Zheng Ruifei,Lyu Xiaofeng,Zhang Jie,et al.Application of enhanced recovery after surgery strategies in the perioperative period of biliary atresia[J].Journal of Clinical Pediatric Surgery,,():729-736.[doi:10.3760/cma.j.cn101785-202310050-006]
Application of enhanced recovery after surgery strategies in the perioperative period of biliary atresia
- Keywords:
- Biliary Atresia; Kasai Surgery; Enhanced Recovery After Surgery; Perioperative Care; Complications
- Abstract:
- Objective To explore the safety and efficacy of various strategies of enhanced recovery after surgery (ERAS) during perioperative period in children with biliary atresia (BA).Methods From January 2019 to August 2023,retrospective analysis was conducted for the relevant clinical data of 103 BA children undergoing Kasai surgery.They were assigned into two groups of ERAS (implementing multiple new ERAS strategies during perioperative period) and control (traditional perioperative management without ERAS).Two groups were compared with regards to postoperative removal time of various tubes,postoperative feeding start time,postoperative duration of intravenous fluid maintenance,postoperative time of anesthetic recovery,perioperative body temperature,intraoperative volume of blood loss,postoperative platelet count,postoperative inflammatory parameters (IL-1β,IL-2,IL-5,IL-6,IL-8 & TNF-α),preoperative/discharge biochemical parameters,postoperative complication rate,postoperative hospitalization stay or total hospitalization expense.Results No statistically significant inter-group differences existed in general profiles,preoperative/discharge biochemical parameters,intraoperative and postoperative temperature,postoperative platelet count or postoperative complication rate (P>0.05).However,initial postoperative feeding time[(1.79±0.60) vs.(3.66±1.00) day;t=-11.391],postoperative removal time of gastrointestinal decompression tube [(1.21±0.41) vs.(2.32±0.55) day;t=-11.575],removal time of urinary catheter [(1.32±0.47) vs.(3.24±1.22) day;t=-10.403],removal time of abdominal drainage tube [(6.74±2.10) vs.(12.30±4.22) day;t=-8.398],postoperative hospitalization stay [(13.91±3.03) vs.(19.12±6.52) day;t=-5.153;],postoperative maintenance time of intravenous fluid [5(4,6) vs.6(5,7) day;Z=-2.339]and postoperative time of anesthetic recovery [(58.38±19.03) vs.(72.88±36.84)min;t=-2.488]were shorter in ERAS group than those in control group.Hospitalization expense [(40 533.95±6 270.58) vs.(45 669.70±10 867.12) yuan;t=-2.915],intraoperative volume of blood loss[10(10,20) vs.30(13.75,30) mL;Z=-3.721]and IL-6 [21.63(6.41,52.41)]vs.71.20(29.71,140.89) pg/mL;Z=-2.719]were lower than those in control group and the difference was statistically significant (P<0.05).Conclusions The application of various ERAS strategies during perioperative period may minimize intraoperative hemorrhage,blunt postoperative inflammation,shorten length of hospitalization,lower hospitalization expense and promote the recovery of BA children.
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Memo
收稿日期:2023-10-27。
基金项目:江苏省卫健委面上项目(M2022037);南京市卫健委医药卫生科研课题(YKK20121)
通讯作者:蒋维维,Email:wwjiang@njmu.edu.cn