先天性食管闭锁围手术期监护及管理

Perioperative monitoring and management of congenital esophageal atresia

目的总结先天性食管闭锁患儿围手术期监护及临床特点,以加强围手术期管理。方法对2005—2013年广州市妇女儿童医疗中心收治的先天性食管闭锁患儿围手术期的临床资料进行回顾性分析。结果研究期间收治的182例食管闭锁患儿中21例放弃治疗,纳入分析161例。术前66例需机械通气,机械通气组早产儿比例及合并心脏畸形患儿比例均高于非机械通气组（63.6%比29.5%,57.6%比16.8%,P〈0.05）。术后每隔1 h采用CRIES评分法进行1次疼痛评估,≥4分者137例（85.1%）,1-3分24例（14.9%）。术后1周内开奶患儿（59例）住院时间和机械通气时间与术后1周后开奶患儿（102例）比较差异无统计学意义（P〉0.05）。体重增长良好组（74例）住院时间短于体重增长不良组（87例）[（18.1±4.2）天比（25.3±10.9）天,P〈0.05]。术后使用奥美拉唑组（53例）吻合口漏发生率与未使用奥美拉唑组（108例）差异无统计学意义（P〉0.05）,但吻合口漏持续时间缩短[（7.2±4.3）天比（13.1±6.8）天,P〈0.05]。结论先天性食管闭锁患儿中早产及合并心脏畸形者需呼吸支持的比率较高,营养状态良好可缩短住院时间,术后使用奥美拉唑抑酸可缩短食管吻合口漏持续时间。

Objective To summarize perioperative monitoring and clinical characteristics of congenital esophageal atresia in order to improve perioperative management of patients.Methods Perioperative data of patients diagnosed with congenital esophageal atresia patients in our tertiary center from 2005 to 2013 was collected and analyzed in this retrospective study. Results Among the 182 patients admitted with congenital esophageal atresia,21 patients were excluded due to parental decision to give up on treatment. Among the 161 cases enrolled in the study,66 patients needed preoperative mechanical ventilation. The incidence of of preterm birth and congenital cardiac abnormalities in infants of the mechanical ventilated group were higher than those who didn＇ t require mechanical ventilation（ preterm birth： 63. 6% vs. 29. 5%,congenital cardiac abnormalities： 57. 6%vs. 16. 8%,P〈0. 05）. Postoperative pain score assessment revealed ≥4 points increase in 137 cases（ 85. 1%）,and 1-3 points increase in 24 cases（ 14. 9%）. 59 cases tolerated enteral nutrition within1 week postoperation,while the other 102 parents tolerated enteral feeding after one week,the difference of timing reaching enteral feeding,the duration of hospitalization and the mechanical ventilation between the two groups revealed no statistical significance（ P〈0. 05）. Durations of hospital stay in infants with appropriate weight gain（ 74 cases） as a group were shorter than those in infants with poor weight gain（ 87 cases） [（ 18. 1 ± 4. 2） d vs.（ 25. 3 ± 10. 9） d,P〈0. 05]. The incidence of esophageal anastomotic leakage in infants who were treated with（ 53 cases） or without（ 108 cases） Omeprazole revealed no significant difference. However,infants in the Omeprazole treatment group experienced shorter duration of esophageal anastomotic leakage [ with Omeprazole（ 7. 2 ± 4. 3） d vs. without Omeprazole（ 13. 1 ±6. 8） d,P〉0. 05]. Conclusions Incidence of mechanical ventilation is higher in infants born with congenital esophageal atresia complicated with premature birth and congenital cardiac malformations.Improving nutritional status may shorten the hospital stay. Postoperative Omeprazole usage may shorten the duration of esophageal anastomotic leakage in these infants.