Hua Lei,Yu Jie,Ren Yi,et al.Efficacy of enhanced recovery after surgery on postoperative recovery in funnel chest children undergoing Nuss surgery[J].Journal of Clinical Pediatric Surgery,2024,(11):1082-1087.[doi:10.3760/cma.j.cn101785-202401041-015]
加速康复外科策略在儿童漏斗胸手术中的应用
- Title:
- Efficacy of enhanced recovery after surgery on postoperative recovery in funnel chest children undergoing Nuss surgery
- Keywords:
- Funnel Chest; Thoracic Surgical Procedures; Enhanced Recovery after Surgery; Treatment Outcome; Child
- 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。
- Abstract:
- Objective To explore the effectiveness and safety of enhanced recovery after surgery (ERAS) strategies on postoperative recovery for funnel chest children undergoing Nuss procedure. Methods A 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. Results At 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 (4.0and 4.0) (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). Conclusions Both 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 the incidence of postoperative pulmonary complications.
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备注/Memo
收稿日期:2024-1-18。
基金项目:吴阶平医学基金会临床科研专项基金自助项目(320.6750.19089-102)
通讯作者:张建敏,Email:zjm428@sina.com