摘要
目的探讨胆道闭锁(BA)病儿围手术期应用加速康复外科(ERAS)优化措施的有效性及安全性。方法将2020年1月至2022年3月,在安徽省儿童医院新生儿外科行Kasai手术,并在围术期应用ERAS优化措施的30例BA病儿纳入ERAS组,同时选择2017年1月至2019年12月间采用传统围术期管理模式的37例BA手术病儿为对照组,比较两组病儿在手术时间、术中出血量、术后肠道功能恢复时间、肠外营养时间、白蛋白水平、术后住院时间、住院费用、术后黄疸消退率、胆管炎发作情况及早期并发症等方面的差异。结果两组病儿在性别、体质量、手术日龄、胆道闭锁分型、术前白蛋白水平、肝功能指标、手术时间、术中出血量、术后黄疸消退率、胆管炎发作率、术后并发症、住院费用等方面,差异无统计学意义(P>0.05)。ERAS组的肠道功能恢复时间(39.74±10.18)h、肠外营养时间(3.93±1.08)d、术后住院时间(16.57±3.90)d较对照组[(92.57±23.13)h、(4.95±1.63)d、(19.70±5.14)d]明显缩短,术后白蛋白水平明显增高[(40.26±2.93)g/L比(38.00±4.37)g/L],差异有统计学意义(P<0.05)。结论胆道闭锁病儿应用加速康复外科优化措施能降低手术应激,促进术后恢复,安全有效,具有较好的临床应用价值。
Objective To investigate the efficacy and safety of enhanced recovery after surgery(ERAS)in perioperative patients with biliary atresia(BA).Methods Thirty patients with BA who underwent Kasai surgery and enhanced recovery in Department of Neonatal Surgery of Anhui Children's Hospital from January 2020 to March 2022 were enrolled into ERAS group,and 37 patients with BA who underwent traditional perioperative management mode from January 2017 to December 2019 were selected as the control group.The differences in operative time,intraoperative blood loss,recovery time of postoperative intestinal function,parenteral nutrition time,albumin level,hospital stay,hospitalization cost,the jaundice fading rate,attack of cholangitis and early complications were compared between the two groups.Results There were no significant differences in gender,weight,operative age,classification of BA,preoperative albumin level,preoperative liver function index,operation time,intraoperative bleeding,the jaundice fading rate,attack of cholangitis,postoperative complications and hospitalization cost between the two groups(P>0.05).Intestinal function recovery time,parenteral nutrition time and hospital stay were significantly shorter than those in the control group[(39.74±10.18)h vs.(92.57±23.13)h,(3.93±1.08)d vs.(4.95±1.63)d,(16.57±3.90)d vs.(19.70±5.14)d],the postoperative albumin level was significantly higher than those in the control group[(40.26±2.93)g/L vs.(38.00±4.37)g/L](P<0.05).Conclusions The application of ERAS measures in patients with biliary atresia can reduce surgical stress,promote postoperative recovery.It is safe and effective with better clinical application value.
作者
高威
余晨
左伟
张燕敏
刘翔
GAO Wei;YU Chen;ZUO Wei;ZHANG Yanmin;LIU Xiang(Department of Pediatric Surgery,Anhui Provincial Children's Hospital,Hefei,Anhui 230059,China)
出处
《安徽医药》
CAS
2023年第8期1610-1614,共5页
Anhui Medical and Pharmaceutical Journal
基金
安徽省卫生健康委科研项目(AHWJ2021b140)。
关键词
胆道闭锁
加速康复外科
围术期管理
Biliary atresia
Enhanced recovery after surgery
Perioperative management
