加速康复外科在痉挛型脑瘫患儿治疗的应用
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摘要
[目的]探讨加速康复外科(ERAS)在痉挛型脑瘫患儿治疗中的应用效果。[方法]2014年10月~2017年9月就诊于本院符合纳入标准的痉挛型脑瘫患儿100例,随机分为ERAS治疗组(52例)和常规治疗组(48例)。比较两组的平均住院日、术后每日平均输液量、术后第3 d和第5 d视觉模拟评分量表(VAS)疼痛评分、住院费用、术后并发症发生率、患者满意度。[结果]两治疗组患儿治疗前基线资料差异无统计学意义(P>0.05)。ERAS治疗组患儿平均住院日、术后每日平均输液量、术后第3 d和第5 d VAS疼痛评分、住院费用、术后并发症发生率均显著低于常规治疗组,差异有统计学意义(P<0.05)。ERAS治疗组患者满意度显著高于常规治疗组,差异有统计学意义(P<0.05)。[结论]针对痉挛型脑瘫患儿,ERAS治疗方案能够缩短平均住院日、降低术后每日平均输液量、减轻术后疼痛、减少和降低住院花费及术后并发症发生率,提升患者满意度。
[Objective] To investigate the clinical outcomes of enhanced recovery after surgery(ERAS) for spastic cerebral palsy in children. [Methods] From October 2014 to September 2017, 100 children who met the inclusion criteria of spastic cerebral palsy were randomly divided into ERAS treatment group(52 children) and conventional treatment group(48 children) in the Third of Shandong Provincial Hospital. The hospital stay, daily average of infusion amount, visual analogue scale(VAS) of pain at 3 and 5 days postoperatively, hospitalization expenses, incidence of postoperative complications and patients' satisfaction were compared between the two groups. [Results] There was no statistically significant difference in baseline data before treatment between the two groups(P>0.05). The ERAS group proved significantly lower than the conventional group in hospitalization days, daily average of infusion amount, visual analogue scale(VAS) of pain at 3, 5 days postoperatively, hospitalization expenses and incidence of postoperative complications with statistical differences between them(P<0.05). Contrariwise, the ERAS group was considerably superior to the conventional group in patient.s satisfaction(P<0.05). [Conclusion] The ERAS does shorten hospital stay, reduce the daily average of infusion amount, relieve postoperative pain, decrease hospitalization cost and the incidence of postoperative complications, while improve patient.s satisfaction for spastic cerebral palsy in children.
[Objective] To investigate the clinical outcomes of enhanced recovery after surgery(ERAS) for spastic cerebral palsy in children. [Methods] From October 2014 to September 2017, 100 children who met the inclusion criteria of spastic cerebral palsy were randomly divided into ERAS treatment group(52 children) and conventional treatment group(48 children) in the Third of Shandong Provincial Hospital. The hospital stay, daily average of infusion amount, visual analogue scale(VAS) of pain at 3 and 5 days postoperatively, hospitalization expenses, incidence of postoperative complications and patients' satisfaction were compared between the two groups. [Results] There was no statistically significant difference in baseline data before treatment between the two groups(P>0.05). The ERAS group proved significantly lower than the conventional group in hospitalization days, daily average of infusion amount, visual analogue scale(VAS) of pain at 3, 5 days postoperatively, hospitalization expenses and incidence of postoperative complications with statistical differences between them(P<0.05). Contrariwise, the ERAS group was considerably superior to the conventional group in patient.s satisfaction(P<0.05). [Conclusion] The ERAS does shorten hospital stay, reduce the daily average of infusion amount, relieve postoperative pain, decrease hospitalization cost and the incidence of postoperative complications, while improve patient.s satisfaction for spastic cerebral palsy in children.
引文
[1]范复盛.研究痉挛性脑瘫儿童的康复效果及其影响因素[J].世界最新医学信息文摘,2017,17(66):35-37.
[2]Wu YW,Kuzniewicz M W,Wickremasinghe AC,et al.Risk for cerebral palsy in infants with total serum bilirubin levels at or above the exchange transfusion threshold:a population-based study[J].JAMA Pediatr,2015,169(3):239-246.
[3]胡蓉蓉,易慧智.加速康复外科和损伤控制理念在急腹症中的研究进展[J].世界华人消化杂志,2016,24(14):2204-2212.
[6]王振,丁昌荣,王展,等.加速康复外科在高龄髋部骨折病人围手术期的应用现状和研究进展[J].齐鲁医学杂志,2017,32(4):492-494.
[7]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.
[8]Russell D,Rosenbaum PL,Avery LM,et al.Gross motor function measure.(GMFM-66&GMFM088)user’s manual[M].London,Mac Keith,2002:30-123.
[9]Ansari NN,Nghdi S,Mashayekhi M,et al.Intra-rater reliability of the modified ashworth scale(mmas)in the assessment of upperlimb muscle spasticity[J].Neurorehabilitation,2012,31(2):215-222.
[10]安春梅,侯敏,高建华.痉挛性脑瘫脊神经后根切断术的康复护理[J].现代护理,2004,10(11):1066-1066.
[11]Joynt RL,Leonard JA.Dantrolene sodium suspension in treatment of spastic cerebral palsy[J].Dev Med Child Neurol,1980,22(6):755-767.
[12]Kehlet H.Multimodal approach to control postoperative pathophysiologu and rehabilition[J].British J Anaesthesia,1997,78(5):606-617.
[13]杨伟民,李斯明.加速康复外科理念在髋膝关节置换术围术期的应用研究[J].中华骨与关节外科杂志,2018,11(3):182-185.
[14]陈庆民,范东,吕晓红.加速康复外科在结直肠癌患者中应用的新进展[J].中华结直肠疾病电子杂志,2017,6(2):132-134.
[15]Michael A,Alexander,Dennis M.Pediatric rehabilitation[M].4th ed.New York:Demos Medical Publishing,2010:166-197.
[2]Wu YW,Kuzniewicz M W,Wickremasinghe AC,et al.Risk for cerebral palsy in infants with total serum bilirubin levels at or above the exchange transfusion threshold:a population-based study[J].JAMA Pediatr,2015,169(3):239-246.
[3]胡蓉蓉,易慧智.加速康复外科和损伤控制理念在急腹症中的研究进展[J].世界华人消化杂志,2016,24(14):2204-2212.
[6]王振,丁昌荣,王展,等.加速康复外科在高龄髋部骨折病人围手术期的应用现状和研究进展[J].齐鲁医学杂志,2017,32(4):492-494.
[7]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.
[8]Russell D,Rosenbaum PL,Avery LM,et al.Gross motor function measure.(GMFM-66&GMFM088)user’s manual[M].London,Mac Keith,2002:30-123.
[9]Ansari NN,Nghdi S,Mashayekhi M,et al.Intra-rater reliability of the modified ashworth scale(mmas)in the assessment of upperlimb muscle spasticity[J].Neurorehabilitation,2012,31(2):215-222.
[10]安春梅,侯敏,高建华.痉挛性脑瘫脊神经后根切断术的康复护理[J].现代护理,2004,10(11):1066-1066.
[11]Joynt RL,Leonard JA.Dantrolene sodium suspension in treatment of spastic cerebral palsy[J].Dev Med Child Neurol,1980,22(6):755-767.
[12]Kehlet H.Multimodal approach to control postoperative pathophysiologu and rehabilition[J].British J Anaesthesia,1997,78(5):606-617.
[13]杨伟民,李斯明.加速康复外科理念在髋膝关节置换术围术期的应用研究[J].中华骨与关节外科杂志,2018,11(3):182-185.
[14]陈庆民,范东,吕晓红.加速康复外科在结直肠癌患者中应用的新进展[J].中华结直肠疾病电子杂志,2017,6(2):132-134.
[15]Michael A,Alexander,Dennis M.Pediatric rehabilitation[M].4th ed.New York:Demos Medical Publishing,2010:166-197.
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