胸腔镜联合快速康复方案治疗儿童先天性膈疝  

A combination treatment of thoracoscopy and enhanced recovery after surgery protocol in children with congenital diaphragmatic hernias

作　　者：刘叶[1] 王贤书[1] 王盛华[1] 谷红霞[1] 岳芳[1] 曹红宾[1] 方江顺[1] LIU Ye;WANG Xianshu;WANG Shenghua(Department of Thoracic Surgery,Hebei Children’s Hospital,Hebei,Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院胸外科,石家庄市050031

出　　处：《河北医药》2023年第20期3124-3127,共4页Hebei Medical Journal

基　　金：河北省医学科学研究课题(编号:20190832)。

摘　　要：目的评价快速康复(ERAS)方案在胸腔镜治疗儿童先天性膈疝的临床效果。方法回顾性分析2010年1月至2020年1月收治的先天性膈疝52例,按是否接受快速康复方案分为对照组和ERAS组,快速康复方案主要包括:围术期护理、饮食管理、血液管理、麻醉管理、营养支持、疼痛管理等。对比分析2组患儿术中出血量、手术时间、术后并发症发生率、生活质量等指标。结果ERAS组纳入患儿25例,对照组患儿27例,统计结果显示2组患儿性别、膈疝侧别、出生时体重、手术日龄等指标差异无统计学意义(P>0.05);ERAS组和对照组平均手术时间及术中出血量为[(119±24)min vs(117±19)min,P=0.603;(6.0±2.5)ml vs(7.2±3.1)ml,P=0.006]。2组平均随访时间为(7.3±4.1)年,ERAS组术后并发症发生率低于对照组,生活质量PedsQL 4.0评分高于对照组,组间对比差异统计学意义(P<0.05)。结论ERAS方案可降低胸腔镜治疗先天性膈疝的术中出血和术后并发症发生率,同时提高了此类患儿术后的生活质量。Objective To evaluate the clinical effect of the enhanced recovery after surgery(ERAS)protocol in thoracoscopic treatment of children with congenital diaphragmatic hernias.Methods Retrospective analysis was performed on 52 cases of congenital diaphragmatic hernias admitted to our hospital from January 2010 to January 2020.They were divided into control group and ERAS group according to whether they received ERAS protocol or not.ERAS protocol mainly included perioperative nursing,dietary management,blood management,anesthesia management,nutritional support,pain management,etc.Intraoperative bleeding volume,operation time,incidence of postoperative complications,quality of life and other indicators were compared and analyzed between the two groups.Results There were 25 and 27 children enrolled in ERAS group and control group,respectively.There were no significant differences in the sex,diaphragmatic hernia side,birth weight and age at operation(days)between groups(P>0.05).The mean operation time was comparable between groups([119±24]min vs[117±19]min,P=0.603).The intraoperative bleeding volume in ERAS group was significantly less than that of control group([6.0±2.5]ml vs[7.2±3.1]ml,P=0.006).All patients were followed up for 7.3±4.1 years.The incidence of postoperative complications in ERAS group was significantly lower than that of control group,and the Pediatric Quality of Life(PedsQL 4.0)score was significantly higher(P<0.05).Conclusion ERAS protocol reduces the incidence of intraoperative bleeding and postoperative complications in children with thoracoscopic treatment of congenital diaphragmatic hernia,which improves postoperative quality of life.

关 键 词：快速康复 先天性膈疝 胸腔镜 修补 手术 

分 类 号：R726.562[医药卫生—儿科]