Zhang H W, Liu H N, Zhao M Q, Guo D, Li D Y, Qi X Y, Cao J, Yao Z M, Shi H X, Zhang X J
Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
Zhonghua Yi Xue Za Zhi. 2021 Dec 7;101(45):3730-3735. doi: 10.3760/cma.j.cn112137-20210430-01040.
To explore the perioperative therapeutic effect of enhanced recovery after surgery (ERAS) in children with congenital spinal deformity and summarize the clinical experience. Fifty-nine pediatric patients with congenital spinal deformities admitted to Beijing Children's Hospital from May 2020 to January 2021 were included in this study, and all patients underwent posterior spinal osteotomy orthopedic implant fusion with internal fixation. There were 22 males and 37 females, aged (7.4±4.1) years. Patients were divided into ERAS group (=29) and control group (=30) according to the management model. Patients in the ERAS group were managed with an accelerated recovery management model during the perioperative period, which mainly included: high protein diet, shortened fasting time, optimized anesthesia protocol, and multimodal analgesia. Patients in the control group received the traditional perioperative management model. The indexes of surgery, diet, pain score and laboratory tests were compared between the two groups. All patients completed the surgery successfully. The mean temperature and pain scores of patients in the ERAS group were lower than those in the control group at 3 days postoperatively (<0.05). The time to exhaustion and defecation in the ERAS group was (1.0±0.8) d and (2.5±0.9) d postoperatively, both significantly earlier than those in the control group ((3.4±0.8) d and (4.0±1.1) d) (both <0.05). C-reactive protein was 38(8,46) mg/L in patients of the ERAS group on the day 3 postoperatively, which was significantly lower than that in the control group 47(22,93) mg/L (=0.023). The hemoglobin level on postoperative day 3 was (110.7±9.6) g/L in the ERAS group, which was significantly higher than that in the control group ((104.5±11.4) g/L) (=0.029). Postoperative complications occurred in 8(27.6%) and 9(30.0%) patients in the ERAS and control groups, respectively (=1.000), with mild abdominal pain and bloating being the most common complications in both groups, most of which were not treated specifically. ERAS is a safe and effective perioperative management mode for children with congenital spinal deformity. Compared with the traditional method, it can significantly improve the treatment efficiency and deserve clinical application.
探讨加速康复外科（ERAS）在先天性脊柱畸形患儿围手术期的治疗效果，并总结临床经验。本研究纳入2020年5月至2021年1月在北京儿童医院收治的59例先天性脊柱畸形患儿，所有患儿均接受后路脊柱截骨矫形内固定融合术。其中男性22例，女性37例，年龄（7.4±4.1）岁。根据管理模式将患儿分为ERAS组（n = 29）和对照组（n = 30）。ERAS组患儿在围手术期采用加速康复管理模式，主要包括：高蛋白饮食、缩短禁食时间、优化麻醉方案和多模式镇痛。对照组患儿采用传统围手术期管理模式。比较两组患儿的手术、饮食、疼痛评分及实验室检查指标。所有患儿均顺利完成手术。术后3天，ERAS组患儿的平均体温和疼痛评分均低于对照组（P<0.05）。ERAS组患儿术后疲劳和排便时间分别为（1.0±0.8）天和（2.5±0.9）天，均明显早于对照组（（3.4±0.8）天和（4.0±1.1）天）（均P<0.05）。术后第3天，ERAS组患儿C反应蛋白为38（8，46）mg/L，明显低于对照组的47（22，93）mg/L（P = 0.023）。ERAS组术后第3天血红蛋白水平为（110.7±9.6）g/L，明显高于对照组（（104.5±11.4）g/L）（P = 0.029）。ERAS组和对照组分别有8例（27.6%）和9例（30.0%）患儿发生术后并发症（P = 1.000），两组最常见的并发症均为轻度腹痛和腹胀，多数未进行特殊处理。ERAS是先天性脊柱畸形患儿安全有效的围手术期管理模式。与传统方法相比，可显著提高治疗效率，值得临床应用。
