加速康复外科在游离股前外侧皮瓣修复儿童四肢创面中的应用  

Clinical efficacy of enhanced recovery after surgery in repairing the wounds of children′s limbs with free anterolateral thigh flap

作　　者：姜梦露 印飞[2] 芮永军[2] 王猛[3] 刘祯庆 Jiang Menglu;Yin Fei;Rui Yongjun;Wang Meng;Liu Zhenqing(Medical College of Suzhou university,Suzhou 215000;Department of Hand Surgery,Wuxi 9th People′s Hospital Affiliated to Suzhou University,Wuxi 214062,China;Department of Anesthesiology,Wuxi 9th People′s Hospital Affiliated to Suzhou University,Wuxi 214062,China)

机构地区：[1]苏州大学医学部,苏州215000 [2]苏州大学附属无锡九院手外科,无锡214062 [3]苏州大学附属无锡九院麻醉科,无锡214062

出　　处：《中华手外科杂志》2022年第3期176-179,共4页Chinese Journal of Hand Surgery

基　　金：江苏省青年医学重点人才培养计划(QNRC2016171);无锡市卫健委科技成果与适宜技术推广项目(T201927)。

摘　　要：目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念应用于游离股前外侧皮瓣修复小儿四肢创面中的临床效果。方法将自2013年1月至2016年12月收治的30例游离股前外侧皮瓣修复四肢创面的患儿作为对照组,行传统围手术期管理模式;将自2017年1月至2021年4月收治的30例患儿作为研究组,行ERAS管理模式。对比两组手术时间、术中出血量、术后各时间段疼痛程度、术后并发症(皮瓣血管危象、发热、咳嗽、咳痰、腹泻、呕吐)发生情况、住院时间、住院费用及家属满意度。结果研究组手术时间、术中出血量及术后2、6、12 h的改良面部表情评分法(FLACC)疼痛评分明显低于对照组(P<0.05)。研究组较对照组术后血管危象及不良反应发生率低、住院时间短、住院费用低、家属满意度高(P<0.05)。结论ERAS应用于游离股前外侧皮瓣修复小儿四肢创面围手术期管理能降低围手术期各种应激反应,在降低术后疼痛及并发症的同时能加速机体康复从而达到缩短住院时间的目的,值得临床推广。Objective To investigate the clinical efficacy of enhanced recovery after surgery in repairing the wounds of children′s limbs with free anterolateral thigh flap.Methods Thirty children with limb wounds repaired with free anterolateral thigh flap from January 2013 to December 2016 were treated as the control group,and underwent the traditional perioperative management mode;30 children from January 2017 to April 2021 were treated as the study group and underwent ERAS management mode.The operation time,the amount of intraoperative bleeding,the degree of pain in each time period after operation,the incidence of postoperative complications(flap vascular crisis,fever,cough,expectoration,diarrhea and vomiting),hospital stay,hospital expenses and family members′satisfaction were compared between the two groups.Results The operation time,the amount of intraoperative bleeding and the improved facial expression pain score(FLACC)at 2,6 and 12 hours after operation in the study group were significantly lower than those in the control group(P<0.05).Compared with the control group,the study group had lower incidence of postoperative vascular crisis and adverse reactions,shorter hospitalization time,lower hospitalization expenses and higher satisfaction of family members(P<0.05).Conclusion The application of ERAS in the perioperative management of free anterolateral thigh flap in the repair of limb wounds in children can reduce all kinds of perioperative stress reactions,reduce postoperative pain and complications,accelerate the recovery of the body,so as to shorten the hospital stay,which is worthy of clinical promotion.

关 键 词：外科皮瓣 疼痛 加速康复外科 创面修复 

分 类 号：R726[医药卫生—儿科]