日间手术管理模式在儿童机器人动脉导管结扎术中的应用  

Application of Enhanced Recovery Surgery in Pediatric Robotic Arteriosus Catheter Ligation Day Surgery

作　　者：赵杭燕[1] 刘喜旺[2] 应力阳[2] 林彬洁 章何莹 舒强[2] Zhao Hangyan;Liu Xiwang;Ying Liyang;Lin Binjie;Zhang Heying;Shu Qiang(Department of Operation room,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center For Child Health;Department of Heart Center,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center For Child Health,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院手术室、国家儿童健康与疾病临床医学研究中心 [2]浙江大学医学院附属儿童医院心脏中心、国家儿童健康与疾病临床医学研究中心,杭州310052

出　　处：《临床小儿外科杂志》2024年第10期924-928,共5页Journal of Clinical Pediatric Surgery

基　　金：浙江省中医药科技计划项目(2023ZL499)。

摘　　要：目的探讨日间手术管理模式在先天性动脉导管未闭患儿行机器人动脉导管结扎手术中应用的可行性。方法本研究为回顾性研究, 将浙江大学医学院附属儿童医院2020年8月至2023年10月采用达芬奇机器人手术治疗的275例动脉导管未闭患儿作为研究对象, 将加速康复外科(enhanced recovery after surgery, ERAS)理念下应用日间手术管理方法者纳入日间组(n=120), ERAS下应用常规住院手术管理方法者纳入对照组(n=155), 比较两组手术时长、术前禁饮时长、术后首次进水时间、术后疼痛评分、术后并发症发生率、当日手术取消率、术后家长满意度、住院时长以及住院总费用差异。结果日间组和对照组术前禁饮时间分别为(136.18±23.05)min和(339.28±111.274)min, 术后首次进水时间分别为(63.14±12.841)min和(168.33±59.516)min, 住院时长分别为(1.00±0.00)d和(2.72±2.25)d, 住院费用分别为(5.176±0.135)万元和(5.333±0.187)万元, 差异均有统计学意义(P<0.05)。日间组当日手术取消率为1.64%(2/120), 低于对照组的9.88%(17/155), 差异有统计学意义(P<0.05)。日间组和对照组术后发热发生率分别为7.50%(9/120)和38.06%(59/155)、术后残余漏发生率分别为0.83%(1/120)和7.10%(11/155), 差异均有统计学意义(P<0.05);但两组术后声音嘶哑发生率差异无统计学意义(P>0.05)。日间组和对照组术后疼痛评分分别为(0.83±1.23)分和(0.78±1.10)分, 差异无统计学意义(P>0.05)。结论 ERAS下日间手术管理应用在儿童机器人动脉导管结扎手术中, 可大幅度缩短住院时长, 降低住院总费用, 优化患儿及家长就医体验, 且不增加术后并发症, 临床应用安全可行。Objective To investigate the feasibility and clinical efficacy of a day surgery management model in pediatric patients undergoing robot-assisted patent ductus arteriosus(PDA)ligation as a day surgery.Methods This retrospective study included 275 PDA children undergoing Da Vinci robot assisted endoscopy at the Children's Hospital,Zhejiang University School of Medicine,from August 2020 to October 2023.Patients were divided into two groups:the day surgery group(n=120)managed with a day surgery approach under ERAS protocol,and the control group(n=155)managed with conventional inpatient surgery approach under ERAS protocol,The two groups were compared for differences in surgery duration,preoperative fasting time,time to first postoperative fluid intake,postoperative pain scores,incidence of postoperative complications,sur-gery cancellation rate on the day of surgery,parental satisfaction,length of hospital stay,and total hospitalization costs.Results The day surgery group had a significantly shorter preoperative fasting duration(136.18±23.05 min us.339.28±111.274 min),time to first postoperative fluid intake(63.14±12.841 min vs.168.33±59.516 min),length of hospital stay(1.00±0.00 days us.2.72±2.25 days),and total hospitalization costs(51760±1350 RMB vs.53330±1870 RMB)compared to the control group(P<0.05).The surgery can-cellation rate on the day of surgery was significantly lower in the day surgery group[1.64%(2/120)us.9.88%(17/155),P<0.05].The incidence of postoperative fever[7.50%(9/120)us.38.06%(59/155)]and residual leakage[0.83%(1/120)us.7.10%(11/155)] was significantly lower in the day surgery group(P<0.05),but there was no statistically significant difference in postoperative hoarseness.Postoperative pain scores were similar between the two groups(0.83±1.23 us.0.78±1.10,P>0.05).Conclusions The ap-plication of the day surgery management model under ERAS protocol in pediatric robot-assisted PDA ligation significantly reduces the length of hospital stay and total hospitalization costs,optimizes the health

关 键 词：加速康复外科 机器人手术 日间手术 动脉导管未闭 儿童 

分 类 号：R47[医药卫生—护理学]