加速康复外科理念在新生儿小肠闭锁围手术期的应用  

Application of enhanced recovery after surgery for small intestinal atresia in infants

作　　者：宋鑫 贺亮 刘祖伟 史满玉 李昭铸[1] 崔清波[1] Song Xin;He Liang;Liu Zuwei;Shi Manyu;Li Zhaozhu;Cui Qingbo(Department of Pediatric Surgery,The Sixth Affiliated Hospital,Harbin Medical University,Harbin 150086,China)

机构地区：[1]哈尔滨医科大学附属第六医院小儿外科,哈尔滨150086

出　　处：《中华小儿外科杂志》2023年第2期132-138,共7页Chinese Journal of Pediatric Surgery

基　　金：国家卫生健康委能力建设和继续教育中心课题(GWJJ2020100204)。

摘　　要：目的探讨新生儿小肠闭锁围手术期应用加速康复外科管理模式的安全性及有效性。方法回顾性分析2016年9月至2020年12月在哈尔滨医科大学附属第二医院行手术治疗的27例小肠闭锁患儿的临床资料。2018年9月至2020年12月收治的13例患儿,围手术期采用加速康复外科管理模式为ERAS组,其中男3例,女10例;患儿手术日龄为2.00(1.00,3.00)d。2016年9月至2018年8月收治的14例患儿,采用传统围手术期处理方案为对照组,其中男7例,女7例;患儿手术日龄为3.00(1.75,3.25)d。比较两组患儿术后肠内营养开始时间、术后首次经口喂养时间、术后首次排气时间、术后首次排便时间、完全静脉营养时间、术后住院时间、术后并发症、非计划二次手术、需二次手术率等方面的差异。符合正态分布且方差齐的计量资料组间差异比较采用t检验,其余计量资料采用非参数Mann-Whitney检验;计数资料组间比较采用Fisher确切概率法。结果ERAS组和对照组在术后开始肠内营养的时间[2.0(1.5,2.5)d比6.0(5.0,8.0)d,P<0.0001]、术后首次经口喂养时间[4.0(3.0,5.0)d比9.5(5.0,11.0)d,P=0.0006]、术后首次排气时间[2.0(1.0,2.0)d比2.5(2,3.25)d,P=0.048]、完全静脉营养时间[12.0(8.5,13.0)d比18.0(11.5,21.5)d,P=0.012]、术后住院时间[20.0(11.0,24.5)d比24.5(23.0,27.0)d,P=0.029]显著缩短或提前,差异均有统计学意义。ERAS组术后首次排便时间(3.15±1.63)d比对照组的(4.71±3.10)d有所缩短,但差异无统计学意义。两组患儿在术后相关并发症、非计划二次手术、需二次手术等指标差异无统计学意义。结论新生儿小肠闭锁围手术期应用加速康复外科围手术期管理模式是安全可行的,能够有效加速患儿胃肠道功能恢复速度,缩短完全静脉营养时间,缩短患儿术后住院时间,且不增加并发症的发生率,加速患儿的康复进程。Objective To explore the application value of enhanced recovery after surgery(ERAS)in infants with small intestinal atresia.Methods From September 2016 to December 2020,retrospective analysis of clinical data was performed for 27 neonatal small intestinal atresia operated.From September 2018 to December 2020,13 infants with small intestinal atresia underwent ERAS during perioperative management.There were 3 boys and 10 girls with an operative age of 2.00(1.00,3.00)days.From September 2016 to August 2018,14 infants with traditional perioperative management methods was control group.There were 7 boys and 7 girls with an operative age of 3.00(1.75,3.25)days.The inter-group differences were compared in terms of time of initiating postoperative enteral nutrition,time of initial postoperative oral feeding,time of initial postoperative flatus,time of initial postoperative bowel movement,time of total intravenous nutrition,length of postoperative hospitalization,postoperative complications,unplanned re-surgery and rate of need for re-surgery.And t-test was utilized for compare the inter-group differences for measures conforming to a normal distribution with homogeneous variance.Non-parametric Mann-Whitney test was employed for other measures;Fisher's exact probability method for comparing count data.Results ERAS and control groups had the same time to start postoperative enteral nutrition[2.0(1.5,2.5)vs 6.0(5.0,8.0)days,P<0.0001],time to initial postoperative oral feeding[4.0(3.0,5.0)vs 9.5(5.0,11.0)days,P=0.0006],time to initial postoperative flatus[2.0(1.0,2.0)vs 2.5(2,3.25)days,P=0.048],time to total intravenous nutrition[12.0(8.5,13.0)vs 18.0(11.5,21.5)days,P=0.012]and postoperative hospital stay[20.0(11.0,24.5)vs 24.5(23.0,27.0)days,P=0.029]were significantly shorter;time to initial postoperative bowel movement was shorter in ERAS group than that in control group[(3.15±1.63)vs(4.71±3.10)days].However,the difference was not statistically significant.No statistically significant inter-group difference existed in pos

关 键 词：肠闭锁 加速康复外科 新生儿 

分 类 号：R726.5[医药卫生—儿科]