加速康复外科策略在儿童漏斗胸手术中的应用  

Efficacy of enhanced recovery after surgery on postoperative recovery in funnel chest children undergoing Nuss surgery

作　　者：滑蕾 于洁[2] 任艺 马阳巍 张富洲[1] 张建敏[1] Hua Lei;Yu Jie;Ren Yi;Ma Yangwei;Zhang Fuzhou;Zhang Jianmin(Department of Anesthesiology,Affiliated Beijing Children's Hospital,National Children's Medical Center,Capital Medical University,Beijing 100045,China;Department of Thoracic Surgery,Affiliated Beijing Children's Hospital,National Children's Medical Center,Capital Medical University,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院麻醉科,北京100045 [2]国家儿童医学中心,首都医科大学附属北京儿童医院胸外科,北京100045

出　　处：《临床小儿外科杂志》2024年第11期1082-1087,共6页Journal of Clinical Pediatric Surgery

基　　金：吴阶平医学基金会临床科研专项基金自助项目(320.6750.19089-102)。

摘　　要：目的探索和评价加速康复外科(enhanced recovery after surgery,ERAS)策略应用于儿童漏斗胸Nuss手术的有效性和安全性。方法回顾性分析2020年12月至2022年10月在首都医科大学附属北京儿童医院行Nuss手术的99例漏斗胸患儿临床资料,年龄5~14岁,根据围手术期管理方案分为ERAS组(E组,50例)和对照组(C组,49例)。E组采用策略主要包括:术前宣教、呼吸锻炼、缩短术前禁水时间、多模式镇痛、麻醉深度监测、保护性肺通气、预防术后恶心呕吐等。C组采用常规措施,包括禁食禁饮6 h,仅以静脉滴注阿片类药物镇痛,未予保护性肺通气及预防性止吐药物。比较两组患儿术后镇痛效果、恢复情况、阿片类药物相关不良事件(便秘、恶心、呕吐)、肺部并发症发生率、住院时间、实验室检查结果(C反应蛋白、白细胞计数、中性粒细胞占比)等。结果E组患儿术后第1、6 h的疼痛评分分别为3.0(1.8,5.0)分和3.5(3.0,5.0)分,明显低于C组的4.0(3.0,5.0)分和4.0(3.0,6.0)分;术后48 h内静脉自控镇痛泵(patient controlled analgesia,PCA)总量:E组为41.5(30.8,52.3)mL,小于C组的57.9(43.0,74.0)mL;上述指标差异均有统计学意义(P<0.05)。E组下床活动时间为术后(12.69±4.46)h,早于C组的(17.76±5.54)h;E组开始进食时间为术后(6.26±1.44)h,早于C组的(7.02±1.31)h;上述指标差异均具有统计学意义(P<0.05)。E组术后发生镇痛相关不良事件12例(12/50,24%),少于C组的18例(18/49,36.7%);差异具有统计学意义(P<0.05)。两组术后第12、24、48 h疼痛评分、肛门排气时间、术后肺部并发症发生率、住院时间、住院费用及术后血常规结果差异均无统计学意义(P>0.05)。结论ERAS策略用于儿童Nuss手术安全有效,可显著减轻患儿术后6 h内疼痛感受,减少阿片类药物用量,加快术后恢复速度,降低镇痛相关不良事件的发生率,但尚无充分证据表明其可以缩短住院时间及减少肺部并发症。ObjectiveTo explore the effectiveness and safety of enhanced recovery after surgery(ERAS)strategies on postoperative recovery for funnel chest children undergoing Nuss procedure.MethodsA total of 99 children undergoing elective Nuss procedure were randomized into two groups of ERAS(n=50)and control(n=49).The strategies of ERAS group included preoperative education,breathing exercises,shortening preoperative water fasting time,multimodal analgesia,depth of anesthesia monitoring,lung-protective ventilation and prevention of postoperative nausea&vomiting.Control group fasted for 6 h,only took intravenous opioids for analgesia,no lung protective ventilation and there was no dosing of preventive antiemetic.Postoperative pain score,opioid-related adverse events(constipation,nausea&vomiting),incidence of pulmonary complications,length of hospitalization,laboratory tests(C-reactive protein,white blood cell count&neutrophil proportion)and other outcome parameters were compared between two groups.ResultsAt postoperative 1/6 h,numerical rating scale(NRS)scores were 3.0(1.8,5.0)and 3.5(3.0,5.0)in ERAS group.Both were significantly lower than that in control group(4.0[3.0,5.0]and 4.0[3.0,6.0])(P<0.05).Cumulative usage of PCA was 41.5(30.8,52.3)ml and it was significantly lower than 57.9(43.0,74.0)ml in control group(P<0.05).Twelve cases(12/50,24%)developed adverse events related to postoperative analgesia.It was significantly lower than 18 cases(18/49,36.7%)in control group(P<0.05).No significant inter-group difference existed in NRS scores at postoperative 12/24/48 h,the incidence of postoperative pulmonary complications,length of hospitalization,total expense or postoperative blood tests(all P>0.05).ConclusionsBoth safe and effective for children undergoing NUSS procedure,ERAS strategies may reduce postoperative pain score and usage of opioid within postoperative 6 h and lower the incidence of analgesic-related adverse events.However,there is insufficient evidence of ERAS on shortening length of hospitalization and lowering

关 键 词：漏斗胸 胸外科手术 术后加速康复 治疗结果 儿童 

分 类 号：R47[医药卫生—护理学]