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,2024,(08):729-736.[doi:10.3760/cma.j.cn101785-202310050-006]
加速康复外科策略在胆道闭锁患儿围手术期的应用探讨
- Title:
- 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
- 摘要:
- 目的 探讨多种加速康复外科(enhanced recovery after surgery,ERAS)策略在胆道闭锁患儿围手术期应用的安全性和有效性。 方法 回顾性分析2019年1月至2023年8月南京医科大学附属儿童医院收治的103例资料完整、接受Kasai手术的胆道闭锁患儿临床资料,按照围手术期是否采取ERAS管理路径分为两组,接受ERAS多种新策略管理者为ERAS组,未接受ERAS新策略、按照传统围手术期管理模式者为对照组。观察并对比两组患儿术后拔除各种管道的时间,首次喂养时间,静脉补液维持时间、麻醉苏醒时间,术中及术后体温,术中出血量、血小板计数、炎症指标(IL-1β、 IL-2、IL-5、IL-6、IL-8、TNF-α等),术前及术后生化指标,术后并发症发生率,术后住院时长以及总住院费用。 结果 两组患儿一般资料及手术前、出院时生化指标,术中及术后体温,术后血小板计数以及术后并发症发生率比较,差异均无统计学意义(P>0.05)。ERAS组术后首次喂养时间[(1.79±0.60)d比(3.66±1.00)d,t=-11.391]、胃肠减压时间[(1.21±0.41)d比(2.32±0.55)d,t =-11.575]、留置导尿时间[(1.32±0.47)d比(3.24±1.22)d,t=-10.403]、腹腔引流时间[(6.74±2.10)d比(12.30±4.22)d,t=-8.398]、术后住院时长[(13.91±3.03)d比(19.12±6.52)d,t=-5.153]、术后静脉补液时间[5(4,6)比6(5,7)d,Z=-2.339]以及术后麻醉苏醒时间[(58.38±19.03)min比(72.88±36.84)min, t=-2.488]均短于对照组;住院费用[(40 533.95±6 270.58)元比(45 669.70±10 867.12)元,t=-2.915]、术中出血量[10(10,20)mL比30(13.75,30)mL,Z=-3.721]及炎症指标IL-6[21.63(6.41,52.41)pg/mL比71.20(29.71,140.89)pg/mL,z=-2.719]均少于或低于对照组,差异有统计学意义(P<0.05)。 结论 胆道闭锁患儿围手术期应用多种ERAS策略,可以减少术中出血,减轻术后炎症反应,缩短住院时间,减少住院费用,促进患儿恢复。
- 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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备注/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