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目的:评估应用加速康复外科(enhanced recovery after surgery,ERAS)处理模式在新生儿肠旋转不良微创治疗中的安全性及临床效果。方法:出生1~28 d的肠旋转不良患儿75例,明确诊断后根据家长意愿,有45例在围手术期应用加速康复外科处理模式(ERAS组),30例应用传统处理模式(对照组),比较两组患儿手术时间、术中出血量以及术后肠功能恢复时间、总住院时间、住院费用、术后应激指标和并发症发生率等情况。结果:ERAS组和对照组术中出血量及手术费用未见统计学差异(P>0.05);手术时间ERAS组长于对照组[(111.67±15.61)min vs.(63.00±6.75)min,P<0.05];术后肠功能恢复时间和术后总住院时间ERAS组显著短于对照组[(36.33±6.86)h vs.(60.67±12.15)h,P<0.05;(8.89±1.05)d vs.(12.44±1.59)d,P<0.05];术后主要并发症比较:肠扭转复发率ERAS组和对照组无明显差别(P>0.05),切口感染率、应激反应阳性率和呼吸道感染率ERAS组均低于对照组(0%vs.6.66%,33.33%vs.70%,26.67%vs.66.67%,P均<0.05)。术后随访30 d,ERAS组及对照组均没有再入院患儿。结论:加速康复外科处理模式可以应用于新生儿肠旋转不良的微创治疗。
OBJECTIVE: To evaluate the safety and clinical efficacy of ERAS in the minimally invasive treatment of neonatal intestinal malrotation. METHODS: Seventy-five children with dysplasia of the intestine from January 28 to January 28 were enrolled in this study. According to the parents’ wishes, 45 patients were enrolled in the ERAS group during the perioperative period and 30 patients in the control group ). The operation time, intraoperative blood loss, postoperative intestinal function recovery time, total length of hospital stay, hospitalization expenses, postoperative stress index and complication rate were compared between the two groups. Results: There was no significant difference in operative bleeding volume and operation cost between ERAS group and control group (P> 0.05). The length of ERAS in operation group was significantly higher than that in control group [(111.67 ± 15.61) min vs. (63.00 ± 6.75) min, P < 0.05]. The recovery time of intestinal function and total postoperative hospital stay were significantly shorter in ERAS group than in control group [(36.33 ± 6.86) h vs. (60.67 ± 12.15) h, P <0.05; (8.89 ± 1.05) d vs. (12.44 ± 1.59) d, P <0.05]; Comparison of the main postoperative complications: The recurrence rate of intestine was no significant difference between ERAS group and control group (P> 0.05). The incision infection rate, the positive rate of stress reaction and the respiratory infection rate ERAS group were lower than the control group (0% vs.6.66%, 33.33% vs.70%, 26.67% vs.66.67%, P <0.05 respectively). After 30 days of follow-up, none of the children in the ERAS group and the control group returned to hospital. Conclusion: Accelerated rehabilitation surgical treatment can be applied to minimally invasive treatment of neonatal intestinal malrotation.