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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 574 -577. doi: 10.3877/cma.j.issn.1674-392X.2022.05.019

临床论著

加速康复外科策略对腹股沟疝患儿应激反应及术后恢复的影响
刘光1, 刘支娜1,†(), 张玲1, 王会瑟1, 蔺颐1, 张亚涛1   
  1. 1. 071000　河北省，保定市儿童医院麻醉科　保定市儿童呼吸消化疾病临床研究重点实验室
  • 收稿日期:2022-02-24 出版日期:2022-10-18
  • 通信作者: 刘支娜

Effects of enhanced recovery protocols on stress response and postoperative recovery in children with inguinal hernia

Guang Liu1, Zhina Liu1,†(), Ling Zhang1, Huise Wang1, Yi Lin1, Yatao Zhang1   

  1. 1. Department of Anesthesiology, Baoding Children's Hospital, Baoding Children's Respiratory and Digestive Diseases Clinical Research Key Laboratory, Baoding 071000, China
  • Received:2022-02-24 Published:2022-10-18
  • Corresponding author: Zhina Liu
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刘光, 刘支娜, 张玲, 王会瑟, 蔺颐, 张亚涛. 加速康复外科策略对腹股沟疝患儿应激反应及术后恢复的影响[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(05): 574-577.

Guang Liu, Zhina Liu, Ling Zhang, Huise Wang, Yi Lin, Yatao Zhang. Effects of enhanced recovery protocols on stress response and postoperative recovery in children with inguinal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(05): 574-577.

目的

探讨围手术期麻醉管理应用加速康复外科（ERAS）策略对腹股沟疝患儿应激反应及术后恢复的影响。

方法

选取2019年6-10月在保定市儿童医院择期行腹腔镜下单侧内环结扎术患儿120例，年龄1~3岁，ASA Ⅰ~Ⅱ级。随机将患儿分为常规组和ERAS组，每组60例。常规组采用传统方式进行围手术期麻醉管理，ERAS组采用儿童加速康复外科策略行围手术期麻醉管理。分别于术前（T0）、术毕时（T1）测定血浆皮质醇（Cor）、去甲肾上腺素（NE）、血糖（Glu）水平，于苏醒时（T2）和回病房后2h（T3）测定镇静、疼痛与躁动评分。观察并记录2组患儿手术时间、苏醒时间、住院天数、总费用、术后恶心呕吐不良反应发生率和家长满意率。

结果

T1时，ERAS组Cor、NE显著低于常规组（P<0.05），2组Glu差异无统计学意义（P>0.05）。T2、T3时刻ERAS组患儿镇静、疼痛、躁动评分值显著优于常规组（P<0.05）。术后恢复方面，ERAS组患儿术后不良反应发生率显著低于常规组（P<0.05），家长满意率显著高于常规组（P<0.05），但2组患儿在复苏时间、住院天数和住院总费用方面差异无统计学意义（P>0.05）。

结论

加速康复外科策略能降低腹股沟疝患儿术中应激反应和术后不良反应、提高家长满意度，但对住院时间和费用无明显影响。

关键词: 疝，腹股沟, 加速康复外科, 应激反应, 儿童
Objective

To explore the effect of perioperative anesthetic management with Enhanced Recovery After Surgery (ERAS) Protocols on stress response and postoperative recovery of children with inguinal hernia.

Methods

120 cases of children with inguinal hernia (aged 1~3 years, ASA grade Ⅰ~Ⅱ) who underwent elective laparoscopic unilateral internal ring ligation in Baoding Children's Hospital from June to October 2019 were selected. They were randomly divided into two groups: control group (group C) and ERAS group (group E), with 60 children in each group. Patients in group C were treated with traditional methods for perioperative anesthetic management, while patients in group E were treated with enhanced recovery protocols for perioperative anesthetic management. The plasma levels of cortisol (Cor), norepinephrine (NE) and glucose (Glu) were recorded before operation (T0) and at the end of operation (T1). Ramsay score, FLACC score and PAED score were recorded at the time of awakening (T2) and 2 hours after returning to the ward (T3). The operation time, recovery time, incidence of postoperative nausea and vomiting reactions, hospital stay, total cost of children and satisfaction rate of parents were observed and recorded in the two groups.

Results

At T1, Cor and NE in Group E were significantly lower than those in group C (P<0.05), but there was no significant difference in Glu between the two groups (P>0.05). The scores of Ramsay, FLACC and PAED in Group E were significantly better than those in group C at T2 and T3 (P<0.05). In terms of postoperative recovery, the incidence of postoperative adverse reactions was significantly lower than that in group C (P<0.05), and the satisfaction rate of parents in Group E was significantly higher than those in group C (P<0.05), but there was no significant difference in the recovery time, length of stay and total hospitalization costs between the two groups (P>0.05).

Conclusion

ERAS can reduce the stress response during operation and postoperative adverse reactions in children with inguinal hernia, and improve the satisfaction rate of parents, but it has no significant effect on the length of stay and the cost of hospitalization.

Key words: Hernia, inguinal, Enhanced recovery after surgery, Stress reaction, Child
表1 2组患儿一般资料比较
组别 例数 男/女[例(%)] 年龄(岁,±s) ASA分级 体重(kg,±s) 单侧/双侧[例(%)] 手术时间(min,±s)
Ⅰ/Ⅱ[例(%)]
常规组 60 52(86.7)/8(13.3) 1.92±0.84 55(91.7)/5(8.3) 13.75±1.65 46(76.7)/14(23.3) 12.45±4.22
ERAS组 60 49(81.7)/11(18.3) 2.02±0.76 52(86.7)/8(13.3) 13.45±1.56 50(83.3)/10(16.7) 13.28±3.61
t/χ2   0.563 0.684 0.776 1.023 0.833 1.158
P值   0.453 0.495 0.378 0.308 0.361 0.249
表2 2组患儿应激反应指标的比较（±s）
组别 时间 例数 Cor(ng/ml) NE(pg/ml) Glu(mmol/L)
常规组 T0 60 221.26±24.14 235.32±21.34 4.62±0.21
ERAS组 60 218.37±22.94 242.16±27.94 4.65±0.24
t值     0.672 1.507 0.729
P值     0.503 0.135 0.468
常规组 T1 60 248.74±21.86 265.26±28.17 4.78±0.28
ERAS组 60 240.47±19.74 253.73±22.87 4.82±0.47
t值     2.175 2.461 0.566
P值     0.035 0.015 0.572
表3 2组患儿镇静疼痛躁动评分的比较（±s）
组别 时间 例数 Ramsay评分 FLACC评分 PAED评分
常规组 T2 60 1.1±0.6 3.8±0.6 11.2±2.6
ERAS组 60 1.4±0.8 2.4±0.4 8.1±2.3
t值     2.324 15.038 6.917
P值     0.022 0.000 0.000
常规组 T3 60 1.3±0.8 2.4±0.5 6.8±1.8
ERAS组 60 1.8±0.6 1.8±0.3 4.2±1.9
t值     3.873 7.971 7.695
P值     0.000 0.000 0.000
表4 2组患儿术后恢复情况比较
组别 例数 复苏时间(min,±s) 住院天数(d,±s) 总费用(元,±s) 不良反应发生率[例(%)] 家长满意率[例(%)]
常规组 60 18.28±4.64 3.32±0.35 6231.8±155.5 8(13.3) 47(78.3)
ERAS组 60 17.78±5.44 3.41±0.28 6287.4±183.6 2(3.3) 56(93.3)
t/χ2   0.542 1.555 0.084 3.927 5.551
P值   0.589 0.123 0.934 0.048 0.019
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