[1]李炳钻,宫伟,王建嗣,等.加速康复外科理念在儿童发育性髋关节发育不良围手术期管理中的应用[J].中医正骨,2022,34(12):18-22,28.
　LI Bingzuan,GONG Wei,WANG Jiansi,et al.Application of enhanced recovery after surgery in perioperative period management of developmental dysplasia of the hip in children[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(12):18-22,28.
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加速康复外科理念在儿童发育性髋关节发育不良围手术期管理中的应用()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年12期
页码:
18-22,28
栏目:
临床研究
出版日期:
2022-12-02

文章信息/Info

Title:
Application of enhanced recovery after surgery in perioperative period management of developmental dysplasia of the hip in children
作者:
李炳钻; 宫伟; 王建嗣; 蔡秀英; 郑瑞真; 练志平
(泉州市正骨医院,福建 泉州 362000)
Author(s):
LI Bingzuan; GONG Wei; WANG Jiansi; CAI Xiuying; ZHENG Ruizhen; LIAN Zhiping
Quanzhou Orthopedic-Traumatological Hospital,Quanzhou 362000,Fujian,China
关键词:
发育性髋关节发育不良;  加速康复外科;  围手术期;  儿童;  临床试验
Keywords:
developmental dysplasia of the hip;  enhanced recovery after surgery;  perioperative period;  child;  clinical trial
摘要:
目的:探讨加速康复外科(enhanced recovery after surgery,ERAS)理念在儿童发育性髋关节发育不良(developmental dysplasia of the hip,DDH)围手术期管理中的应用价值。方法:将60例DDH患儿随机分为2组,每组30例。2组患儿均采用骨盆截骨术联合股骨近端截骨术治疗。分别在ERAS理念指导下(ERAS组)和传统康复理念指导下(传统康复组)进行围手术期管理。记录并比较2组患儿的手术时间、术中失血量、术中输血情况、住院时间、髋关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、切口周围肿胀程度、切口周围肿胀消退时间及并发症发生情况。结果:①一般结果。2组患儿手术时间、术中失血量及术中输血情况比较,组间差异均无统计学意义[(107.70±6.92)min,(107.47±6.91)min,t=0.131,P=0.896;(180.00±48.87)mL,(190.83±48.60)mL,t=0.861,P=0.393; χ2=0.647,P=0.421]; ERAS组患儿住院时间短于传统康复组[(7.57±1.65)d,(10.36±1.56)d,t=6.720,P=0.000]。②髋关节疼痛VAS评分。时间因素与分组因素存在交互效应(F=3.220,P=0.047); 2组患儿髋关节疼痛VAS评分总体比较,组间差异有统计学意义,即存在分组效应(F=33.928,P=0.000); 术后不同时间点髋关节疼痛VAS评分的差异有统计学意义,即存在时间效应(F=108.156,P=0.000); 2组患儿髋关节疼痛VAS评分随时间变化均呈下降趋势,但2组的下降趋势不完全一致[(3.23±1.57)分,(2.17±1.15)分,(1.60±0.72)分,F=74.242,P=0.000;(4.57±1.07)分,(3.83±1.21)分,(3.32±0.87)分,F=37.134,P=0.000]; 术后6 h、12 h、24 h,ERAS组髋关节疼痛VAS评分均低于传统康复组(t=14.768,P=0.000; t=30.083,P=0.000; t=77.440,P=0.000)。③切口周围肿胀情况。ERAS组患儿术后24 h切口肿胀Ⅰ级22例、Ⅱ级8例,传统康复组术后24 h切口肿胀Ⅰ级14例、Ⅱ级16例。ERAS组患儿术后24 h切口周围肿胀程度低于传统康复组(χ2=4.444,P=0.035),切口周围肿胀消退时间短于传统康复组[(3.50±1.11)d,(5.43±1.14)d,t=6.680,P=0.000]。④并发症发生情况。ERAS组术后3例发生早期发热、2例发生恶心呕吐、2例发生腹痛腹胀,传统康复组术后8例发生早期发热、4例发生恶心呕吐、3例发生腹痛腹胀。2组患儿均未发生切口感染、尿路感染等并发症。ERAS组患儿并发症发生率低于传统康复组(χ2=4.593,P=0.032)。结论:在儿童DDH围手术期管理中应用ERAS理念,能够缩短住院时间、缓解髋关节疼痛及切口周围肿胀,提高手术安全性。
Abstract:
Objective:To explore the application value of enhanced recovery after surgery(ERAS)in perioperative period management of developmental dysplasia of the hip(DDH)in children.Methods:Sixty DDH children were randomly divided into two groups,with 30 cases in each group.All cases were treated with pelvic osteotomy combined with proximal femoral osteotomy.Perioperative period management was performed under the guidance of ERAS(ERAS group)and traditional rehabilitation(traditional rehabilitation group).The operation time,intraoperative blood loss,intraoperative blood transfusion,length of hospital stay,hip pain visual analogue scale(VAS)score,swelling around the incision site,reduction time of the swelling around the incision site,and the incidence of complications were recorded and compared between the two groups.Results:①General results.There were no significant differences in operation time,intraoperative blood loss,and intraoperative blood transfusion between the two groups(107.70±6.92 vs 107.47±6.91 min,t=0.131,P=0.896; 180.00±48.87 vs 190.83±48.60 mL,t=0.861,P=0.393; χ2=0.647,P=0.421).The length of hospital stay in the ERAS group was shorter than that in the traditional rehabilitation group(7.57±1.65 vs 10.36±1.56 d,t=6.720,P=0.000).②VAS score.There was an interaction effect between the time factor and the grouping factor(F=3.220,P=0.047).There was a statistically significant difference in hip pain VAS scores between the two groups,which was indicative of grouping effect(F=33.928,P=0.000).There was a statistically significant difference in hip pain VAS scores between different time points after operation,which was indicative of time effect(F=108.156,P=0.000).The hip pain VAS scores of the two groups showed a downward trend over time,but the downward trend was not completely consistent between the two groups(3.23±1.57,2.17±1.15,1.60±0.72 points,F=74.242,P=0.000; 4.57±1.07,3.83±1.21,3.32±0.87 points,F=37.134,P=0.000).The hip pain VAS scores of the ERAS group was lower than those of the traditional rehabilitation group at 6,12 and 24 h after operation(t=14.768,P=0.000; t=30.083,P=0.000; t=77.440,P=0.000).③Swelling around the incision site.There were 22 cases of grade Ⅰ swelling and 8 cases of grade Ⅱ swelling around the incision site 24 h after operation in the ERAS group,and 14 cases of grade Ⅰ swelling and 16 cases of grade Ⅱ swelling around the incision site 24 h after operation in the traditional rehabilitation group.The swelling level around the incision site 24 h after operation in the ERAS group was lower than that in the traditional rehabilitation group(χ2=4.444,P=0.035),and the reduction time of the swelling around the incision site was shorter than that of the traditional rehabilitation group(3.50±1.11 vs 5.43±1.14 d,t=6.680,P=0.000).④Occurrence of complications.In the ERAS group,early fever occurred in three cases,nausea and vomiting in two cases,and abdominal pain and distension in two cases,while in the traditional rehabilitation group,eight cases had early fever,four cases had nausea and vomiting,and three cases had abdominal pain and distension.No incision infection,urinary tract infection,and other complications occurred in the two groups.The incidence of complications in the ERAS group was lower than that in the traditional rehabilitation group(χ2=4.593,P=0.032).Conclusion:The application of ERAS in perioperative period management of DDH in children can shorten the length of hospital stay,relieve hip pain and swelling around the incision site,and improve surgical safety.

参考文献/References:

[1] SANKAR W N,GORNITZKY A L,CLARKE N M P,et a1.Closed reduction for developmental dysplasia of the hip:early-term results from a prospective,multicenter cohort[J].J Pediatr Orthop,2019,39(3):111-118.
[2] 岳宇航,余京杭,李连永,等.股骨短缩截骨对发育性髋关节发育不良患儿下肢骨性长度的影响[J].骨科临床与研究杂志,2019,4(3):133-137.
[3] AARVOLD A,SCHAEFFER E K,KELLEY S,et al.Management of irreducible hip dislocations in infants with developmental dysplasia of the hip diagnosed below 6 months of age[J].J Pediatr Orthop,2019,39(1):e39-e43.
[4] 余京杭,李连永,张立军,等.股骨近端截骨在发育性髋关节发育不良手术治疗中的必要性研究[J].临床小儿外科杂志,2019,18(11):927-934.
[5] 沙佳,严亚波,徐会法,等.不同年龄组大龄发育性髋关节脱位患者手术疗效的临床研究[J].中国矫形外科杂志,2017,25(9):775-780.
[6] FEEIEY I H,GREEN C J,ROWAN F E,et al.International variance in the treatment of developmental dysplasia of the hip[J].J Child Orthop,2014,8(5):381-386.
[7] 舒强,钭金法.加速康复外科在小儿外科中的应用与展望[J].临床小儿外科杂志,2019,18(4):253-256.
[8] 中华医学会骨科学分会.发育性髋关节发育不良诊疗指南(2009年版)[J].中国矫形外科杂志,2013,21(9):953-954.
[9] 中华医学会外科学分会,中华医学会麻醉学分会.加速康复外科中国专家共识及路径管理指南(2018版)[J].中国实用外科杂志,2018,38(1):1-20.
[10] 吴庭楣,郭航,马亚群,等.加速康复外科在儿童围手术期的应用发展现状[J].中华小儿外科杂志,2019,40(7):668-672.
[11] 高小雁,董秀丽.积水潭小儿骨科护理[M].北京:北京大学医学出版社,2014:181-191.
[12] WONG D L,BAKER C M.Smiling faces as anchor for pain intensity scales[J].Pain,2001,89(2/3):295-300.
[13] 杨建平,吕正祥,蒋涛,等.不放置引流管对中重度膝骨关节炎初次全膝关节置换术后快速康复的影响[J].中医正骨,2019,31(5):7-14.
[14] 包展程,吕存贤.中西医结合快速康复外科模式在髋关节置换围手术期中的应用进展[J].中医正骨,2020,32(6):40-43.
[15] LI J,RAI S,ZE R,et al.Enhanced recovery care versus traditional non-ERAS care following osteotomies in developmental dysplasia of the hip in children:a retrospective case-cohort study[J].BMC Musculoskelet Disord,2020,21(1):234.
[16] 齐金莲,贾英萍,张现伟,等.加速康复外科技术在小儿发育性髋关节脱位围手术期应用的研究[J].临床小儿外科杂志,2021,20(10):962-967.
[17] GIBB A C N,CROSBY M A,MCDIARMID C,et al.Creation of an enhanced recovery after surgery(ERAS)guideline for neonatal intestinal surgery patients:a knowledge synthesis and consensus generation approach and protocol study[J].BMJ Open,2018,8(12):e023651.
[18] 李庭,周雁,孙旭,等.缩短创伤骨科择期手术患者围手术期禁食水时间的前瞻性队列研究[J].中华创伤骨科杂志,2018,20(4):312-317.
[19] CHOU R,GORDON D B,DE LEON-CASASOLA O A,et al.Management of postoperative pain:a clinical practice guideline from the American Pain Society,the American Society of Regional Anesthesia and Pain Medicine,and the American Society of Anesthesiologists'Committee on Regional Anesthesia,Executive Committee,and Administrative Council[J].J Pain,2016,17(4):508-510.
[20] 唐维兵,路长贵.儿童加速康复外科的现状与展望[J].中华小儿外科杂志,2019,40(9):769-771.
[21] JOSHI G P,KEHLET H.Postoperative pain management in the era of ERAS:an overview[J].Best Pract Res ClinAnaesthesiol,2019,33(3):259-267.
[22] 万丽,赵晴,陈军,等.疼痛评估量表应用的中国专家共识(2020版)[J].中华疼痛学杂志,2020,6(16):177-187.
[23] 谭惠兴,许雪洁,骆美芳.会阴冰敷贴在预防产后会阴部切口疼痛及肿胀患者中的应用[J].齐鲁护理杂志,2021,27(9):135-137.
[24] 李天友,王延宙,王恒冰,等.血红蛋白<80 g/L作为儿童发育性髋关节发育不良术后输血指征安全性的初步观察[J].中国矫形外科杂志,2014,22(13):1182-1185.
[25] 卢红信,陈笑天,肖玉周.儿童发育性髋关节脱位的治疗进展[J].安徽医药,2019,23(4):738-742.
[26] 方继红,肖玉梅,武凤芹,等.发育性髋关节脱位患儿术中低体温及其并发症研究[J].安徽医学,2019,40(9):1057-1059.
[27] 周志羽.儿童发育性髋关节脱位骨盆截骨术后早期发热的危险因素分析[J].实用临床医药杂志,2019,23(10):78-80.
(收稿日期:2022-07-06 本文编辑:吕宁)

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备注/Memo

备注/Memo:
基金项目:泉州市高层次人才创新创业项目(2019C078R) 通讯作者:宫伟 E-mail:gongwei362000@163.com
更新日期/Last Update: 1900-01-01