加速康复外科在小儿肠重复畸形围手术期的应用研究  

Application of enhanced recovery after surgery for perioperative management of intestinal duplication in children

作　　者：李鑫 林松 詹江华[3] 余晨 阿里木江·阿不都热依木 Li Xin;Lin Song;Zhan Jianghua;Yu Chen;Alimujiang Abudureyimu(Graduate School, Tianjin Medical University, Tianjin 300070, China;Department of Pediatric Surgery, Urumqi Children's Hospital, Urumqi 830000, China;Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin 300134, China)

机构地区：[1]天津医科大学研究生院,300070 [2]乌鲁木齐儿童医院普外科,830000 [3]天津市儿童医院普外科,300134

出　　处：《中华小儿外科杂志》2019年第9期779-783,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨加速康复外科理念在小儿肠重复畸形围手术期应用的安全性和有效性。方法回顾性分析天津市儿童医院普外科和乌鲁木齐儿童医院普外科于2015年1月至2019年1月收治的38例小儿肠重复畸形患儿的临床资料。根据围手术期管理方式不同,将2015年1月至2017年7月间以传统围手术期管理模式、开放手术治疗的18例患儿,设为对照组;将2017年8月至2019年1月间以加速康复外科管理模式、微创手术治疗的20例患儿,设为研究组(ERAS组)。比较两组患儿手术时间,术中出血量,术后首次喂水、进食、排便时间,肠外营养持续时间,术后并发症(吻合口瘘、术后出血、肠梗阻、切口感染、呼吸道感染),术后住院时间,住院费用及患儿家长满意度。结果两组患儿在年龄、入院体重、术前营养状况、手术时间、术中出血量及并发症发生情况等方面比较,差异均无统计学意义(P>0.05)。ERAS组与对照组患儿术后首次喂水时间[(25.90±4.53)h比(103.00±8.94)h]、术后首次进食时间[(36.90±4.42)h比(127.28±6.52)h]、术后首次排便时间[(35.45±7.05)h比(43.56±10.38)h]、肠外营养持续时间[(7.05±0.83)d比(10.06±0.80)d]、住院时间[(9.26±0.59)d比(11.64±1.91)d]和住院费用[(14627.71±478.36)元比(16493.28±511.46)元]比较,差异均有统计学意义(P<0.05或P<0.001);且ERAS组患儿家属满意度较对照组明显提高(92.06%比79.36%,P=0.037)。结论小儿肠重复畸形围手术期采用加速康复外科管理模式是安全有效的;可以降低患儿围手术期创伤应激,促进术后康复,缩短住院时间,降低住院费用,提高患儿家属满意度。Objective To explore the safety and effectiveness of employing the model of enhanced recovery after surgery (ERAS) for perioperative management of intestinal duplication in children. Methods A total of 38 children hospitalized with intestinal duplication at Tianjin Children's Hospital and Urumqi Children's Hospital were analyzed retrospectively from January 2015 to January 2019. According to different perioperative management methods, 18 children undergoing open surgery with traditional perioperative management mode were selected as the control group. From January 2015 to July 2017, 20 children undergoing minimally invasive surgery with ERAS management mode were included into the study group (ERAS group). The parameters of operative duration, intraoperative blood loss, time of initial intake of water/feeding/defecation, duration of parenteral nutrition, occurrence of postoperative complications (anastomotic leakage, postoperative bleeding, intestinal obstruction, wound infection & respiratory infection), hospitalization time, hospitalization expenses and parental satisfaction of patients were compared between two groups. Results No significant inter-group difference existed in age, admission weight, preoperative nutritional status, operative duration, intraoperative blood loss or occurrence of postoperative complications (P>0.05). ERAS and control groups were compared in terms of postoperative time of initial intake of water [(25.90±4.53) vs.(103.00±8.94) hours, P<0.001], feeding [(36.90±4.42) vs.(127.28±6.52) hours, P<0.001], defecation [(35.45±7.05) vs.(43.56±10.38) hours, P<0.05], parenteral nutrition duration [(7.05±0.83) vs.(10.06±0.80) days, P<0.05] and hospitalization time [(9.26±0.59) vs.(11.64±1.91) days, P<0.001] and hospitalization expenses [(14 627.71±478.36) vs.(16 493.28±511.46) yuan]. The differences were statistically significant (P<0.05 or P<0.001). The satisfaction of families of ERAS group was significantly higher than that of control group (92.06% vs. 79.36%, P=0.037). Conclusions

关 键 词：肠重复畸形 安全性 加速康复外科 

分 类 号：R726.5[医药卫生—儿科]