临床小儿外科杂志2024，Vol.23Issue(8)：729-736,8.DOI:10.3760/cma.j.cn101785-202310050-006
加速康复外科策略在胆道闭锁患儿围手术期的应用探讨
Application of enhanced recovery after surgery strategies in the perioperative period of biliary atresia
摘要
Abstract
Objective To explore the safety and efficacy of various strategies of enhanced recovery after surgery(ERAS)during perioperative period in children with biliary atresia(BA).Methods From January 2019 to August 2023,retrospective analysis was conducted for the relevant clinical data of 103 BA children un-dergoing Kasai surgery.They were assigned into two groups of ERAS(implementing multiple new ERAS strate-gies during perioperative period)and control(traditional perioperative management without ERAS).Two groups were compared with regards to postoperative removal time of various tubes,postoperative feeding start time,postoperative duration of intravenous fluid maintenance,postoperative time of anesthetic recovery,perioper-ative body temperature,intraoperative volume of blood loss,postoperative platelet count,postoperative inflamma-tory parameters(IL-1 β,IL-2,IL-5,IL-6,IL-8 & TNF-α),preoperative/discharge biochemical parameters,post-operative complication rate,postoperative hospitalization stay or total hospitalization expense.Results No sta-tistically significant inter-group differences existed in general profiles,preoperative/discharge biochemical param-eters,intraoperative and postoperative temperature,postoperative platelet count or postoperative complication rate(P＞0.05).However,initial postoperative feeding time[(1.79±0.60)vs.(3.66±1.00)day;t=-11.391],postoperative removal time of gastrointestinal decompression tube[(1.21±0.41)vs.(2.32±0.55)day;t=-11.575],removal time of urinary catheter[(1.32±0.47)vs.(3.24±1.22)day;t=-10.403],removal time of abdominal drainage tube[(6.74±2.10)vs.(12.30±4.22)day;t=-8.398],postoperative hospi-talization stay[(13.91±3.03)vs.(19.12±6.52)day;t=-5.153;],postoperative maintenance time of in-travenous fluid[5(4,6)vs.6(5,7)day;Z=-2.339]and postoperative time of anesthetic recovery[(58.38±19.03)vs.(72.88±36.84)min;t=-2.488]were shorter in ERAS group than those in control group.Hos-pitalization expense[(40 533.95±6 270.58)vs.(45 669.70±10 867.12)yuan;t=-2.915],intraopera-tive volume of blood loss[10(10,20)vs.30(13.75,30)mL;Z=-3.721]and IL-6[21.63(6.41,52.41)]vs.71.20(29.71,140.89)pg/mL;Z=-2.719]were lower than those in control group and the difference was statistically significant(P＜0.05).Conclusions The application of various ERAS strategies during perioper-ative period may minimize intraoperative hemorrhage,blunt postoperative inflammation,shorten length of hospi-talization,lower hospitalization expense and promote the recovery of BA children.关键词
胆道闭锁/Kasai手术/加速康复外科/围手术期/并发症Key words
Biliary Atresia/Kasai Surgery/Enhanced Recovery After Surgery/Perioperative Care/Complications引用本文复制引用
郑瑞飞,吕小逢,张杰,路长贵,耿其明,唐维兵,蒋维维..加速康复外科策略在胆道闭锁患儿围手术期的应用探讨[J].临床小儿外科杂志,2024,23(8):729-736,8.基金项目
江苏省卫健委面上项目(M2022037) （M2022037）
南京市卫健委医药卫生科研课题(YKK20121) General Project of Health Commission of Jiangsu Province(M2022037) （YKK20121）
Healthcare Re-search Project of Health Commission of Nanjing Municipality(YKK20121) （YKK20121）
