精细化管理对小儿腹股沟斜疝腹腔镜术后疼痛及并发症的影响

nfluence of refined management on pain and complications after laparoscopic surgery for indirect inguinal hernia in children

目的观察精细化管理对小儿腹股沟斜疝腹腔镜术后疼痛及并发症的影响。方法选择2019年10月至2020年9月在海南省妇女儿童医学中心行腹腔镜高位结扎术的86例腹股沟斜疝患儿为研究对象。根据管理干预方式不同将患儿随机分为2组,每组患儿43例。对照组患儿给予常规管理,试验组在对照组的基础上给予精细化管理模式。对比2组患儿干预前和干预后视觉模拟评分(VAS)、世界卫生组织生命质量量表(WHOQOL-100)、术后并发症、手术指标及术后恢复情况。结果干预前,2组患儿VAS评分和WHOQOL-100评分比较,差异无统计学意义(P>0.05)。干预后,2组患儿VAS评分和WHOQOL-100评分较干预前均有所改善,且试验组评分改善情况均优于对照组(P<0.05);试验组患儿皮下气肿、切口出血、切口感染以及腹腔积液等并发症总发生率为4.65%,明显低于对照组20.93%(P<0.05);试验组患儿术中失血量、手术时间以及肛门排气时间等手术指标均优于对照组(P<0.05);试验组患儿术后饮食时间、下地时间以及住院时间均优于对照组(P<0.05)。结论精细化管理模式应用于腹腔镜手术腹股沟斜疝患儿,可有效减少术中出血量、手术时间、肛门排气时间,缓解患儿术后疼痛,提高患儿生命质量。

Objective To observe the effect of meticulous management on pain and complications after laparoscopic surgery for indirect inguinal hernia in children.Methods A total of 86 children with indirect inguinal hernia who underwent laparoscopic high ligation in our hospital from October 2019 to September 2020 were selected as the research subjects.Children were randomly divided into control group(n=43)and experimental group(n=43)according to different management intervention methods.The children in the control group were given routine management intervention,while the experimental group was given the intervention of the refined management model on the basis of the control group.The VAS score,WHOQOL-100,postoperative complications,surgical indicators and postoperative recovery were compared between the two groups before and/or after the intervention.Results Before the intervention,the VAS scores and WHOQOL-100 scores of the two groups of children were compared(P>0.05).The VAS scores and WHOQOL-100 scores of the two groups of children were improved compared with those before the intervention,and the VAS scores of the children in the experimental group were improved.The WHOQOL-100 score improvement was significantly better than that in the control group(P<0.05).After intervention,the incidence of complications such as subcutaneous emphysema,incision bleeding,incision infection and ascites in the experimental group(4.65%)was significantly lower than that in the control group(20.93%)(P<0.05);The intraoperative blood loss,operation time and anal exhaust time of the children in the experimental group were significantly better than those in the control group(P<0.05);The post-diet time,the time to get off the ground and the length of hospital stay were significantly better than those of the control group (P<0.05). Conclusion The refined management mode can effectively reduce intraoperative blood loss, operation time, and anal exhaust time in children with indirect inguinal hernia undergoing laparoscopic surgery, relieve postoperative pain, and improve the children's quality of life.