加速康复外科在儿童先天性脊柱侧凸患者围手术期管理中的应用

Application of enhanced recovery after surgery in the perioperative management of pediatric patients with congenital scoliosis

目的:探讨加速康复外科(enhanced recovery after surgery,ERAS)在儿童先天性脊柱侧凸患者围手术期管理中的应用效果。方法:将2020年10月~2021年12月期间于我院接受后路截骨矫形植骨融合内固定术的90例先天性脊柱侧凸患儿纳入研究,根据围手术期管理模式将患儿分为ERAS组(45例)和对照组(45例)。ERAS组采用加速康复模式进行管理,包括入院宣教、加强营养、减少围手术期禁食水时间、优化麻醉、避免过量补液、减少引流管留置、多模式镇痛等15项措施;对照组采用传统围术期管理模式。对比两组患儿各项临床及化验指标,临床指标包括围手术期禁食水时间、术后住院日、并发症发生情况以及术后3d内疼痛评分、体温、进食水量;化验指标包括术后第1、3天血红蛋白(hemoglobin,Hb)、白蛋白(albumin,ALB)和白细胞介素-6(interleukin-6,IL-6)等。结果:所有患者均顺利完成手术。术后3d内ERAS组患儿疼痛评分均明显低于对照组(P<0.001),患儿饮食恢复更快,每日进食水量均明显多于对照组(P<0.001)。术后3d内ERAS组和对照组分别有27例次和44例次每日最高体温>38.5℃,ERAS组明显偏低(χ^(2)=7.211,P=0.007)。ERAS组和对照组围手术期禁食水时间分别为11.0±5.6h和30.1±8.1h(t=-13.028,P<0.001),术后住院日分别为6d(6,7d)和7d(6,7d)(Z=-0.206,P=0.040),ERAS组均明显低于对照组。术后ERAS组和对照组分别有8例(17.8%)和6例(13.3%)患儿发生并发症(χ^(2)=0.338,P=0.561),两组均以轻度腹痛或腹胀最为常见。术后第1、3天两组患儿Hb和ALB均无统计学差异(P>0.05),术后第1天ERAS组和对照组IL-6分别为147.7±116.1mmol/L和184.5±144mmol/L(t=-1.334,P=0.186),术后第3天IL-6分别为19.4±12.2mmol/L和33.5±26.3mmol/L(t=-3.252,P=0.002),ERAS组明显低于同时间点对照组。结论:与传统模式相比ERAS可有效提高先天性脊柱侧凸患儿围手术期管理水平,促进患儿术后早期恢复,降低应激反应。

Objectives:To explore the application effects of enhanced recovery after surgery(ERAS)in the perioperative management of children with congenital scoliosis(CS).Methods:90 pediatric patients with CS treated in our hospital with posterior osteotomy and bone graft fusion combined with internal fixation from October 2020 to December 2021 were included in this study.The patients were divided into the ERAS group(n=45)and control group(n=45)according to the periorperative management model.Patients in the ERAS group were managed with an accelerated recovery protocol including preoperative education,high protein diet,shortened fasting time,optimized anesthesia,non-excessive fluid infusion,decreased drainage placement,and multi-model analgesia,while patients in the control group were managed with the traditional model during perioperative period.Clinical data comprising perioperative fasting time,postoperative length of hospital stay,complication rate,and amount of oral intake,pain score and body temperature within postoperative 3d,and laboratory tests included hemoglobin(Hb),albumin(ALB)and interleukin-6(IL-6)on postoperative 1d and 3d were collected and compared between groups.Results:All the patients completed the surgery successfully.In the first 3 days after surgery,the pain score of the ERAS group was significantly lower than that of control group(P<0.001),and the diet of patients of ERAS group recovered faster with a significantly greater amount of daily intake than that of control group(P<0.001).Within 3d after operation,the maximum body temperature>38.5℃was observed in 27 and 44 patients in the ERAS and control group,respectively,and the ERAS group was significantly smaller in the number than control group(χ^(2)=7.211,P=0.007).The fasting time were 11.0±5.6h and 30.1±8.1h(t=-13.028,P<0.001)and postoperative length of hospital stay were 6d(6,7d)and 7d(6,7d)(Z=-0.2057,P=0.040)in the ERAS and control group,respectively,and the ERAS group was significantly shorter than control group.Postoperative complications were observed in 8(17.8%)and 6(13.3%)patients in the ERAS and control group(χ^(2)=0.338,P=0.561),and the most common complication was mild abdominal pain and distention in both groups.Both Hb and ALB in the two groups showed no significant difference on postoperative day 1 and 3(P>0.05).IL-6 tested on postoperative day 1 was 147.7±116.1mmol/L and 184.5±144mmol/L(t=-1.334,P=0.186)in the ERAS and control group,while the data was 19.4±12.2mmol/L and 33.5±26.3mmol/L(t=-3.252,P=0.002)on postoperative day 3,and the ERAS group was significantly lower than the control group.Conclusions:Comparing with traditional model,ERAS can improve the perioperative management level,promote the early recovery,and decrease the postoperative stress reaction for pediatric patients with congenital spinal scoliosis.