Hu Menglong,Qi Jirong.Research advances in enhanced recovery after surgery for pediatric pectus excavatum during perioperative period[J].Journal of Clinical Pediatric Surgery,2022,21(06):582-585.[doi:10.3760/cma.j.cn101785-202002009-016]
围手术期加速康复理念在漏斗胸中的应用进展
- Title:
- Research advances in enhanced recovery after surgery for pediatric pectus excavatum during perioperative period
- 摘要:
- 加速康复外科(enhanced recovery after surgery,ERAS)理念在成人外科领域已得到推广并取得良好效果。近年来ERAS理念被引入小儿外科,但由于儿童疾病谱的特殊性以及对麻醉、手术的耐受性与成人不同,ERAS在儿童外科的应用面临挑战。就漏斗胸而言,患儿围手术期的疼痛、腹胀、心理或进食障碍等,严重影响手术后的加速康复;同时漏斗胸患儿往往年龄偏大,在临床处理上更接近成人,因此,能否借鉴成人外科在ERAS方面的经验用于漏斗胸患儿的围手术期加速康复,是近年来国内外关注的热点。本文就儿童漏斗胸围手术期镇痛、心理疏导以及术后加速康复策略进行综述。
- Abstract:
- Enhanced recovery after surgery (ERAS) has been popular during adult surgery.Recently people have shifted their attention to children.Children’s special disease spectrum and tolerance to anesthesia and surgery are different from those of adults.Thus it has challenged the focus of ERAS approach.The incidence of adverse reactions such as pain, bloating, psychological or eating disorders remains high during perioperative period of surgery for pediatric pectus excavatum (PE).Thus postoperative recovery is poor.Also PE children tend to be older and closer to adults in clinical management.Whether it can learn from the experience of adult surgery in ERAS and promote the accelerated rehabilitation of pediatric PE is a hot topic in recent years.This review summarized the concrete steps of promoting accelerated rehabilitation during perioperative period of pediatric PE in terms of analgesia, psychological counseling and postoperative rehabilitation.
参考文献/References:
[1] Cramm SL, Luckhurst C, Galls A, et al.Thoracic epidural-based enhanced recovery after surgery (ERAS) pathway for Nuss repair of pectus excavatum shortened length of stay and decreased rescue intravenous opiate use[J].Pediatr Surg Int, 2021, 37(9):1191-1199.DOI:10.1007/s00383-021-04934-x.
[2] Nuss D, Obermeyer RJ, Kelly RE Jr.Pectus excavatum from a pediatric surgeon’s perspective[J].Ann Cardiothorac Surg, 2016, 5(5):493-500.DOI:10.21037/acs.2016.06.04.
[3] 王会, 刘威, 苏芷惠, 等.漏斗胸住院患儿营养状况筛查及影响因素分析[J].中华实用儿科临床杂志, 2019, 34(18):1415-1417.DOI:10.3760/cma.j.issn.2095-428X.2019.18.014.Wang H, Liu W, Su ZH, et al.Screening and influencing factors analysis for nutritional status in hospitalized children with pectus excavatum[J].Chinese Journal of Applied Clinical Pediatrics, 2019, 34(18):1415-1417.DOI:10.3760/cma.j.issn.2095-428X.2019.18.014.
[4] Rove KO, Edney JC, Brockel MA.Enhanced recovery after surgery in children:Promising, evidence-based multidisciplinary care[J].Paediatr Anaesth, 2018, 28(6):482-492.DOI:10.1111/pan.13380.
[5] Shinnick JK, Short HL, Heiss KF, et al.Enhancing recovery in pediatric surgery:a review of the literature[J].J Surg Res, 2016, 202(1):165-176.DOI:10.1016/j.jss.2015.12.051.
[6] George JA, Koka R, Gan TJ, et al.Review of the enhanced recovery pathway for children:perioperative anesthetic considerations[J].Can J Anaesth, 2018, 65(5):569-577.DOI:10.1007/s12630-017-1042-6.
[7] 滑蕾, 高铮铮, 王小雪, 等.加速术后康复(ERAS)策略在儿童漏斗胸手术中的临床应用[J].基础医学与临床, 2018, 38(8):1131-1134.DOI:10.3969/j.issn.1001-6325.2018.08.015.Hua L, Gao ZZ, Wang XX, et al.Clinical application of enhanced recovery after surgery (ERAS) protocol in pediatric patients undergoing Nuss repair of pectus excavatum[J].Basic & Clinical Medicine, 2018, 38(8):1131-1134.DOI:10.3969/j.issn.1001-6325.2018.08.015.
[8] 杨宇蝶, 贾科.胸外科手术围术期的加速康复外科研究进展[J].实用临床医药杂志, 2021, 25(10):119-123.DOI:10.7619/jcmp.20210104.Yang YD, Jia K.Progress of enhanced recovery after surgery in perioperative period of thoracic surgery[J].Journal of Clinical Medicine in Practice, 2021, 25(10):119-123.DOI:10.7619/jcmp.20210104.
[9] 中国心胸血管麻醉学会日间手术麻醉分会, 中华医学会麻醉分会小儿麻醉学组.儿童加速康复外科麻醉中国专家共识[J].中华医学杂志, 2021, 101(31):2425-2432.DOI:10.3760/cma.j.cn112137-20201108-03034.Branch of Ambulatory Surgical Anesthesiology, Chinese Society of Cardiothoracic and Vascular Anesthesiology;Group of Pediatric Anesthesiology, Branch of Anesthesiology, Chinese Medical Association:Chinese Expert Consensus on Enhanced Recovery after Surgery during Anesthesia in Children[J].National Medical Journal of China, 2021, 101(31):2425-2432.DOI:10.3760/cma.j.cn112137-20201108-03034.
[10] Wang L, Guo T, Zhang H, et al.Three-dimensional printing flexible models:a novel technique for Nuss procedure planning of pectus excavatum repair[J].Ann Transl Med, 2020, 8(4):110.DOI:10.21037/atm.2019.12.124.
[11] 扶剑.儿童及青少年漏斗胸患者心理研究进展[J].重庆医学, 2019, 48(4):665-667.DOI:10.3969/j.issn.1671-8348.2019.04.027.Fu J.Advances in psychological research of children and adolescents with pectus excavatum[J].Chongqing Med, 2019, 48(4):131-133.DOI:10.3969/j.issn.1671-8348.2019.04.027.
[12] Li H, Jin X, Fan S, et al.Behavioural disorders in children with pectus excavatum in china:a retrospective cohort study with propensity score matching and risk prediction model[J].Eur J Cardiothorac Surg, 2019, 56(3):596-603.DOI:10.1093/ejcts/ezz038.
[13] Luo L, Xu B, Wang X, et al.Intervention of the nuss procedure on the mental health of pectus excavatum patients[J].Ann Thorac Cardiovasc Surg, 2017, 23(4):175-180.DOI:10.5761/atcs.oa.17-00014.
[14] 谭小莉, 高乐, 何良平, 等.认知行为干预对漏斗胸患儿NUSS术后心理状况及自我效能的影响[J].海南医学, 2020, 31(6):802-804.DOI:10.3969/j.issn.1003-6350.2020.06.036.Tan XL, Gao L, He LP, et al.Effect of cognitive behavioral intervention on psychological status and self-efficacy of children with pectus excavatum after Nuss repair[J].Hainan Medical Journal, 2020, 31(6):802-804.DOI:10.3969/j.issn.1003-6350.2020.06.036.
[15] Wildemeersch D, D’Hondt M, Hondt M, et al.Implementation of an enhanced recovery pathway for minimally invasive pectus surgery:a population-based cohort study evaluating short- and long-term outcomes using ehealth technology[J].JMIR Perioper Med, 2018, 1(2):e10996.DOI:10.2196/10996.
[16] Braegger C, Decsi T, Dias JA, et al.Practical approach to paediatric enteral nutrition:a comment by the ESPGHAN committee on nutrition[J].J Pediatr Gastroenterol Nutr, 2010, 51(1):110-122.DOI:10.1097/MPG.0b013e3181d336d2.
[17] Li R, Qi J.Research progress of perioperative energy metabolism in infants with congenital heart disease[J].Chinese Journal of Clinical Nutrition, 2015, 23(3):189-192.DOI:10.3760/cma.j.issn.1674-635X.2015.03.013.
[18] Wharton K, Chun Y, Hunsberger J, et al.Successful use of an enhanced recovery after surgery (ERAS) pathway to improve outcomes following the Nuss procedure for pectus excavatum[J].J Pediatr Surg, 2020, 55(6):1065-1071.DOI:10.1016/j.jpedsurg.2020.02.049.
[19] 中华医学会小儿外科分会, 中华医学会麻醉学分会小儿麻醉学组.加速康复外科指导下的儿童围手术期处理专家共识[J].中华小儿外科杂志, 2021, 42(12):1057-1065.DOI:10.3760/cma.j.cn421158-20210822-00417.Branch of Pediatric Surgery, Chinese Medical Association;Group of Pediatric Anesthesiology, Branch of Anesthesiology, Chinese Medical Association:Expert Consensus on Perioperative Management of Children under the Guidance of Enhanced Recovery after Surgery[J].Chin J Pediatr Surg, 2021, 42(12):1057-1065.DOI:10.3760/cma.j.cn421158-20210822-00417.
[20] Gelman D, Gelmanas A, Urbanait[KG-1.1mm] e[DD(-*3/4]·D, et al.Role of multimodal analgesia in the evolving enhanced recovery after surgery pathways[J].Medicina (Kaunas), 2018, 54(2):E20.DOI:10.3390/medicina54020020.
[21] Crumley S, Schraag S.The role of local anaesthetic techniques in ERAS protocols for thoracic surgery[J].J Thorac Dis, 2018, 10(3):1998-2004.DOI:10.21037/jtd.2018.02.48.
[22] Piccioni F, Segat M, Falini S, et al.Enhanced recovery pathways in thoracic surgery from Italian VATS Group:perioperative analgesia protocols[J].J Thorac Dis, 2018, 10(Suppl 4):S555-S563.DOI:10.21037/jtd.2017.12.86.
[23] Semenkovich TR, Hudson JL, Subramanian M, et al.Enhanced recovery after surgery (eras) in thoracic surgery[J].Semin Thorac Cardiovasc Surg, 2018, 30(3):342-349.DOI:10.1053/j.semtcvs.2018.06.001.
[24] Brockel MA, Polaner DM, Vemulakonda VM.Anesthesia in the pediatric patient[J].Urol Clin North Am, 2018, 45(4):551-560.DOI:10.1016/j.ucl.2018.06.003.
[25] Thaker S, McKenna E, Rader C, et al.Pain management in pectus excavatum surgery:a comparison of subcutaneous catheters versus epidurals in a pediatric population[J].J Laparoendosc Adv Surg Tech A, 2019, 29(2):261-266.DOI:10.1089/lap.2018.0244.
[26] Graves C, Idowu O, Lee S, et al.Intraoperative cryoanalgesia for managing pain after the Nuss procedure[J].J Pediatr Surg, 2017, 52(6):920-924.DOI:10.1016/j.jpedsurg.2017.03.006.
[27] Lobe TE.Perioperative hypnosis reduces hospitalization in patients undergoing the Nuss procedure for pectus excavatum[J].J Laparoendosc Adv Surg Tech A, 2006, 16(6):639-642.DOI:10.1089/lap.2006.16.639.
[28] 吴娜, 谢乂民, 陈思远, 等.微创Nuss手术治疗儿童漏斗胸的研究进展[J].临床小儿外科杂志, 2020, 19(2):176-180.DOI:10.3969/j.issn.1671-6353.2020.02.017.Wu N, Xie YM, Chen SY, et al.Research advances of mini-invasive Nuss operation in the treatment of pectum excavatum in children[J].J Clin Ped Sur, 2020, 19(2):176-180.DOI:10.3969/j.issn.1671-6353.2020.02.017.
[29] Castellani C, Schalamon J, Saxena AK, et al.Early complications of the Nuss procedure for pectus excavatum:a prospective study[J].Pediatr Surg Int, 2008, 24(6):659-666.DOI:10.1007/s00383-008-2106-z.
[30] Pawlak K, G?siorowski L[KG-2.2mm] [HZ(] [HT5.]/[HZ)], Gabryel P, et al.Video-assisted-thoracoscopic surgery in left-to-right Nuss procedure for pectus excavatum for prevention of serious complications-technical aspects based on 1006 patients[J].Wideochir Inne Tech Maloinwazyjne, 2018, 13(1):95-101.DOI:10.5114/wiitm.2018.72683.
[31] Clavien PA, Barkun J, de Oliveira ML, et al.The Clavien-Dindo classification of surgical complications:five-year experience[J].Ann Surg, 2009, 250(2):187-196.DOI:10.1097/SLA.0b013e3181b13ca2.
[32] 唐林晨, 莫绪明.漏斗胸Nuss手术研究进展[J].中华解剖与临床杂志, 2016, 21(4):368-371.DOI:10.3760/cma.j.issn.2095-7041.2016.04.022.Tang LC, Mo XM.The research progress of Nuss procedure for pectus excavatum repair[J].Chin J Anat Clin, 2016, 21(4):368-371.DOI:10.3760/cma.j.issn.2095-7041.2016.04.022.
[33] 商宏伟, 李强.漏斗胸外科治疗进展[J].中国胸心血管外科临床杂志, 2021, 28(9):1119-1124.DOI:10.7507/1007-4848.202006072.Shang HW, Li Q.Progress in surgical treatment of pectus excavatum[J].Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(9):1119-1124.DOI:10.7507/1007-4848.202006072.
[34] Xu X, An J, Zhang Y, et al.Investigation of the quality of recovery of surgical patients based on the chinese version of the quality of recovery-15 survey, a cross-sectional study[J].J Perianesth Nurs, 2022, 37(2):199-203.DOI:10.1016/j.jopan.2021.04.002.
相似文献/References:
[1]阳广贤高纪平刘平波曾德斌.NUSS手术矫治先天性漏斗胸102例[J].临床小儿外科杂志,2010,9(03):0.
YANG Guang-xian,GAO Ji-ping,LIU Ping-bo,et al.NUSS procedure for pectus excavatum repair in 102 patients.[J].Journal of Clinical Pediatric Surgery,2010,9(06):0.
[2]段贤伦,曾骐.微创Nuss手术治疗小儿漏斗胸[J].临床小儿外科杂志,2008,7(01):35.
[3]范茂槐,侯文英,张军,等.NUSS手术治疗小儿漏斗胸的临床效果观察[J].临床小儿外科杂志,2007,6(04):13.
[4]王贤书 崔泽 杨志国 张晓茹 岳芳 程征海 景世元. 胸腔镜辅助经胸膜外放置矫形板治疗儿童漏斗胸[J].临床小儿外科杂志,2012,11(02):123.
[5]吴娜,谢乂民,陈思远,等.微创Nuss手术治疗儿童漏斗胸的研究进展[J].临床小儿外科杂志,2020,19(02):176.[doi:10.3969/j.issn.1671-6353.2020.02.017]
Wu Na,Xie Yimin,Chen Siyuan,et al.Research advances of mini-invasive Nuss operation in the treatment of pectum excavatum in children[J].Journal of Clinical Pediatric Surgery,2020,19(06):176.[doi:10.3969/j.issn.1671-6353.2020.02.017]
备注/Memo
收稿日期:2021-06-09。
基金项目:青海省自然科学基金(2021—ZJ—751)
通讯作者:戚继荣,Email:qjr7@163.com