日归模式在日间手术的临床应用与探讨  

Clinical application and discussion of same-day discharge in day surgery

作　　者：詹丽莉 刘洋[2] 蒋丽莎[2] 李兰 黄明君[1] 刘茜 戴燕[1] ZHAN Lili;LIU Yang;JIANG Lisha;LI Lan;HUANG Mingjun;LIU Qian;DAI Yan(Day Surgery Center,West China Hospital,Sichuan University/West China School of Nursing,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Day Surgery Center,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院日间手术中心/四川大学华西护理学院,成都610041 [2]四川大学华西医院日间手术中心,成都610041

出　　处：《华西医学》2022年第2期189-193,共5页West China Medical Journal

基　　金：国家自然科学基金(71804118,72104161);四川省科技计划项目(2018ZR0129,2021YFS0186)。

摘　　要：目的探讨日归手术模式下小儿血管瘤硬化剂注射术及成人腹股沟疝无张力修补术的安全性及应用效果。方法回顾性分析2020年11月-2021年10月在四川大学华西医院日间服务中心接受小儿血管瘤硬化剂注射术和成人无张力疝修补术患者,按照患者病情和意愿分为日归组(小儿162例、成人180例)和日间组(小儿68例、成人271例),分析比较两组患者术中出血量、住院时长、住院费用、出院前疼痛以及术后短期并发症等指标。疼痛评估时,成人及6岁后儿童采用视觉模拟评定量表,6岁前儿童采用笑脸评分法。结果日归手术患者比日间手术患者术中出血量少[小儿:(0.45±0.05)vs.(2.76±1.21)mL,P<0.05;成人:(1.20±0.05)vs.(6.76±2.30)mL,P<0.05],住院时长短[小儿:(7.99±1.22)vs.(23.10±1.42)h,P<0.05;成人:(6.13±1.79)vs.(22.75±1.80)h,P<0.05],住院费用低[小儿:(5094.00±1320.14)vs.(6263.52±1220.20)元,P<0.05;成人:(7199.21±1535.84)vs.(7976.82±1967.82)元,P<0.05],出院前疼痛程度轻[小儿:(0.05±0.02)vs.(0.50±0.01)分,P<0.05;成人:(1.20±0.01)vs.(2.01±0.20)分,P<0.05],两种模式患者术后并发症发生率和30 d内非计划再就诊率差异无统计学意义(P>0.05)。结论日归手术模式在小儿血管硬化剂注射术和成人无张力疝修补术上是安全和可行的,并能缩短住院时长,降低住院成本,建议在临床中推广该模式。Objective To investigate the safety and effect of same-day discharge in injection sclerotherapy for children with hemangioma(IJCH)and tension-free hernioplasty for adults with inguinal herinia(TFHA).Methods A retrospective analysis was conducted on patients undergoing IJCH or TFHA in the Day Surgery Center of West China Hospital of Sichuan University between November 2020 and October 2021.According to the patient’s condition and willingness,they were divided into same-day discharge group(162 children and 180 adults)and overnight hospitalization group(68 children and 271 adults).The amount of intraoperative bleeding,length of hospital stay,hospitalization expenses,pain before discharge,and short-term postoperative complications were compared between the two groups.Visual analogue scale was used for pain assessment in adults and children over 6 years old,and smiley face score was used in children below 6 years old.Results Compared with those in the overnight discharge group,the amount of intraoperative bleeding in the same-day discharge group was less[IJCH:(0.45±0.05)vs.(2.76±1.21)mL,P<0.05;TFHA:(1.20±0.05)vs.(6.76±2.30)mL,P<0.05],length of hospital stay was shorter[IJCH:(7.99±1.22)vs.(23.10±1.42)h,P<0.05;TFHA:(6.13±1.79)vs.(22.75±1.80)h,P<0.05],hospitalization cost was lower[IJCH:(5094.00±1320.14)vs.(6263.52±1220.20)yuan,P<0.05;TFHA:(7199.21±1535.84)vs.(7976.82±1967.82)yuan,P<0.05],pain before discharge was milder(IJCH:0.05±0.02 vs.0.50±0.01,P<0.05;TFHA:1.20±0.01 vs.2.01±0.20,P<0.05).There was no significant difference in the incidence of postoperative complications or unplanned revisit within 30 days between the two modes(P>0.05).Conclusions The same-day surgery mode is safe and feasible in IJCH and TFHA,and can shorten the length of hospital stay and reduce the cost of hospitalization.It is suggested to popularize this mode in clinical practice.

关 键 词：日归手术 日间手术 小儿血管瘤 腹股沟疝 

分 类 号：R473.6[医药卫生—护理学]