加速康复外科在儿童尿道下裂一期修复手术围术期的应用

Application of enhanced recovery after surgery in the perioperative period of primary repair for hypospadias inchildren

目的探讨加速康复外科(ERAS)在儿童尿道下裂一期修复围术期的临床应用效果。方法非随机对照研究。回顾性分析2018年3月至2022年3月山西省儿童医院泌尿外科收治的206例尿道下裂患儿的临床资料, 根据围术期管理模式是否采用ERAS理念, 将其分为ERAS组(109例)和非ERAS组(97例)。采用t检验、χ^(2)检验对比分析2组患儿在住院天数、住院费用、术后第1天疼痛评分、术后5 d内平均排便次数、首次下床活动时间、住院满意度评分及并发症发生率等相关指标中的差异。结果 ERAS组患儿在住院天数、住院费用、术后第1天疼痛评分、5 d内平均排便次数、首次下床活动时间、住院满意度评分分别为(7.71±1.12)d、(10 043.21±1 341.00)元、(5.21±1.32)分、(5.16±0.65)次、(5.03±0.61) d、(4.71±0.21)分, 均优于非ERAS组[(21.00±1.07) d、(12 993.44±1 081.00)元、(6.09±1.07)分、(2.91±0.48)次、(7.12±0.57) d、(4.14±0.15)分], 差异均有统计学意义(均P<0.05)。ERAS组患儿拔除尿管前出现发热、便秘的发生率分别为6.42%(7/109)、3.67%(4/109), 均较非ERAS组降低[21.64%(21/97)、28.87%(28/97)], 差异均有统计学意义(均P<0.05), 而导尿管脱出、感染、创面延期愈合、出渗血及拔除尿管后出现尿道狭窄、尿道瘘、尿道憩室等并发症发生率比较差异均无统计学意义(均P>0.05)。结论儿童尿道下裂一期修复术围术期应用ERAS管理措施, 能缩短住院时间, 降低住院费用, 促进患儿康复, 值得进一步推广。

Objective To investigate the clinical application effect of enhanced recovery after surgery(ERAS)in the perioperative period of primary repair for children with hypospadias.Methods Non-randomized controlled study.Retrospective analysis was made on clinical data of 206 children with hypospadias admitted to the Department of Urology,Shanxi Children′s Hospital from March 2018 to March 2022.According to whether the concept of ERAS was adopted for perioperative management of children,they were divided into the ERAS group(109 cases)and the non-ERAS group(97 cases).t-test and Chi-square test were used to analyze the differences between the two groups of patients in hospitalization days,hospitalization costs,pain scores on the first day after surgery,average number of bowel movements within 5 days after surgery,first out-of-bed activity time,hospital satisfaction score,and complication rate.Results Pediatric patients in the ERAS group showed better outcomes compared to the non-ERAS group:shorter hospital stays[(7.71±1.12)d vs.(21.00±1.07)d],lower hospitalization costs[(10043.21±1341.00)yuan vs.(12993.44±1081.00)yuan],lower postoperative pain scores on the first day[(5.21±1.32)points vs.(6.09±1.07)points],more frequent bowel movements within 5 days[(5.16±0.65)times vs.(2.91±0.48)times],earlier time to first out-of-bed activity[(5.03±0.61)d vs.(7.12±0.57)d],and higher hospital satisfaction scores[(4.71±0.21)points vs.(4.14±0.15)points],and the differences were statistically significant(all P<0.05).Additionally,the ERAS group had lower rates of fever(6.42%,7/109)and constipation(3.67%,4/109)before urinary catheter removal compared to the non-ERAS group[21.64%(21/97)and 28.87%(28/97),respectively](all P<0.05).There were no significant differences in the incidences of complications such as urethral prolapse,infection,delayed wound healing,and bleeding,as well as urethral stricture,urethral fistula,and urethral diverticulum after urinary catheter removal between the two groups(all P>0.05).Conclusions ERAS protocol applied in the perioperative period of primary repair for children with hypospadias can shorten the hospitalization time,lower the hospitalization costs,and accelerate the rehabilitation of children.It is worth further promotion.