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加速康复外科在儿童肝囊型棘球蚴病围手术期的应用 被引量:3

Application of enhanced recovery after surgery for perioperative management of hepatic cystic echinococcosis in children
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摘要 目的探讨儿童肝囊型棘球蚴病围手术期采用加速康复外科管理模式的安全性及有效性。方法本研究为回顾性研究,连续纳入2017年2月至2019年1月期间在新疆医科大学第一附属医院小儿外科收治的肝囊型棘球蚴病患儿44例。根据围手术期是否采用加速康复外科管理模式,将患儿分为ERAS组与对照组。其中,围手术期采用加速康复外科管理模式的患儿设为ERAS组(20例),采用传统方法进行围手术期管理的患儿归为对照组(24例)。比较两组患儿的手术时间、术中出血量、术中与术后输血和术后并发症情况,术后第一天血清C反应蛋白、降钙素原、白细胞介素6及空腹血糖水平,术后首次下床活动时间、进食时间、肛门排气时间及住院天数和住院费用。结果ERAS组术后第1天C反应蛋白和白细胞介素6分别为5.73 mg/L和8.17 pg/ml低于对照组的7.57 mg/L和11.7 pg/ml,但差异无统计学意义(P>0.05)。ERAS组术后第1天降钙素原和空腹血糖值分别为(0.24±0.28)ng/L和(5.05±0.96)mmol/L较对照组的(0.75±1.16)ng/L和(5.77±0.86)mmol/L显著降低,且差异有统计学意义(P<0.05)。ERAS组患儿无术后并发症出现;对照组出现4例(16.7%),其中残腔积液2例,感染1例,胆漏1例,均经保守治疗后好转。两组术后并发症发生率比较,差异有统计学意义(P<0.05)。ERAS组术后首次下床活动时间、进食时间、肛门排气时间和住院天数、住院费用分别为(11.1±3.22)h、(17.7±3.61)h、(12.6±6.7)h、(7.75±1.58)d和(14951±3418)元,均少于对照组的(16.2±5.32)h、(21.5±3.81)h、(24.8±8.2)h、(9.50±2.57)d和(21085±5560)元,且差异有统计学意义(P<0.05)。结论儿童肝囊型棘球蚴病围手术期采用加速康复外科管理模式,可以降低患儿术后应激反应,促进术后康复,减少住院时间和费用。 Objective To explore the safety and efficacy of employing the model of enhanced recovery after surgery(ERAS)in perioperative management of hepatic cystic echinococcosis in children.Methods From February 2017 to January 2019,retrospective analyses were performed for 44 hospitalized children with hepatic cystis echinococcosis.They were divided into two groups of ERAS(n=20)and control(n=24)according to whether or not ERAS management model was adopted.Two groups were compared with regards to operation duration,intraoperative volume of blood loss,perioperative volume of blood transfusion,postoperative complications and serum C-reactive protein(CRP),procalcitonin(PCT),interleukon-6(IL-6),fasting plasma glucose(FPG)at Day 1 postoperatively,initial time of postoperative ambulation,fasting time,exhaust time,stay of postoperative hospitalization and hospitalization expenditure.Results The levels of CRP and IL-6 at Day 1 postoperatively were lower in ERAS group than those in control group(5.73 vs.7.57 mg/L,8.17 vs.11.7 pg/ml).However,the difference was not statistically significant(P>0.05).The values of PCT and FPG at Day 1 post-operation were lower in ERAS group than those in control group[(0.24±0.28)vs.(0.75±1.16)ng/L,(5.05±0.96)vs.(5.77±0.86)mmol/L]and the difference was statistically significant(P<0.05).No postoperative complication occurred in ERAS group;Four cases(16.7%)in control group,including residual cavity effusion(n=2),infection(n=1)and biliary leakage(n=1).All complications improved after conservative measures.Statistically significant inter-group differences existed in the incidence of postoperative complications(P<0.05).In ERAS group,initial time of postoperative ambulation,fasting time,exhaust time,postoperative hospitalization stay and hospitalization expenditure were(11.1±3.22)h,(17.7±3.61)h,(12.6±6.7)h,(7.75±1.58)d and(14951±3418)yuan.They were less than control group(16.2±5.32)h,(21.5±3.81)h,(24.8±8.2)h,(9.50±2.57)d and(21085±5560)yuan,And the difference was statistically significant(P<0.05).Conclusions ERAS model may lower traumatic stress,promote postoperative recovery and reduce hospitalization expenditure.And it is both safe and effective for perioperative management of children with hepatic cystic echinococcosis.
作者 胡健 李万富 李朝旺 马柱 樊珈榕 Hu Jian;Li Wanfu;Li Chaowang;Ma Zhu;Fan Jiarong(Department of Pediatric Surgery,First Affiliated Hospital,Xinjiang Medical University,Urumqi 830011,China)
出处 《中华小儿外科杂志》 CSCD 北大核心 2021年第2期103-108,共6页 Chinese Journal of Pediatric Surgery
基金 新疆维吾尔自治区自然科学基金(2017D01C321)。
关键词 儿童 肝囊型棘球蚴病 加速康复外科 Child Hepatic cystic echinococcosis Enhanced recovery after surgery
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