加速康复外科在新生儿肠旋转不良微创治疗中的应用

发布时间：2019-05-17 06:52

【摘要】：目的:评估应用加速康复外科(enhanced recovery after surgery,ERAS)处理模式在新生儿肠旋转不良微创治疗中的安全性及临床效果。方法:出生1~28 d的肠旋转不良患儿75例,明确诊断后根据家长意愿,有45例在围手术期应用加速康复外科处理模式(ERAS组),30例应用传统处理模式(对照组),比较两组患儿手术时间、术中出血量以及术后肠功能恢复时间、总住院时间、住院费用、术后应激指标和并发症发生率等情况。结果:ERAS组和对照组术中出血量及手术费用未见统计学差异(P0.05);手术时间ERAS组长于对照组[(111.67±15.61)min vs.(63.00±6.75)min,P0.05];术后肠功能恢复时间和术后总住院时间ERAS组显著短于对照组[(36.33±6.86)h vs.(60.67±12.15)h,P0.05;(8.89±1.05)d vs.(12.44±1.59)d,P0.05];术后主要并发症比较:肠扭转复发率ERAS组和对照组无明显差别(P0.05),切口感染率、应激反应阳性率和呼吸道感染率ERAS组均低于对照组(0%vs.6.66%,33.33%vs.70%,26.67%vs.66.67%,P均0.05)。术后随访30 d,ERAS组及对照组均没有再入院患儿。结论:加速康复外科处理模式可以应用于新生儿肠旋转不良的微创治疗。
[Abstract]:Objective: to evaluate the safety and clinical effect of accelerated rehabilitation surgery (enhanced recovery after surgery,ERAS) in minimally invasive treatment of neonatal intestinal malrotation. Methods: 75 children with intestinal malrotation were diagnosed according to the wishes of their parents. 45 cases were treated with accelerated rehabilitation surgery during perioperative period (ERAS group) and 30 cases were treated with traditional management mode (control group). The operation time, intraoperative blood loss, postoperative intestinal function recovery time, total hospitalization time, hospitalization cost, postoperative stress index and incidence of complications were compared between the two groups. Results: there was no significant difference in intraoperative blood loss and operation cost between ERAS group and control group (P 0.05), and the operation time of ERAS was longer than that of control group [(111.67 卤15.61) min vs. (63.00 卤6.75) min,P0.05]. The recovery time of intestinal function and the total hospitalization time in ERAS group were significantly shorter than those in control group [(36.33 卤6.86) h vs. (60.67 卤12.15) h, P0.05; (8.89 卤1.05) d vs. (12.44 卤1.59) d, P 0.05]. There was no significant difference in the recurrence rate of intestinal volvulus between the ERAS group and the control group (P 0.05). The incision infection rate, the positive rate of stress reaction and the respiratory tract infection rate in the ERAS group were lower than those in the control group (0% vs. 6.66%). 33.33% vs.70%, 26.67% vs.66.67%, P 0.05). No children in ERAS group and control group were re-admitted to hospital after 30 days follow-up. Conclusion: accelerated rehabilitation surgery can be used in minimally invasive treatment of intestinal malrotation in neonates.
【作者单位】：南京医科大学附属儿童医院新生儿外科;徐州市儿童医院新生儿外科;安徽省立儿童医院新生儿外科;
【基金】：国家自然科学基金(81370473,81570467)
【分类号】：R722.1

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