小儿腹腔镜巨结肠根治术后拔除胃管时机的应用研究  

Application research of timing of removal of the nasogastric tube after laparoscopic assisted Hirschsprung’s radical operation in children

作　　者：刘笑天 韩丁[1] 张震[2] 李龙[2] 李颀[2] 吴新雁 潘守东[1] LIU Xiao-tian;HAN Ding;ZHANG Zhen;LI Long;LI Qi;WU Xin-yan;PAN Shou-dong(Department of Anesthesiology,the Children’s Hospital Affiliated to Capital Institute of Pediatrics;不详)

机构地区：[1]首都儿科研究所附属儿童医院麻醉科 [2]首都儿科研究所附属儿童医院普外科

出　　处：《中华全科医学》2020年第3期349-351,441,共4页Chinese Journal of General Practice

基　　金：国家自然科学基金资助项目(81700451)。

摘　　要：目的探讨小儿巨结肠术后不保留胃管的安全性和可行性。方法从2018年2月-2019年2月,选取60例首都儿科研究所附属儿童医院诊断为短段型和常见型巨结肠,行腹腔镜辅助巨结肠根治术的患儿。患儿入手术室后按随机数字表分成2组,观察组(30例)麻醉清醒后即刻拔出胃管,对照组(30例)术后保留胃管至排便。比较2组患儿一般资料、手术时间、术后排便时间、腹围(术前、术毕、术后24 h、术后48 h),呕吐发生率、进水时间、进食时间、术后住院时间、总住院费用、术后30 min躁动评分。结果 2组患儿性别构成、年龄[5.5(3.0,23.2)月龄vs. 6.5(3.0,19.5)月龄]、体重[(8.6±3.1)kg vs.(9.1±2.3)kg]、手术时间[107(97,118)min vs. 110(99,130)min]、进食时间[64(52,74)h vs. 75(52,84)h]、术后排便时间[24(20,33)h vs. 25(15,40)h]差异无统计学意义(均P>0.05)。与对照组比较,观察组术后30 min躁动评分[5.0(5.0,5.0)vs. 7.0(5.0,10.0)]、呕吐发生率[4(13%) vs. 13(43%)]、进水时间[(30(20,48)h vs. 48(35,71)h]、术后住院时间[6.0(5.0,7.0)d vs. 6.6(5.6,9.6)d]、总住院费用[3.4(2.4,3.7)万元vs. 4.0(3.0,4.3)万元]明显降低均(P<0.05),术后24 h观察组腹围显著大于对照组(P<0.05)。结论腹腔镜下小儿短段型、常见型巨结肠根治术后移除胃管是安全、可行的,可以提高患儿舒适度。Objective To evaluate the safety and feasibility of removing nasogastric tube in children after laparoscopic assisted Hirschsprung’s radical operation. Methods From February 2018 to February 2019, 60 children in the Children’s Hospital affiliated to Capital Institute of Pediatrics diagnosed with short-segment and common type of Hirschsprung’s disease and undergoing laparoscopic assisted radical operation were selected. The children were divided into study group(n=30) and control group(n=30) according to the random number table after entering the operating room. In the study group, the nasogastric tube was removed immediately after recovery of anesthesia, while in the control group, the nasogastric tube was left in place after surgery until the patient passed stool. General information, operative time, postoperative first dejection time, abdominal perimeter(prior to surgery, end of surgery, 24-hour and 48-hour post-surgery), frequency of vomiting, time to start of water and food intake, length of postoperative hospital stay, cost of hospitalization, and pediatric anesthesia emergence delirium(PAED) 30-minutes after surgery were compared between the two groups. Results The gender structure, age [5.5(3.0, 23.2) vs. 6.5(3.0, 19.5) months)], weight [(8.6±3.1) kg vs.(9.1±2.3) kg], operative time [107(97, 118) vs. 110(99, 130) min], time to start of food intake [64(52, 74) vs. 75(52, 84)], and postoperative first dejection time [24(20, 33) h vs. 25(15, 40) h] were not significantly different between the two groups(all P>0.05). Compared with control group, PAED 30-minutes after surgery [5.0(5.0, 5.0) vs. 7.0(5.0, 10.0)], frequency of vomiting [4(13%) vs. 13(43%)], time to start of water intake [30(20, 48) h vs. 48(35, 71) h], length of postoperative hospital stay [6.0(5.0, 7.0) vs. 6.6(5.6, 9.6) days], and cost of hospitalization [3.4(2.4, 3.7) vs. 4.0(3.0, 4.3) ] were significantly decreased in the study group(all P<0.05). The abdominal perimeter 24-hour post-surgery was significantly higher in the study group t

关 键 词：不留置胃管 先天性巨结肠 快速康复外科 腹腔镜 

分 类 号：R726.1[医药卫生—儿科]