加速康复外科模式在先天性脊柱侧凸患者围手术期治疗中的应用研究

Efficacy of enhanced recovery after surgery for children with congenital spinal scoliosis during perioperative period

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)模式在先天性脊柱侧凸患者围术期中的应用效果。方法选择首都医科大学附属北京儿童医院2020年8月至10月接受手术治疗的27例先天性脊柱侧凸患者作为研究对象,男7例,女20例,平均年龄7.3岁,患者均接受脊柱后路截骨矫形植骨融合内固定术,围手术期应用ERAS模式进行管理,主要措施包括:入院宣教、加强营养、减少禁食禁饮时间、优化麻醉方案、多模式镇痛等。收集患者手术与饮食情况、血糖、疼痛评分、并发症等资料。结果27例均顺利完成手术,手术时间252.6 min,平均3个手术节段,术中失血量524.8 mL,侧弯矫正率77.9%。围手术期平均禁食禁饮时间9.0 h,多数患者术后早期可进食和饮水。围手术期血糖相对平稳。术后3天疼痛评分有一定波动,但整体疼痛程度较低。术后第1天白细胞介素-6水平最高,主要与术前血糖、术后疼痛评分、术后进食量等因素相关。术后第3天C反应蛋白水平均较高,主要与患者术前营养状态、术后补液量、术后体温等因素相关。术后共7例患者(8人次)出现并发症,以轻度腹痛、腹胀多见,均未给予特殊处理,无一例发生呛咳、误吸、伤口感染、呕吐等严重并发症。结论儿童脊柱畸形患者围手术期ERAS管理模式安全有效,能够提高治疗效果,值得临床推广应用。

Objective To explore the clinical efficacy of enhanced recovery after surgery(ERAS)for childrens with congenital spinal scoliosis.Methods From July 2020 to October 2020,a total of 27 childrens with congenital spinal scoliosis undergoing posterior spinal osteotomy and fusion with pedicle screws were recruited.There were 7 boys and 20 girls with a mean age of 7.3 years.They were managed according to the ERAS protocol including admission consueling,enhanced nutrition,shorter fasting,optimized anesthesia and multimodal pain management.The relevant data of operation,feeding,blood glucose,pain,laboratory tests and complications were collected.Results All operations were completed successfully.The operative duration was 252.6 min and the number of fused levels was 3.The volume of blood loss was 524.8 ml and the correction rate for deformity was 77.9%.The perioperative fasting duration was 9.0 h and the levels of blood glucose remained stable.Pain was mild and pain scores fluctuated at Day 3 post-operation.The peak level of interleukin-6(IL-6)occurred at Day 1 post-operation and it was correlated with preoperative blood glucose,postoperative pain score and postoperative amount of food intake.The peak level of C-reactive protein(CRP)occurred at Day 3 post-operation and it was correlated with preoperative nutrition status,postoperative volume of intravenous fluid and postoperative body temperature.Seven cases(8 person occasions)developed the complications of abdominal pain and distension.No specific intervention was taken.There was no onset of bucking,aspiration,infection or vomiting.Conclusion As an effective and safe protocol for congenital spinal scoliosis,ERAS may improve therapeutic efficacy and it is worth a wider popularization.