加速康复外科管理联合竖脊肌平面阻滞麻醉在小儿脊髓栓系手术后镇痛中的应用  

Application of accelerated rehabilitation surgical management plus erector spinal plane block during postoperative analgesia of children with tethered spinal cord

作　　者：张立 王君璐 顾志清 肖波[1] Zhang Li;Wang Junlu;Gu Zhiqing;Xiao Bo(Department of Neurosurgery,Affiliated Children's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200062,China;Department of Anesthesiology,Affiliated Children's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200062,China)

机构地区：[1]上海交通大学医学院附属儿童医院神经外科,上海200062 [2]上海交通大学医学院附属儿童医院麻醉科,上海200062

出　　处：《临床小儿外科杂志》2023年第11期1065-1071,共7页Journal of Clinical Pediatric Surgery

基　　金：上海市科学技术委员会上海市2020年度科技创新行动计划医学创新研究专项项目(20Y11905800)

摘　　要：目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念联合竖脊肌平面阻滞(erector spinae plane block,ESPB)麻醉用于小儿脊髓栓系手术后镇痛的效果。方法回顾性分析2020年1月至2022年11月上海交通大学医学院附属儿童医院神经外科收治的79例脊髓栓系患儿临床资料。2020年1月至2021年3月收治的40例为常规组,2021年4月至2022年11月收治的39例为ERAS+ESPB组。比较两组患儿术后3 d内疼痛程度、各项临床功能转归以及并发症发生率等。结果两组患儿术后24 h、48 h、72 h的疼痛评分差异均有统计学意义(P<0.001);时间因素与组别因素的交互效应有统计学意义(F=9.566,P<0.001)。进一步分析术后不同时间点和组别的单独效应,发现常规组术后24 h、术后48 h疼痛评分差异无统计学意义(P=0.180)、术后72 h疼痛评分较术后24 h、术后48 h明显降低(P<0.001);ERAS+ESPB组疼痛评分随着时间的延长而明显降低(P<0.001);术后24 h、48 h、72 h三个时间点ERAS+ESPB组的疼痛评分均明显低于常规组(P<0.001)。在术后临床功能转归中,ERAS+ESPB组住院天数较常规组明显减少[(9.23±1.13)d比(13.85±2.9)d,t=4.683,P=0.022]、按压镇痛泵次数较常规组明显减少[(5.67±1.94)次比(9.18±2.65)次,t=3.818,P=0.031]、下肢功能锻炼开始时间较常规组明显缩短[(4.62±0.66)d比(7.75±0.54)d,t=8.689,P=0.006];两组拔除导尿管的时间差异无统计学意义[(6.66±0.84)d比(6.51±0.72)d,t=1.665,P=0.249]。ERAS+ESPB组术后并发症发生率较常规组明显降低[7.7%(3/39)比25%(10/40),χ^(2)=4.302,P=0.038]。结论对于脊髓栓系患儿实施ERAS理念联合ESPB麻醉管理可以有效控制术后早期疼痛,加快临床功能恢复,减少并发症,缩短住院时间,提高患儿生活质量。Objective To explore the clinical efficacy of enhanced recovery after surgery(ERAS)plus erector spinae plane block(ESPB)for post-untethering analgesia in children.Methods The relevant clinical data were retrospectively reviewed for 79 children with tethered cord syndrome(TCS)from January 2020 to November 2022.A total of 40 cases were in conventional administration group from January 2020 to March 2021 and 39 cases in ERAS+ESPB group from April 2021 to November 2022.Pain degrees,function outcomes and complication rates of two groups were compared within 3 days post-operation.Results Significant inter-group differences existed in pain scores at 24/48/72 h post-operation(F=24.261,P<0.001).Pain scores of conventional and ERAS+ESPB groups were statistically significant(F=176.080,P<0.001).Interaction between time factor and group was statistically significant(F=9.566,P<0.001).Further analysis of separate effects of postoperative analgesic management at different monitoring timepoints and groups revealed no statistically significant difference in pain scores between 24 h and 48 h post-operation in conventional group(P=0.180)and pain scores declined significantly at 72 h versus 24/48 h post-operation(P<0.001).Pain scores at Day 3 post-operation decreased obviously with the elapsing of time in ERAS+ESPB group(P<0.001).Pain scores were significantly lower in ERAS+ESPB group than those in conventional group at 24/48/72 h post-operation(P<0.001).Regarding postoperative function outcomes,length of hospital stay dropped in ERAS+ESPB group compared with conventional group[(9.23±1.13)vs.(13.85±2.9)day,t=4.683,P=0.022],frequency of postoperative analgesic pump compression declined greatly in ERAS+ESPB group versus conventional group[(5.67±1.94)vs.(9.18±2.65),t=3.818,P=0.031].Start time of postoperative functional exercise of lower extremity was significantly shorter in ERAS+ESPB group than that in conventional group[(4.62±0.66)vs.(7.75±0.54)day,t=8.689,P=0.006].No inter-group difference existed in catheter removal time[(6.6

关 键 词：加速康复外科 竖脊肌平面阻滞麻醉 儿童 脊髓栓系 镇痛管理 

分 类 号：R726.1[医药卫生—儿科]