加速康复外科在体外循环下小儿先天性心脏病围手术期护理中的应用

Application of Enhanced Recovery After Surgery in the Perioperative Nursing of Children with Congenital Heart Disease Under Extracorporeal Circulation

目的分析加速康复外科(ERAS)在体外循环下小儿先天性心脏病(CHD)围手术期护理中的应用效果。方法选取2019年6月至2020年5月在郑州大学附属儿童医院接受体外循环下CHD手术的108例患儿作为研究对象,按随机数表法分为对照组和干预组,每组54例。对照组接受常规围手术期护理,干预组接受ERAS理念护理,记录并比较两组患儿的术后住院时间、拔出气管插管及胸腔引流管时间、进食时间、下床活动时间、疼痛时间及程度和并发症发生例数,采用儿童疼痛行为评估量表(FLACC)对患儿疼痛程度进行评分。结果干预组患儿的住院时间短于对照组患儿(P<0.05);干预组患儿拔除气管插管及胸腔引流管的时间、进食时间和下床活动时间均早于对照组患儿(P<0.05);干预组患儿的疼痛时间短于对照组,FLACC评分低于对照组患儿(P<0.05);干预组患儿的并发症发生率低于对照组患儿(P<0.05)。结论ERAS护理能有效缩短CHD患儿的住院时间,尽早拔出气管插管和引流管,尽早喂养,早期下床活动,减轻患儿疼痛并且减少并发症的发生。

Objective To analyze the application effect of enhanced recovery after surgery(ERAS)in the perioperative nursing of children with congenital heart disease(CHD)under extracorporeal circulation.Methods A total of 108 children with CHD under extracorporeal circulation in Children’s Affiliated Hospital of Zhengzhou University from June 2019 to May 2020 were selected as the research objects,and they were randomly divided into control group and intervention group,with 54 cases in each group.The control group received routine perioperative care,and the intervention group received ERAS concept care.The postoperative hospitalization days,the time of tracheal intubation and thoracic drainage,the time of eating,the time of getting out of bed,the time and degree of pain,and the number of complications were recorded and compared between the two groups.Pain level was scored using the face,legs,activity,cry,consolability behavioral tool(FLACC).Results Children in intervention group had shorter hospitalization days than that in control group(P<0.05).The time to remove the tracheal intubation and chest drainage tube,the time to eat,and the time to get out of bed in intervention group were earlier than those in control group(P<0.05).The pain time in intervention group was shorter than that in control group and FLACC score in intervention group was lower than that in control group(P<0.05).The incidence of complications in intervention group was lower than that in control group(P<0.05).Conclusion ERAS nursing can effectively shorten the hospitalization days of children with CHD,pull out the tracheal intubation and drainage tube as soon as possible,feed as soon as possible,get out of bed early,reduce the pain of the child and the occurrence of complications.