Li Yuxuan,Zhang Hanwen,Wei Nan,et al.Application of a process-based communication model plus a concept of accelerated recovery after surgery in children undergoing congenital spinal malformation surgery:one case-control study[J].Journal of Clinical Pediatric Surgery,2024,(03):267-272.[doi:10.3760/cma.j.cn101785-202307058-013]
流程化沟通模式结合加速康复外科理念在先天性脊柱畸形手术患儿中应用的病例对照研究
- Title:
- Application of a process-based communication model plus a concept of accelerated recovery after surgery in children undergoing congenital spinal malformation surgery:one case-control study
- 摘要:
- 目的 探究流程化沟通模式结合加速康复外科(enhanced recovery after surgery,ERAS)理念在先天性脊柱畸形(congenital scoliosis,CS)患儿围术期应用效果,总结临床经验。 方法 本研究为前瞻性研究,选取2022年2月至2023年2月于我院接受手术治疗的CS患儿共68例作为研究对象,根据管理模式分为研究组(n=34)和对照组(n=34)。对照组采取单纯ERAS围术期管理模式,研究组采取流程化沟通模式结合ERAS理念进行围术期干预。比较两组患者术后首次排气时间、伤口愈合时间、平均住院日、中文版儿童焦虑性情绪障碍筛查表(Screen for Child Anxiety Related Emotional Disorders,SCARED)得分、中文版儿童抑郁障碍量表(Depression Self-rating Scale for Children,DSRSC)得分、治疗依从性评分、ERAS措施完成项目数、并发症率以及疼痛评分的差异。 结果 68例中,男27例、女41例,平均年龄(8.31±3.79)岁,两组基线资料差异无统计学意义(P>0.05)。研究组术后首次排气时间、伤口愈合时间分别为(32.76±5.57)h和(8.41±1.65)d,均明显早于对照组的(62.94±7.81)h和(9.56±2.60)d,差异均有统计学意义(P<0.05);研究组平均住院日为(11.12±2.14)d,较对照组的(15.18±2.48)d明显更短(t=7.221,P<0.001);两组患者入院时SCARED评分[研究组(20.65±2.01)分比对照组 (20.18±2.17)分,t=0.928,P=0.357]和DSRSC评分[研究组(12.59±2.12)分比对照组 (12.68±2.07)分,t=0.174,P=0.863]差异无统计学意义(P>0.05),但研究组出院时SCARED和DSRSC评分为(12.35±2.10)分和(9.88±1.70)分,明显低于对照组的(18.59±1.79)分和(11.09±1.85)分,差异均有统计学意义(P<0.05);研究组治疗依从性评分[研究组(13.76±1.44)分比对照组 (9.32±1.84)分,t=11.102,P<0.001]、ERAS措施完成项目数[研究组(15.91±1.49)项比对照组(13.35±1.54)项,t=6.987,P<0.001]、并发症发生率(研究组5.88%比对照组23.53,χ2= 4.221,P=0.040)和疼痛评分[研究组(2.91±0.87)分比对照组(3.76±1.39)分,t=3.031,P=0.003]均优于对照组。 结论 CS患儿围术期应用流程化沟通模式结合ERAS理念进行围术期管理效果更好,可有效提高患儿的术后康复水平和治疗依从性、减轻其心理应激程度、减少并发症发生率。
- Abstract:
- Objective Exploring the perioperative application effect of a process based communication model combined with the concept of accelerated recovery after surgery (ERAS) in children with congenital spinal deformities (CS),and summarizing clinical experience.Methods This study is a prospective study.A total of 68 pediatric patients with CS who underwent surgical treatment in our hospital from February 2022 to February 2023 were selected as the study subjects.They were divided into a study group (n=34) and a control group (n=34) based on management mode.The control group adopted a simple ERAS perioperative management model,while the research group adopted a procedural communication model combined with ERAS philosophy for perioperative intervention.Compared the time of first postoperative discharge,wound healing time,average hospital stay,Chinese version of the screening chart (screen for child anxiety related emotional disorders,SCARED) Score,Chinese version of children Depression Disorder scale (depression self-rating scale for children,DSRSC) differences in scores,treatment adherence scores,number of ERAS measures completed,complication rate,and pain scores.Results Among all patients,27 were male and 41 female,mean age (8.31±3.79) years,and there was no significant difference between the baseline data of the two groups (P>0.05).The postoperative time of first discharge and wound healing time in the study group were (32.76±5.57) h and (8.41±1.65) d,significantly earlier than the control group (62.94±7.81) h and (9.56±2.60) d (first discharge time t=18.345,P<0.001;wound healing time t=2.173,P=0.033).The mean hospital day of stay in the study group was (11.12±2.14) d,significantly shorter than d (15.18±2.48) in the control group (t=7.221,P<0.001).Tthe two groups’ admission SCARED score[Study group (20.65±2.01) vs.Control group (20.18±2.17),t=0.928,P=0.357] and DSRSC score (study group (12.59±2.12) vs.control group (12.68±2.07),t=0.174,P=0.863］ not significant (P greater than 0.05).However,the SCARED and DSRSC scores of the study group were (12.35±2.10) and (9.88±1.70),significant lower (18.59±1.79) and (11.09±1.85) points than the control group,The differences were statistically significant (P was less than 0.05);[Study group (13.76±1.44) vs. control group (9.32±1.84),t=11.102,P<0.001],number of items completed by ERAS measures [Study group (15.91±1.49) vs. Control group (13.35±1.54),t=6.987,P<0.001],complication rate (5.88% of the study group vs. 23.53 of the control group,χ2= 4.221,P=0.040) and pain score [study group (2.91±0.87) vs.control group (3.76±1.39),t=3.031,P=0.003] were all superior over the control group.Conclusions The application of a procedural communication model combined with ERAS concept in perioperative management of CS patients has a better effect,which can effectively improve the postoperative rehabilitation level and treatment compliance of patients,reduce their psychological stress level,and reduce the incidence of complications.
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备注/Memo
收稿日期:2023-7-24。
基金项目:深圳市“医疗卫生三名工程”项目 (SZSM202011012)
通讯作者:张凤云,Email:zhangfengyun@163.com