临床小儿外科杂志2024，Vol.23Issue(11)：1082-1087,6.DOI:10.3760/cma.j.cn101785-202401041-015
加速康复外科策略在儿童漏斗胸手术中的应用
Efficacy of enhanced recovery after surgery on postoperative recovery in funnel chest children undergo-ing Nuss surgery
摘要
Abstract
Objective To explore the effectiveness and safety of enhanced recovery after surgery(ERAS)strategies on postoperative recovery for funnel chest children undergoing Nuss procedure.Methods A total of 99 children undergoing elective Nuss procedure were randomized into two groups of ERAS(n=50)and control(n=49).The strategies of ERAS group included preoperative education,breathing exerci-ses,shortening preoperative water fasting time,multimodal analgesia,depth of anesthesia monitoring,lung-pro-tective ventilation and prevention of postoperative nausea & vomiting.Control group fasted for 6 h,only took in-travenous opioids for analgesia,no lung protective ventilation and there was no dosing of preventive antiemetic.Postoperative pain score,opioid-related adverse events(constipation,nausea & vomiting),incidence of pulmo-nary complications,length of hospitalization,laboratory tests(C-reactive protein,white blood cell count & neu-trophil proportion)and other outcome parameters were compared between two groups.Results At postopera-tive 1/6 h,numerical rating scale(NRS)scores were 3.0(1.8,5.0)and 3.5(3.0,5.0)in ERAS group.Both were significantly lower than that in control group(4.0[3.0,5.0]and 4.0[3.0,6.0])(P＜0.05).Cumula-tive usage of PCA was 41.5(30.8,52.3)ml and it was significantly lower than 57.9(43.0,74.0)ml in con-trol group(P＜0.05).Twelve cases(12/50,24％)developed adverse events related to postoperative analgesi-a.It was significantly lower than 18 cases(18/49,36.7％)in control group(P＜0.05).No signifiicant inter-group difference existed in NRS scores at postoperative 12/24/48 h,the incidence of postoperative pulmonary complications,length of hospitalization,total expense or postoperative blood tests(all P＞0.05).Conclusions Both safe and effective for children undergoing NUSS procedure,ERAS strategies may reduce postoperative pain score and usage of opioid within postoperative 6 h and lower the incidence of analgesic-related adverse events.However,there is insufficient evidence of ERAS on shortening length of hospitalization and lowering the inci-dence of postoperative pulmonary complications.关键词
漏斗胸/胸外科手术/术后加速康复/治疗结果/儿童Key words
Funnel Chest/Thoracic Surgical Procedures/Enhanced Recovery after Surgery/Treatment Outcome/Child引用本文复制引用
滑蕾,于洁,任艺,马阳巍,张富洲,张建敏..加速康复外科策略在儿童漏斗胸手术中的应用[J].临床小儿外科杂志,2024,23(11):1082-1087,6.基金项目
吴阶平医学基金会临床科研专项基金自助项目(320.6750.19089-102) Clinical Research Grant of Wu Jieping Medical Foundation(320.6750.19089-102) （320.6750.19089-102）
