperative patients. Nelson et al.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]conducted a prospective analysis of 100 cancer patients, finding that the majority reported experiencing moderate to severe thirst and oral discomfort, with distress levels occasionally surpassing postoperative pain. One study indicated that the incidence of thirst in patients extubated from general anaesthesia reached 50.8% [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Chinese researchers Feng Yating et al.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] investigated thirst prevalence among 183 gastrointestinal surgery patients under general anaesthesia, finding 41.5% experienced varying degrees of thirst[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Persistent severe thirst not only increases oxygen consumption and exacerbates metabolic burden on organs, but also induces negative emotions such as anxiety, irritability, and even delirium. This diminishes perioperative comfort, heightens complication risks, and ultimately impedes the patient's recovery process[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the high incidence and significant risks associated with thirst in perioperative patients, it remains more readily overlooked by clinical healthcare professionals compared to conditions such as pain, vomiting, or agitation during the perioperative period [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] The reasons for this oversight are twofold. Firstly, healthcare professionals exhibit insufficient awareness of the negative implications of thirst. Surveys indicate that nurses consistently score low in understanding thirst's causes, assessment methods, patient impact, and intervention strategies, often perceiving thirst as a reversible symptom posing no threat to patient health[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Simultaneously, a Japanese cross-sectional study revealed that nurses primarily identified postoperative thirst through patient self-reports rather than objective assessments. They also predominantly relied on personal experience for nursing interventions (e.g., using mouth rinses in wards or moist gauze to moisten lips in operating theatres), lacking systematic evaluation and standardised intervention protocols [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Secondly, patients rarely proactively report thirst due to adherence to traditional fasting and fluid restriction protocols. Research indicates only 12% of patients actively express thirst, while 61.7% do not report it even when experiencing severe thirst, perceiving it as an inherent perioperative condition[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Consequently, healthcare professionals' awareness of thirst management in perioperative patients requires enhancement. With the advancement of enhanced recovery programmes, numerous studies have been conducted globally to develop targeted interventions for alleviating thirst symptoms. Oliveira et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]demonstrated that carbohydrate solutions effectively reduce thirst intensity. Oztas et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] showed that cold stimulation effectively alleviates thirst in perioperative patients. Garcia et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]confirmed that peppermint chewing gum effectively quenches thirst. Chinese researcher Kong Xiangyi[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]found that patients' thirst levels significantly decreased after receiving 6 hours of acupoint massage. Chinese researchers Chang Xiaolan et al.[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] applied acupoint patches to patients on the morning of surgery, confirming that this method not only reduces thirst incidence but also significantly alleviates thirst severity. Whilst these interventions alleviate perioperative thirst discomfort, there remains a lack of tailored, multi-stage thirst management protocols for gastrointestinal cancer patients. Moreover, these strategies are often fragmented and evidence-based, primarily relying on empirical approaches such as lip balm application, without establishing an evidence-based consensus on thirst management. Consequently, there is an urgent need to develop a scientific, systematic, targeted, and actionable comprehensive thirst management protocol to guide clinical practice.\u003c/p\u003e \u003cp\u003eThe Thirst Management Model (TMM) was developed by the State University of Londrina, Brazil, based on symptom management theory and clinical experience, and applied to perioperative thirst management [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This model encompasses four key components: identifying and measuring perioperative thirst in patients, assessing the safety of thirst management interventions, and the clinical application of thirst relief strategies for perioperative patients. The model provides systematic scientific evidence and demonstrates significant outcomes, making it suitable for clinical practice. Concurrently, Garcia[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]has applied this model to burn patients, demonstrating its acceptability and feasibility within burn nursing teams. It provides nursing staff with safe, evidence-based guidance for managing thirst symptoms. This study aims to develop a perioperative thirst management protocol for gastrointestinal cancer patients based on the TMM model and to validate it clinically. Building upon these findings, we designed and implemented a nursing intervention programme guided by the thirst management model, providing a multi-stage optimised strategy to alleviate thirst symptoms in patients undergoing gastrointestinal tumour surgery. This clinical trial aims to evaluate the efficacy of this intervention in improving thirst and dry mouth in such patients. We hypothesize that patients receiving the multi-stage optimised strategy based on the thirst management model will experience greater improvement in thirst and dry mouth compared to those receiving standard care.\u003c/p\u003e"},{"header":"2 THE STUDY","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Design\u003c/h2\u003e \u003cp\u003eWe conducted a quasi-experimental study comprising two phases: (1) developing a perioperative thirst management protocol for gastrointestinal cancer patients based on the TMM model, and (2) validating the clinical efficacy of this management protocol. The study design and reporting adhered to the Trial Reporting in Clinical Trials (TREND) statement [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Participants\u003c/h2\u003e \u003cp\u003eParticipants were selected from 132 patients diagnosed with gastrointestinal tumours and experiencing thirst symptoms in the General Surgery Department of a Grade A tertiary hospital between August and December 2024. They were divided into a control group and an intervention group based on their surgical timing. Inclusion criteria: ① Patients with pathologically confirmed gastrointestinal tumours, meeting physical criteria for surgery, scheduled for general anaesthesia-assisted gastrointestinal surgery, and presenting with thirst symptoms; ② Age 18\u0026thinsp;\u0026le;\u0026thinsp;age\u0026thinsp;\u0026le;\u0026thinsp;80 years; ③ Patients were conscious and capable of normal communication; ④ Patients were able to complete the survey and sign an informed consent form. Exclusion criteria: ① Patients with Sj\u0026ouml;gren's syndrome or a history of long-term use of salivary gland secretion-inhibiting drugs; ② Patients undergoing palliative surgery; ③ Patients with comorbidities severely impacting quality of life, such as cardiac, cerebral, renal, or diabetic conditions; ④ Comatose patients, those with psychiatric disorders, or individuals unable to participate in the survey for other reasons.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Sample size\u003c/h2\u003e \u003cp\u003eThis study aims to validate trends in thirst changes among perioperative gastrointestinal cancer patients, with the primary outcome being alterations in thirst severity scores. To detect a small effect size, referencing Statistical Power Analysis in Behavioural Science, an effect size f of 0.10 was adopted with α\u0026thinsp;=\u0026thinsp;0.05 and power\u0026thinsp;=\u0026thinsp;0.80, and inter-measurement correlation\u0026thinsp;=\u0026thinsp;0.5. Using GPower software for repeated measures analysis, the calculated sample size was 109 cases. Accounting for a 20% dropout rate, this study requires a minimum sample size of 132 participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Intervention and Control Groups\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 Control Group\u003c/h2\u003e \u003cp\u003eThe control group received standard perioperative care for gastrointestinal cancer patients, comprising: (1) Establishing trust: Nurses demonstrated a friendly and patient demeanour during communication, respecting patients' feelings and rights to foster trust; (2) Dietary care: The responsible nurse provided dietary education upon admission. Perioperative patients commenced the hospital's standard preoperative fasting protocol (no food or drink) from 22:00 the night before surgery. (3) Thirst management: On the first postoperative day back in the ward, the responsible nurse performed oral care at 8:00 and 18:00. From postoperative days 1 to 3, cotton swabs moistened with warm water were used to hydrate the oral cavity and lips every two hours. Following passage of flatus or on postoperative days 4\u0026ndash;5, the responsible nurse will resume moistening the oral cavity and lips with a cotton swab dipped in warm water. Following each intervention, lip balm will be applied and chewing gum provided to alleviate thirst. This intervention will be performed hourly between 09:00\u0026ndash;12:00 and 15:00\u0026ndash;18:00. (4) Health Education: During the perioperative period, the responsible nurse provided health education to patients regarding disease-related knowledge and dietary guidance.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.4.2 Intervention Group\u003c/h2\u003e \u003cp\u003e In addition to routine nursing care, participants in the intervention group received a multi-stage optimised strategy based on the thirst management model. The specific steps are as follows.\u003c/p\u003e \u003cp\u003e(1) Formation of the Intervention Team\u003c/p\u003e \u003cp\u003eThe nurse-led intervention team comprised: \u0026minus;\u0026thinsp;3 physicians (1 general surgeon, 1 anaesthetist, 1 traditional Chinese medicine practitioner)\u0026thinsp;\u0026minus;\u0026thinsp;2 head nurses (1 general surgery head nurse, 1 anaesthesia head nurse)\u0026thinsp;\u0026minus;\u0026thinsp;3 responsible nurses\u0026thinsp;\u0026minus;\u0026thinsp;2 postgraduate nursing students All nursing staff held bachelor's degrees or higher, possessed nurse professional titles or equivalent qualifications, and had over five years' clinical experience. Specific roles are as follows: the two head nurses serve as team leaders, responsible for coordination, planning, training, guidance, and supervision; the general surgeon and anaesthetist act as deputy leaders, overseeing intervention guidance and evaluation; the three charge nurses manage intervention implementation; TCM-related procedures are performed by the TCM physician; and the two nursing postgraduates undertake data collection and analysis.\u003c/p\u003e \u003cp\u003e(2) Developing the Intervention Protocol\u003c/p\u003e \u003cp\u003eThe research team first compiled and synthesised high-quality evidence from literature on perioperative thirst management. This yielded 21 best-practice recommendations across four domains: thirst risk factor assessment, thirst severity evaluation and measurement, thirst relief strategies, and team collaboration. A preliminary intervention plan was drafted based on this evidence. Subsequently, 15 experts in relevant fields were invited to participate in a Delphi expert consultation. The response rates for the two rounds of questionnaires were 93.3% and 100%, respectively. The rates of expert recommendations were 60% and 26.66%, respectively, with an expert authority coefficient of 0.86 for both rounds. The coefficients of variation for the two rounds were 0.08\u0026ndash;0.25 and 0.10\u0026ndash;0.20, respectively, 0.10\u0026ndash;0.20, and Kendall's coefficient of concordance was 0.336 and 0.559, respectively, demonstrating the scientific rigour and reliability of the protocol. The research team subsequently integrated expert feedback through multiple rounds of discussion and, incorporating findings from a small-scale feasibility assessment (sample size n\u0026thinsp;=\u0026thinsp;15), continuously refined the intervention plan. This culminated in the finalisation of the definitive perioperative thirst management protocol for gastrointestinal cancer patients.\u003c/p\u003e \u003cp\u003e(3) Implementation of Intervention Measures\u003c/p\u003e \u003cp\u003eBuilding upon the perioperative thirst management protocol for gastrointestinal cancer patients, a multi-stage optimisation strategy based on the thirst management model was developed. This strategy encompasses intervention themes, content, timing, personnel, and specific measures (detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMulti-stage optimisation strategy based on the thirst management model\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme of intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003cp\u003eContent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003cp\u003eT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeam\u003c/p\u003e \u003cp\u003eFormation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFormation includes\u003c/p\u003e \u003cp\u003eMultidisciplinary\u003c/p\u003e \u003cp\u003eteam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdmission\u003c/p\u003e \u003cp\u003eDay 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Team formation with general surgery, anesthesiology, dietetics, oral and mucosal medicine, and Chinese medicine to work together\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eThirst\u003c/p\u003e \u003cp\u003eRecognition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eRecognition\u003c/p\u003e \u003cp\u003ePatient\u003c/p\u003e \u003cp\u003ePotential\u003c/p\u003e \u003cp\u003erisk of thirst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdmission\u003c/p\u003e \u003cp\u003eDay 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Identify risk factors by determining the patient's age, gender, BMI, and asking about the patient's smoking history, previous history of postoperative nausea and vomiting or dizziness, and the patient's psychological state\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Use the Nutritional Risk Screening (NRS) 2002 to assess the patient's nutritional status during the\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePerioperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Record perioperative body intake, excretion, and potassium levels.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Identify whether the patient is at risk for thirst based on the nurse's records, the patient's surgical procedure, anaesthesia medications, medications taken, and nutritional risk status.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"24\" rowspan=\"25\"\u003e \u003cp\u003eThirst\u003c/p\u003e \u003cp\u003eStrategies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003cp\u003eManagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eThe day before surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTeach the patient how to use a numerical rating scale, inform the patient of the possibility of self-reporting, and teach the patient how to use an elephant trunk spray.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Individualized preoperative counseling on the type and amount of diet and avoidance of stimulants.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Introduce patients to perioperative treatment, operating room environment, surgical procedures, and successful cases to relieve patients' tension and anxiety.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Evaluate the t for the patient to receive the table for surgery, assess whether the patient is combined with delayed gastric emptying, abnormal gastrointestinal peristalsis, diabetes mellitus, emergency surgery and other factors, if not, drink 800ml of clear liquid containing 12.5% carbohydrate solution or glucose solution 10h before the operation, and abstain from food for 6h before the operation, and abstain from drinking for 2h before the operation.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003cp\u003eOn the day of surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Score the patient's thirst and thirst discomfort on a numerical rating scale and a perioperative thirst discomfort scale.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Provide psychological care to patients to reduce their anxiety and tell them to promote salivary secretion and moisten the mouth to relieve thirst through psychological suggestion therapy.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Avoid taking medications that may cause vomiting and use antiemetic drugs as prescribed by the doctor.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Avoid preoperative mechanical bowel preparation.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Determine the patient's level of thirst by using the Oral Mucosal Wetting Scale.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntraoperative\u003c/p\u003e \u003cp\u003eManagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUse goal-directed fluid therapy to guide infusion and actively maintain zero fluid balance.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"14\" rowspan=\"15\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003cp\u003eManagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003cp\u003e2h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Observe the degree of wetness of the oral mucosa to determine the degree of thirst.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Score the patient's thirst and thirst discomfort on a numerical rating scale and a perioperative thirst discomfort scale.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Ensure that the temperature in the ward is constant to minimize factors that aggravate the patient's thirst.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003cp\u003e6h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Observe the patient's oral cavity and predictively assess the trend of the patient's thirst.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Replenish fluids in a timely manner according to the patient's intake and output\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Use the elephant trunk spray with 0\u0026ndash;6℃ ice saline to spray the patient's palate, left and right cheeks, and tongue and face 3 times, 1.2 ml each time, the frequency of intervention is one hour, and apply lipstick on the patient's lips after spraying.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ePostoperative period\u003c/p\u003e \u003cp\u003eDay 1\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Observe the patients' oral mucous membrane wetness to determine the patients' thirst level, and use the Adult Thirst Management Safety Assessment Scale to assess whether the patients are ready for the relevant interventions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Massage ShuiQuan, YuJi, and ShakZe points to relieve thirst by a TCM doctor twice a day at 9:00 am and 4:00 pm respectively\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-If passed the assessment, the patient was instructed to use an elephant trunk type spray to relieve thirst every 1 hour, on top of that, the patient was instructed to take a sitting or semi-recumbent position and to chew 1 piece of gum every 2 h for 10 min each t, if the assessment was not passed, after informing the doctor, the patient was assessed every 30 min, if not passed, the patient was given a continuous oxygen-driven nebulization using 15 ml of a 0.45% sodium chloride solution at 35\u0026ndash;37\u0026deg;C Inhalation 20\u0026ndash;30 min/ts, nebulized inhalation oxygen flow rate of 6\u0026ndash;8 L/min, the mask for the mask-type medical nebulizer, assessment until passed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Provide psychological counseling to patients, encourage patients to express their emotions, and enhance their confidence in treatment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;24h after surgery, the patients' thirst and thirst discomfort were scored by the numerical rating scale and perioperative thirst discomfort scale.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003cp\u003eDay 1\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAccording to the doctor's instruction, use the sputum medicine with 0.9% sodium chloride solution, 15ml continuous oxygen-driven nebulized inhalation for 20\u0026minus;30min/ts, the oxygen flow rate of nebulized inhalation is 6\u0026minus;8L/min, and the frequency is once a day.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003cp\u003e4\u0026ndash;5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Observe the degree of wetness of the oral mucosa to determine the degree of thirst of the patient, and dynamically adjust the rehydration measures according to the patient's intake and output.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIf the indication of drinking water is not reached, instruct the patient to take a sitting position or semi-recumbent position on the basis of the use of elephant trunk spray, and mouthwash to alleviate thirst every 2h, and chew 1 piece of gum every 2h for 10 minutes each t; if the indication of drinking water is reached, then drink small amounts of water according to the doctor's instructions.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-Patients' thirst and thirst discomfort were scored on a numeric rating scale and a perioperative thirst discomfort scale.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Outcome Measures\u003c/h2\u003e \u003cp\u003eA custom-designed questionnaire was employed to collect patients' sociodemographic characteristics and baseline clinical data. This primarily included age, gender, hospital admission number, educational attainment, duration of surgery, preoperative fasting period, intraoperative fluid administration volume, and medication use.Study outcomes will be measured at the following time points: T0 (baseline), T1 (2 hours post-surgery), T2 (6 hours post-surgery), T3 (24 hours post-surgery), T4 (3 days post-surgery), and T5 (5 days post-surgery).\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.6.1 Numerical Scoring Scale for Thirst Severity\u003c/h2\u003e \u003cp\u003eThis scale evolved from the visual analogue scale, quantifying patient thirst levels numerically via an 11-point horizontal line (0\u0026ndash;10). Scores of 0 denote no thirst, 1\u0026ndash;3 mild thirst, 4\u0026ndash;7 moderate thirst, and 8\u0026ndash;10 severe thirst. This scale is currently the only clinically available tool for grading thirst severity, demonstrating retest reliability coefficients of 0.65\u0026ndash;0.85 [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e2.6.2 Perioperative Thirst Discomfort Scale\u003c/h2\u003e \u003cp\u003eThis scale assesses patients' thirst discomfort during the perioperative period. Developed by Martins et al. in 2017[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], it was primarily compiled based on the Consensus Criteria for Bias Risk Assessment Checklist from methodological research. Chinese scholars Huang Chenshan et al.[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] conducted Chinese adaptation and reliability/validity testing. The scale demonstrated internal consistency (Cronbach's α) of 0.813, with reliability and validity coefficients of 0.93 and 0.95, respectively. It primarily inquires whether patients experience 'dry mouth, lips, or throat', desire to drink water, or discomfort characterised by 'thick saliva, coated tongue, or foul breath'. These seven aspects of discomfort are scored using a three-point Likert scale, where 0\u0026ndash;2 points represent 'no related distress' to 'severe distress'. The minimum total score is 0, indicating no thirst-related discomfort, while the maximum score of 14 indicates extremely severe thirst discomfort.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e2.6.3 Lip, Tongue, and Oral Mucosal Moisture Measurement Scale\u003c/h2\u003e \u003cp\u003e The Objective Oral Mucosa Scale (OOMS) assesses thirst indirectly through visual inspection of the patient's lips and oral mucosa by the attending nurse. This scale has undergone multiple validations both domestically and internationally[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. It comprises four levels ranging from oral dryness and lip desquamation to complete moisture of the lips, tongue, and oral mucosa. The maximum score is 4 points (Level 1: lip desquamation and fissures, oral dryness with whitening), while the minimum is 1 point (Level 4: lips and oral mucosa fully moist).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e2.7. Statistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using SPSS 26.0 software. The count data were described using frequency (n) and percentage (%). Hypothesis testing employed Pearson's chi-square test, with Fisher's exact test used when chi-square conditions were not met. For continuous data, normally or approximately normally distributed variables were described using mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD), with hypothesis testing using t-tests or analysis of variance (ANOVA). Statistical descriptions for non-normally distributed variables were presented using median and interquartile range, with intergroup comparisons conducted using the rank-sum test. Generalised estimating equations were employed to analyse changes in thirst discomfort and thirst intensity at different time points, thereby controlling for confounding effects such as time.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e2.8 Ethical Considerations\u003c/h2\u003e \u003cp\u003e This study has been approved by the Medical Ethics Committee of Tangdu Hospital, Fourth Military Medical University (Approval No. : K202405-02), dated 7 April 2024.The research team strictly adheres to the principles of the Declaration of Helsinki, fully safeguarding participants' privacy rights while respecting their autonomy and informed consent to participate. Researchers provided male participants with comprehensive project explanations and ample time to consider their participation decision, ensuring each individual's choice is fully respected. All participants signed informed consent forms, and their involvement in the study will not affect the implementation of their original treatment protocols.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eThis study initially enrolled 132 patients who met the inclusion criteria and signed informed consent forms. Participants were allocated to either the intervention group (66 patients) or the control group (66 patients) based on their admission date. All 132 participants completed baseline data collection and subsequent follow-up.\u003c/p\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1. Homogeneity of study participants\u0026apos; characteristics\u003c/h2\u003e\n \u003cp\u003eThe mean ages of the participants in the two groups were 57.98\u0026thinsp;\u0026plusmn;\u0026thinsp;11.53 years and 62.59\u0026thinsp;\u0026plusmn;\u0026thinsp;11.42 years, respectively. The majority of participants had an educational level of junior high school or above. The groups were also comparable in terms of clinical characteristics, including operation duration, anaesthesia duration, preoperative fasting and water deprivation duration, and intraoperative fluid balance. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of general characteristics between the two groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eIntervention group(n\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003et/x\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e57.98\u0026thinsp;\u0026plusmn;\u0026thinsp;11.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e62.59\u0026thinsp;\u0026plusmn;\u0026thinsp;11.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e\u0026minus;1.799\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003ePrimary school or below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003e\u0026minus;0.461\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003e0.646\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eCollege degree or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\n \u003cp\u003e0.434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\n \u003cp\u003e0.665\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eDuration of surgery (h)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e4.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e3.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e1.231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e0.221\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eDuration of anaesthesia (h)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e4.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e0.824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e0.411\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePreoperative fasting and water deprivation duration (h)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e13.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e13.97\u0026thinsp;\u0026plusmn;\u0026thinsp;3.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e\u0026minus;0.507\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eIntraoperative fluid balance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003ePositive balance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\n \u003cp\u003e\u0026minus;0.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\n \u003cp\u003e0.409\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eRelative balance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eNegative balance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eDiuretics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\n \u003cp\u003e0.561\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\n \u003cp\u003e0.576\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAntihypertensive drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e1.244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eProton pump inhibitors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e1.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e0.281\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eGland suppressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e0.357\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.2 Comparison of thirst degree scores between the two groups of patients\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\n \u003cp\u003e3.2.1 Intergroup comparison of perioperative thirst degree between the two groups of patients\u003c/p\u003e\n \u003cp\u003eAt baseline (T1), there was no statistical difference in thirst degree scores between the two groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating balanced grouping. As shown in Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e6\u003c/span\u003e, at each postoperative time point (T1, T2, T3, T4, T5), the scores of the intervention group were significantly lower than those of the control group (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eThe greatest intergroup difference was observed at the postoperative T3 time point, suggesting that the intervention had the most pronounced alleviating effect during the period of most severe thirst.\u003cbr\u003e\u003cbr\u003e\u003cstrong\u003eTable\u0026nbsp;3: Intergroup comparison of thirst degree scores at each time point between the two groups of patients (N\u0026thinsp;=\u0026thinsp;132)\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003egroup\u003c/p\u003e\n \u003cp\u003etime\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eIntervention group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eT0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e\n \u003cp\u003e4.236\u0026thinsp;\u0026plusmn;\u0026thinsp;0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e\n \u003cp\u003e4.329\u0026thinsp;\u0026plusmn;\u0026thinsp;0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e-1.633\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e\n \u003cp\u003e5.402\u0026thinsp;\u0026plusmn;\u0026thinsp;0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e\n \u003cp\u003e5.658\u0026thinsp;\u0026plusmn;\u0026thinsp;0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e-6.316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e\n \u003cp\u003e7.038\u0026thinsp;\u0026plusmn;\u0026thinsp;0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e\n \u003cp\u003e7.435\u0026thinsp;\u0026plusmn;\u0026thinsp;0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e-8.723\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e\n \u003cp\u003e6.432\u0026thinsp;\u0026plusmn;\u0026thinsp;0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e\n \u003cp\u003e6.795\u0026thinsp;\u0026plusmn;\u0026thinsp;0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e-5.781\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e\n \u003cp\u003e5.338\u0026thinsp;\u0026plusmn;\u0026thinsp;0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e\n \u003cp\u003e5.580\u0026thinsp;\u0026plusmn;\u0026thinsp;0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e-3.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eT5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\"±\" colname=\"c2\"\u003e\n \u003cp\u003e3.576\u0026thinsp;\u0026plusmn;\u0026thinsp;0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\"±\" colname=\"c3\"\u003e\n \u003cp\u003e3.738\u0026thinsp;\u0026plusmn;\u0026thinsp;0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e-2.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\n \u003ch2\u003e3.2.2 Within-group and between-group comparisons of changes in thirst degree scores\u003c/h2\u003e\n \u003cp\u003eTo evaluate the dynamic changes induced by the intervention, we calculated the change values in scores from baseline (T1) to each postoperative time point (T2\u0026ndash;T6) for each group and compared them (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Paired samples t-tests (within-group comparisons) revealed that the thirst degree scores of patients in both groups at all postoperative time points differed significantly from the baseline (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that thirst sensation underwent substantial dynamic changes after surgery. The key finding lies in the comparison of the magnitude of change between groups. Independent samples t-test results showed significant differences between the intervention group and the control group in the amount of change from T0 to T1, T2, and T3 (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This indicates that the intervention not only reduced the absolute scores at each time point but, more importantly, significantly altered the trajectory of thirst degree evolution. For instance, from T1 to T3 (the peak period), the control group exhibited a substantial increase in scores (change value: 3.106), whereas the increase in the intervention group was significantly smaller (change value: 2.802). This demonstrates that the intervention effectively buffered the peak intensity of the symptom.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u003cstrong\u003eTable 4: Comparison of within-group and between-group changes in thirst degree scores from baseline to each time point (N=132)\u003c/strong\u003e\u003c/div\u003e\n \u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithin-group paired t-test:\u0026nbsp;\u003c/strong\u003eall time points vs T0 for both groups (P＜0.05),\u003c/p\u003e\n \u003ch2\u003e3.2.3 Analysis Results of the Generalized Estimating Equations Model\u003c/h2\u003e\n \u003cp\u003eAfter controlling for repeated measurement correlations and potential confounding factors using generalized estimating equations (GEE), the model parameter estimate values are shown in Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e5\u003c/span\u003e. The main effect of the group did not reach a significant level (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), suggesting that if the time factor is ignored, the average score difference between the two groups is not significant. However, the interaction term between group and time was statistically significant at time points T1, T2, and T3 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cp\u003eThese negative interaction term coefficients indicate that, compared to the control group, the intervention group had an additional, significant decrease in thirst degree scores at these time points. Among them, the interaction effect was greatest at the T2 time point (\u0026beta; = -0.305, Wald \u0026chi;\u0026sup2;=16.432, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), further confirming that the intervention was most prominent in alleviating postoperative 6h thirst degree.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eGeneralized estimating equation analysis of the group‑by‑time interaction effect on thirst degree scores in the two groups (N\u0026thinsp;=\u0026thinsp;132)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\n \u003cp\u003e95%\u003cem\u003eCI\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\n \u003cp\u003eHypothesis Test\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eLower Limit\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eUpper Limit\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\n \u003cp\u003eWald \u0026sup2;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c9\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e(Intercept)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e4.329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e.0250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e4.280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e4.378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e30060.\u003c/p\u003e\n \u003cp\u003e914\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eGroup (Ref: Control Group)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eIntervention Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e-0.203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e2.707\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\n \u003cp\u003e0.100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\n \u003cp\u003eTime (Ref: T0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e1.329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1.264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e1.394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e1603.922\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e3.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e3.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e4481.435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2.467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e2.369\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e2.565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e2425.611\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e1.252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e1.391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e311.473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eT5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-0.591\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e-0.682\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e-0.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e160.875\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\n \u003cp\u003eGroupTime\u003c/p\u003e\n \u003cp\u003e(Intervention group * T0 as reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eIntervention group* T1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e-0.292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e-0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e6.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eIntervention group* T2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-0.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e-0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e-0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e16.432\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eIntervention group *T3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-0.271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e-0.431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e-0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e11.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eIntervention group *T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e-0.335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e2.521\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eIntervention group* T5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e-0.254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e0.549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\n \u003cp\u003e0.459\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\u003cbr\u003e\u003cstrong\u003e3.3 Comparison of thirst discomfort scores between the two patient groups\u003c/strong\u003e\u003cbr\u003e3.3.1 Between-group comparison of thirst discomfort scores at each time point\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e\n \u003cp\u003eA total of 132 patients were enrolled in this study, with 66 in the intervention group and 66 in the control group. At baseline (T0), there was no statistical difference in thirst discomfort scores between the two groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating comparability. As shown in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, at the postoperative time points from T1 to T4, the scores in the intervention group were significantly lower than those in the control group (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). By the T5 time point, the difference between the two groups was no longer statistically significant (p\u0026thinsp;=\u0026thinsp;0.469).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBetween-group comparison of thirst discomfort scores for the two patient groups (N\u0026thinsp;=\u0026thinsp;132)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e时间点\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eControl GroupX\u0026thinsp;\u0026plusmn;\u0026thinsp;S\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eIntervention group\u0026oline;X\u0026thinsp;\u0026plusmn;\u0026thinsp;S\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eT0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e4.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.665\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e4.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.728\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e-1.381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e0.169\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e8.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.839\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e6.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.965\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e6.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e11.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e9.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e6.907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e7.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.905\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e6.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e4.208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e5.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.765\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e5.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eT5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.727\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e0.469\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\n \u003ch2\u003e3.3.2 Comparison of within-group and between-group changes in thirst discomfort scores\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eNote\u0026nbsp;\u003c/strong\u003eBetween-group comparisons were performed using the independent samples t-test.\u003c/p\u003e\n \u003cp\u003eTo evaluate the dynamic changes induced by the intervention, we compared the change values in scores from baseline to each subsequent time point between the two groups. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e7\u003c/span\u003e, significant differences were observed between the intervention group and the control group in the magnitude of change from T0 to all other time points (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This indicates that the intervention significantly altered the degree of thirst discomfort. For example, from T0 to T2, the control group\u0026apos;s score increased by 7.48 points, whereas the intervention group\u0026apos;s score increased by only 4.86 points, resulting in an intervention effect difference of 2.62 points (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of within-group and between-group changes in thirst discomfort scores from baseline to each time point (N\u0026thinsp;=\u0026thinsp;132)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eTime point\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eDifference in the intervention group (n\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eDifference in the control group (n\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eT0 至 T1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e4.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e-7.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0..001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eT0 至 T2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e4.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e7.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e-5.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eT0 至 T3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e-5.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eT0 至 T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e-1.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e0.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e-4.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eT0 至 T5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e-2.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-2.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e2.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eWithin-group paired t-test: all time points vs T1: P\u0026lt;.001\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec24\" class=\"Section3\"\u003e\n \u003ch2\u003e3.3.3 Results of the Generalized Estimating Equation Model Analysis\u003c/h2\u003e\n \u003cp\u003eAfter controlling for repeated-measures correlations and potential confounding factors using Generalized Estimating Equations (GEE), the overall model test indicated that group (Wald \u0026chi;\u0026sup2; = 83.63, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), time (Wald\u0026chi;\u0026sup2;= 2393.48, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and their interaction (Wald \u0026chi;\u0026sup2; = 127.39, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were all statistically significant. However, the parameter estimates revealed that the main effect of group was not significant after controlling for the time effect (\u0026beta; = -0.38, p\u0026thinsp;=\u0026thinsp;0.14), suggesting a need to examine the specific differences at each time point. See Table \u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e8\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eFurther analysis of the interaction effect parameters showed that, compared to the control group, the intervention group exhibited an additional, significant reduction in thirst discomfort scores at time points T1 to T4 (all interaction terms p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among these, the interaction effect was greatest at the T1 time point (\u0026beta; = -2.30, Wald\u0026chi;\u0026sup2;= 49.17, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This indicates that the intervention group demonstrated the most pronounced effect during the T1 phase, suggesting that the intervention\u0026apos;s effect on alleviating thirst was most prominent 2 hours after surgery. In other words, the intervention was most effective in the short-term post-intervention, with its effect gradually diminishing over time, though it remained superior to that observed in the control group.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eGeneralized Estimating Equation Analysis of the Group-by-Time Interaction Effect on Thirst Discomfort Score (N\u0026thinsp;=\u0026thinsp;132)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\n \u003cp\u003e95%\u003cem\u003eCI\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\n \u003cp\u003eHypothesis Test\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eLower Limit\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eUpper Limit\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eWald \u0026sup2;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e(Intercept)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e4.606\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e4.252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e4.960\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e651.930\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eGroup (Ref: Control Group)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eIntervention Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-0.379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e-0.877\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e2.221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\n \u003cp\u003eTime (Ref: T0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e4.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e3.616\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e4.505\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e320.990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e7.318\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e6.954\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e7.682\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e1551.968\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e3.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e3.903\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e227.637\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e1.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e0.712\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e1.560\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e27.604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eT5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-2.364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e-2.772\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e-1.955\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e128.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\n \u003cp\u003eGroupTime\u003c/p\u003e\n \u003cp\u003e(Intervention group * T0 as reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eIntervention group *T1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-2.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e-2.947\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e-1.659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e49.170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eIntervention group* T2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-2.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e-2.728\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e-1.302\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e30.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eIntervention group *T3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-1.894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e-2.554\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e-1.233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e31.590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eIntervention group* T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-1.591\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.358\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e-2.292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e-0.889\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e19.753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eIntervention group *T5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e0.758\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e1.328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e6.775\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\u003cbr\u003e\u003cstrong\u003e3.4 Comparison of oral mucosa moisture between the two groups\u003c/strong\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\n \u003cp\u003eThe results in Table 9 show that there was no statistically significant between-group difference in oral mucosa moisture between the two groups of patients before surgery (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). From 6 hours after surgery onwards, a significant difference in moisture scores emerged between the intervention group and the control group, which persisted until T5 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Further observation of the oral mucosa moisture scores revealed that, starting from 6 hours post-surgery, the proportion of patients with higher moisture grades in the intervention group gradually increased. This indicates that the intervention effectively improved the postoperative oral mucosa moisture status of the patients, with the effect becoming apparent from 6 hours after surgery and lasting until 5 days post-surgery.\u003cbr\u003e\u003cbr\u003eTable 9: Comparison of oral mucosa moisture scores between the two groups\u003c/p\u003e\n \u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003etime\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003egrade\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eintervention group (n\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003econtrol group (n\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eZ值\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eP值\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003eT0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003e-1.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003e0.297\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e6 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e9 (13.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e32 (48.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e34 (51.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e28 (42.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e23 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e11 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e13 (19.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003e-1.421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003e0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e16 (24.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e23 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e27 (40.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e22 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e12 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e8 (12.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e7 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e15 (22.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003e-2.581\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e18 (27.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e24 (36.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e25 (37.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e18 (27.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e16 (24.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e9 (13.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e4 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e7 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003e-2.344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e12 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e17 (25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e23 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e28 (42.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e27 (40.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e14 (21.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e7 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003e-1.982\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e11 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e16 (24.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e20 (30.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e18 (27.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e32 (48.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e25 (37.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003eT5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e2 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003e-2.519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e1 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e3 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e14 (21.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e23 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e51 (77.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e38 (57.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e This study evaluated an intervention plan grounded in the thirst management model, designed to alleviate thirst and dry mouth in patients undergoing perioperative care for gastrointestinal tumours and thereby enhance their comfort. The findings demonstrated statistically significant reductions in both thirst degree and thirst discomfort, alongside a clinically meaningful decrease in dry mouth. These results suggest that the thirst management model\u0026ndash;based intervention plan may serve as an effective adjunctive strategy for symptom management in clinical nursing practice.\u003c/p\u003e \u003cp\u003e \u003cb\u003e4.1 The thirst management programme for patients undergoing perioperative care for gastrointestinal tumours reduced thirst severity during the perioperative period\u003c/b\u003e \u003c/p\u003e \u003cp\u003eGastrointestinal surgery presents unique complexities; to ensure patient safety and minimise the risk of complications such as anastomotic fistula, most healthcare professionals permit oral intake only after the return of flatus. This practice inevitably prolongs fasting duration and consequently exacerbates postoperative thirst[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In a qualitative study exploring thirst experiences among perioperative patients, participants described thirst as an intensely distressing sensation, with some even reporting feelings of despair and thoughts related to mortality [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Currently, clinical attention in China towards perioperative patients is predominantly focused on domains such as pain management, with relatively limited emphasis placed on thirst. The findings of this study indicate that there was no statistically significant difference in thirst degree between the two groups at baseline (T\u003csub\u003e0\u003c/sub\u003e) (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, at all postoperative time points, the thirst degree scores in the intervention group were significantly lower than those in the control group; the between-group difference was most pronounced at T₃ (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This may be attributable to the peak intensity of thirst experienced during this period, which is likely driven by factors including recovery from anaesthesia, prolonged fasting duration, and surgical stress. Furthermore, generalised estimating equation (GEE) analysis confirmed a statistically significant interaction effect between group and time at the three key time points\u0026mdash;T₂, T₃, and T₄ (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u0026mdash;indicating that the intervention not only reduced the absolute level of thirst but also modified its temporal trajectory. These findings suggest that the intervention plan has clinical relevance in alleviating postoperative thirst symptoms, with particularly pronounced effects during the peak symptom phase. Consistent with both domestic and international research findings\u0026mdash;including those reported by Chen L [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u0026mdash;this pattern may be attributable to progressive stimulation of thirst induced by surgical stress and prolonged pre- and postoperative fasting, resulting in a gradual increase in thirst degree from the preoperative period to 6 hours after surgery. At the 6-hour postoperative time point, patients are generally able to actively cooperate with relevant clinical nursing interventions, which not only help mitigate anxiety and tension but also reduce thirst discomfort.\u003c/p\u003e \u003cp\u003e \u003cb\u003e4.2 The thirst management program for patients undergoing perioperative care for gastrointestinal tumours reduces thirst discomfort throughout the perioperative period.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAccording to multiple studies, the incidence of thirst during the initial postoperative period may reach as high as 78% [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Prolonged dehydration can adversely affect patients' cognition and psychological functioning [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Consequently, exploring effective thirst management programmes in clinical practice is of particular importance. Generalized estimating equation (GEE) analysis in this study revealed that, at 2 hours, 6 hours, day 1, and day 3 after surgery, the intervention group demonstrated significantly greater improvement in thirst discomfort compared with the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with the most pronounced effect observed at 2 hours after surgery. These findings indicate that a systematic assessment and intervention approach can effectively alleviate thirst discomfort, especially during the early postoperative phase. This outcome is consistent with the clinical validation reported by Ma Xiaolan et al. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], who implemented a perioperative thirst symptom management protocol. Further analysis showed that the intervention not only reduced the absolute level of thirst but also altered its temporal trajectory. Thirst discomfort in the control group peaked at six hours after surgery, whereas the intervention group exhibited a significantly lower peak value (9.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.915) and earlier resolution. This improvement in the temporal trajectory of thirst discomfort may help reduce anxiety, agitation, and oral complications arising from severe thirst, thereby potentially facilitating early postoperative recovery and alleviating nursing workload. The underlying rationale is that the thirst management program for patients undergoing perioperative care for gastrointestinal tumours is a comprehensive, individualised approach. It entails a thorough assessment of each patient's condition using validated scales, followed by the implementation of tailored interventions. Such an individualised strategy is more effective in alleviating thirst discomfort throughout the perioperative period, consequently reducing patients' anxiety and distress and promoting faster recovery. Overall, the perioperative thirst management program reduced the severity of thirst discomfort in patients through individualised assessment and targeted interventions. This finding is consistent with those reported in existing studies [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e\u003cb\u003e 4.3 The thirst management program for patients undergoing gastrointestinal tumour surgery improved moisture levels of the lips, tongue, and oral mucosa.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e In this study, the conventional nursing group (control group) exhibited consistently low mucosal moisture scores across all postoperative time points, which may be attributable to the routine practice of using cotton swabs dipped in warm water to moisten the oral cavity. This approach may accelerate evaporation of moisture and thereby exacerbate thirst[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. In contrast, the intervention group undertook an objective assessment of each patient's thirst status before implementing individualised operational measures\u0026mdash;including saline-filled elephant-trunk sprays, chewing sugar-free gum, applying lip balm, and rinsing with mouthwash\u0026mdash;to enhance hydration of the lips, tongue, and oral mucosa. Clinical validation demonstrated that the intervention group achieved significantly higher oral mucosal moisture scores than the control group at multiple postoperative time points (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), thereby effectively maintaining mucosal hydration. These improvements are likely mediated by increased salivary flow induced by chewing gum, cold stimulation, or exposure to acidic solutions. These findings are consistent with those reported in both domestic and international studies[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Furthermore, the lip balm, mouthwash, sugar-free chewing gum, and elephant-trunk spray bottles incorporated into the protocol are all low-cost and widely available, thereby avoiding any increase in healthcare expenditure. Consequently, this protocol demonstrates favourable cost-effectiveness and a degree of clinical applicability.\u003c/p\u003e"},{"header":"5. Limitations","content":"\u003cp\u003eDuring the protocol development phase, the literature review was restricted to sources published in Chinese and English, which may have led to the omission of high-quality evidence available in other languages and thereby compromised the comprehensiveness of the protocol. In the clinical validation phase, the study was conducted at a single Class III Grade A hospital located in Xi\u0026rsquo;an City, Shaanxi Province, with a sample size of only 132 participants; such a small-scale, single-centre design inherently limits the generalisability of the findings. Furthermore, because patients undergoing perioperative care were all accommodated within the same ward in the participating department, it was not feasible to conduct a randomised controlled trial, and a quasi-experimental design was therefore adopted instead. Future research should build upon ongoing evidence updates and protocol refinements to implement multicentre, large-sample randomised controlled trials to rigorously evaluate the feasibility and effectiveness of this protocol. In addition, objective assessment of intervention outcomes could be enhanced through physiological monitoring techniques, including unstimulated whole salivary flow rate (UWSFR) and oral pH measurement.\u003c/p\u003e"},{"header":"6. Conclusions","content":"\u003cp\u003eThis study developed a perioperative thirst management protocol for gastrointestinal tumor patients through evidence synthesis, expert consultations, and pilot trials, which was clinically validated. The results demonstrated that the protocol effectively alleviated thirst symptoms, reduced discomfort levels, and improved oral mucosal moisture retention during perioperative care. The approach proved feasible, scientifically sound, and clinically effective, providing valuable guidance for healthcare professionals in managing patient thirst during gastrointestinal tumor surgeries.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has obtained approval from our hospital\u0026apos;s Medical Ethics Committee (Approval No.: K202405-02) and has formally commenced recruitment of participants. The research team strictly adheres to the principles of the Declaration of Helsinki, fully safeguarding participants\u0026apos; privacy rights while respecting their autonomy and informed consent in participating in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interest \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their sincere gratitude to all participants for their active involvement. \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eZheng R, Chen R, Han BF, et al. Analysis of malignant tumour prevalence in China in 2022[J]. 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DOI:10.3969/j.issn.1671-8283.2023.09.010\u003c/li\u003e\n \u003cli\u003eChen Jian, Lu Yongmei, Wu Fengling, et al. Experimental and clinical application study of plum spray in alleviating postoperative xerostomia following gastrointestinal surgery [J]. Nursing Research, 2011, 25(27): 2475-2476. DOI:10.3969/j.issn.1009-6493.2011.27.014\u003c/li\u003e\n \u003cli\u003eSun S, Zhu Y, Zheng H, Yu L, Li M .Postoperative thirst nursing intervention based on action research in patients with gastrointestinal tumours[J]. Journal of Nursing Science ,2020,35:65\u0026ndash;67. doi:org/10.3870/j.issn.1001-4152.2020.18.065\u003c/li\u003e\n \u003cli\u003eGlobal cancer burden growing, amidst mounting need for services[J]. Saudi Med J,2024,45(3):326-327.\u003c/li\u003e\n \u003cli\u003eChen L, Li BX, Gan QZ, et al. Enhanced recovery after surgery-based evidence-based care plus ice stimulation for thirst management in convalescent patients following digestive surgery under general anaesthesia[J]. 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Application of ice-water spray based on symptom management theory for thirst in patients undergoing thoracoscopic lobectomy [J]. Chinese Journal of Nursing Science, 2025, 32(04):70-73. DOI:10.16460/j.issn1008-9969.2025.04.070\u003c/li\u003e\n \u003cli\u003eSun Shu-feng, Zhu Yong-jian, Zheng Hui, et al. Action research-based nursing intervention for postoperative thirst in gastrointestinal cancer patients [J]. Journal of Nursing Science, 2020, 35(18): 65-67. DOI:10.3870/j.issn.1001-4152.2020.18.065\u003c/li\u003e\n \u003cli\u003eLian R, Zhou S, Guo Y, Liang H, Lin J, Li D, Wu W, Rao Y, Shao D, Zheng P, Yang X. The effect of ice-cold water spray on postoperative thirst in patients undergoing thoracoscopic lung lobectomy [J]. Journal of Nursing Science, 2025, 32(04): 70-73. doi: 10.1016/j.iccn.2023.103571.\u003c/li\u003e\n \u003cli\u003eWaldr\u0026eacute;us N, Jaarsma T, van der Wal MH, Kato NP. Development and psychometric evaluation of the Thirst Distress Scale for patients with heart failure[J]. Eur J Cardiovasc Nurs,2018 ,17(3):226-234. doi: 10.1177/1474515117728624.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Thirst management, Gastrointestinal cancer, Perioperative care, TMM model, Symptom relief","lastPublishedDoi":"10.21203/rs.3.rs-9038991/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9038991/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThis study aimed to develop and evaluate a multi-stage optimisation strategy based on the thirst management model to alleviate perioperative thirst and dry mouth symptoms in patients with gastrointestinal cancer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA total of 132 patients undergoing gastrointestinal tumour surgery were enrolled and divided into an intervention group and a control group based on surgical duration, with 66 patients in each group. The intervention group received a multi-stage thirst management programme based on the Total Modular Management (TMM) approach; the control group received conventional perioperative thirst care. Thirst status, thirst intensity, and lip and tongue mucosal moisture levels were measured at six time points: preoperatively, and at 2 hours, 6 hours, 1 day, 3 days, and 5 days postoperatively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 132 gastrointestinal cancer patients were recruited (66 in each intervention and control group). The intervention group exhibited statistically significant reductions in thirst intensity and thirst-related discomfort scores at time points T1 to T4, alongside statistically significant improvements in oral mucosal moisture scores from T2 to T5.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis clinical trial demonstrates that, compared with conventional nursing approaches, a multi-stage thirst management protocol based on the TMM model effectively reduces thirst intensity, alleviates thirst-related discomfort, and improves oral mucosal moisture levels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial and Protocol Registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study underwent supplementary registration with the China Clinical Trial Registry on 9 March 2026, bearing the registration number ChiCTR2600120065.\u003c/p\u003e","manuscriptTitle":"The Effect of a Multi-stage Optimisation Strategy on Perioperative Thirst and Dry Mouth in Gastrointestinal Cancer Patients: A Quasi-experimental Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-20 12:01:09","doi":"10.21203/rs.3.rs-9038991/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-05T10:10:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"279570671721174349475404240072577404061","date":"2026-04-14T10:24:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"234637881096664284379566961199986511512","date":"2026-04-13T04:07:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-13T04:03:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-11T14:37:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-13T01:04:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2026-03-05T10:13:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"cbcde409-0941-4a59-9069-03fb11e3e7da","owner":[],"postedDate":"April 20th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-05T10:10:32+00:00","index":25,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T12:01:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-20 12:01:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9038991","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9038991","identity":"rs-9038991","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}