ERAS在儿童鞘膜积液日间手术中的应用价值研究

Study on application value of enhanced recovery after surgery in day surgery for child hydrocele

目的评估加速康复外科(ERAS)在儿童鞘膜积液日间手术中的应用价值。方法回顾性分析2015年12月至2019年12月重庆医科大学附属儿童医院日间外科应用ERAS策略手术治疗的656例鞘膜积液患儿(ERAS组)的临床资料,并与泌尿外科应用常规临床路径治疗的98例鞘膜积液患儿(常规治疗组)进行比较。两组患儿均随访3~14个月,中位7.5个月。结果ERAS组患儿术后出现不良反应33例(5.0%),其中呕吐5例,发热9例,伤口疼痛8例,伤口出血5例,伤口感染4例,复发2例;常规治疗组患儿术后出现不良反应10例(10.2%),其中呕吐1例,发热3例,伤口疼痛3例,伤口出血2例,伤口感染1例。两组患儿术后不良反应发生率比较,差异有统计学意义(χ^(2)=4.244,P=0.039)。ERAS组患儿手术时间[(11.49±3.91)min],与常规治疗组[(11.90±3.98)min]比较,差异无统计学意义(t=-0.999,P=0.318);ERAS组患儿麻醉时间[(16.62±5.06)min]、麻醉复苏时间[(37.64±14.03)min]、平均住院时间[(8.19±0.93)h]均明显短于常规治疗组[分别为(21.26±5.62)、(46.61±20.65)min,(111.18±20.11)h],差异均有统计学意义(t=-8.062、-3.984、-16.645,P=0.001)。ERAS组患儿的家属满意度(96.95%)明显优于常规治疗组(91.84%),差异有统计学意义(χ^(2)=4.889,P=0.027)。结论ERAS策略用于鞘膜积液患儿日间手术安全、可靠,有效加速了患儿术后康复,降低了并发症发生率,缩短了住院时间,提高了患儿的家属满意度。

Objective To evaluate the application value of enhanced recovery after surgery(ERAS)in day surgery for child hydrocele.Methods The clinical data in 656 cases of child hydrocele(ERAS group)surgically treated by the ERAS strategy in the day surgery of this hospital from December 2015 to December 2019 were retrospectively analyzed and compared with 98 children patients with hydrocele treated by the conventional clinical pathway(conventional treatment group)in the urological surgery.The two groups were followed up for 3-4 months with a median of 7.5 months.Results In the ERAS group,33 cases(5.0%)appeared postoperative adverse reactions,including 5 cases of vomiting,9 cases of fever,8 cases of wound pain,5 cases of wound bleeding,4 cases of wound infection and 2 cases of recurrence.In the conventional treatment group,10 cases(10.2%)appeared postoperative adverse reactions,including 1 case of vomiting,3 cases of fever,3 cases of wound pain,2 cases of wound bleeding and 1 case of wound infection,the differences inthe incidence rate of postoperative adverse reactions between the two groups were statistically significant(χ^(2)=4.244,P=0.039).The surgery time(11.49±3.91)min in the ERAS group and(11.90±3.98)min in the conventional treatment group,the difference was not statistically significant(t=-0.999,P=0.318).The anesthesia time[(16.62±5.06)min],time of anaesthetic resuscitation[(37.64±14.03)min],average hospitalization time[(8.19±0.93)h]in the ERAS group were significantly shorter than(21.26±5.62)min,(46.61±20.65)min and(111.18±20.11)h in the conventional treatment group,and the differences were statistically significant(t=-8.062,-3.984,-16.645,P=0.001).The satisfaction of family members in the ERAS group was better than that in the conventional treatment group,and the difference was statistically significant(96.95%vs.91.84%,χ^(2)=4.889,P=0.027).Conclusion The ERAS strategy is safe and reliable in the application of day surgery for child hydrocele,which reduces the incidence rate of complications,shortens the time of hospital stay,and improve the satisfaction of the children′s family members.