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| 加速康复外科策略应用于患儿腹腔镜阑尾切除术的效果 |
| Effect of enhanced recovery after surgery concept in pediatric patients of abdomen surgery |
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| DOI：10.12089/jca.2019.02.010 |
| 中文关键词: 腹腔镜 阑尾切除术 超声引导 腰方肌阻滞 加速康复外科 |
| 英文关键词: Laparoscopic Appendectomy Ultrasound-guided Quadratus lumborum block Enhanced recovery after surgery |
| 基金项目:山东省医药卫生发展计划（2015WS0236） |
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| 中文摘要: |
目的 观察加速康复外科（enhanced recovery after surgery，ERAS）策略下超声引导下腰方肌神经阻滞应用于患儿腹腔镜阑尾切除术的临床疗效。
方法 选择拟行腹腔镜阑尾切除术患儿154例，男114例，女40例，年龄3~10岁，ASA Ⅰ或Ⅱ级，采用随机对照法分为两组：ERAS组（E组）和对照组（C组），每组77例。E组于超声引导下腰方肌深面注射0.2%罗哌卡因0.75 ml/kg，同时参照加速康复指南禁食4 h禁饮2 h、术前30 min给予功能饮料、麻醉诱导期家长陪同，麻醉方式采用喉罩全麻，即丙泊酚2~6 mg·kg-1·h-1持续泵入，吸入2%~6%七氟醚;C组采用传统麻醉方法，严格禁食6 h禁饮4 h，咪达唑仑、丙泊酚、阿曲库铵、舒芬太尼诱导后气管插管全麻。记录术后1、2、3、6、12、24、48 h VAS评分;随访患儿术后苏醒时间、首次肛门排气时间、下床时间、住院时间、家属满意度，术后恶心、呕吐等不良反应发生率。
结果 术后2、3、6、12 h E组VAS评分明显低于C组（P<0.05）;E组术后苏醒时间、首次肛门排气时间、下床时间、住院时间明显短于C组（P<0.05），家属满意度明显高于C组（P<0.05）。E组恶心、呕吐发生率明显低于C组（P<0.05）。
结论 ERAS策略应用于患儿腹腔镜阑尾切除术，并发症发生减少、术后疼痛明显减轻，患儿康复快、住院时间缩短，患儿家属满意度升高。 |
| 英文摘要: |
Ojective To observe the clinical effect of ultrasound-guided quadratus lumborum block combined with enhanced recovery after surgery (ERAS) for the laparoscopic appendectomy in children.
Methods A total of 154 children undergoing laparoscopic appendectomy, 114 males and 40 females, aged 3 - 10 years, ASA physical status Ⅰ or Ⅱ, were divided into the ERAS group (group E) and control group (group C), n = 77 each group. Patients in group E received ultrasound-guided deep injection of 0.2% ropivacaine 0.75 ml/kg into quadratus lumbar muscle. According to the guidelines for rapid rehabilitation fasting for 4 h and abstaining from drinking for 2 h, functional beverages were given 30 min before operation and parental escort during induction of anesthesia while given general anesthesia with laryngeal mask, that is, propofol 2 - 6 mg·kg-1·h-1 was continuously pumped with 2% - 6% sevoflurane. Patients in group C were given traditional anesthesia, strict fasting for 6 h and no drinking for 4 h, as while as induction with midazolam, propofol, atracurium and sufentanil and tracheal intubation. The VAS scores at 2, 3, 6 and 12 h post-operation were recorded. The awakening time, anal exhaust time, ambulation time, hospitalization days, the patient’s satisfaction rates were recorded. The cases of nausea, vomiting, regurgitation and aspiration were recorded.
Results The VAS scores at 2, 3, 6 and 12 h post-operation in group E were significantly lower than that in group C (P < 0.05). All the postoperative rehabilitation indicators in group E were superior to group C, including the awakening time, anal exhaust time, ambulation time, hospitalization days and patient’s satisfaction (P < 0.05). Complication incidences in group E were significantly declined compared with group C (P < 0.05).
Conclusion For children undergoing laparoscopic appendectomy, ultrasound-guided quadratus lumborum block combined with the ERAS strategy could result in less postoperative complications, reduced postoperative pain, rapid rehabilitation, shortened hospitalization time and increased patients’ satisfaction. |
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