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青少年特发性脊柱侧凸术后快速康复管理方案及效果评价

蔡思逸 邱贵兴 王以朋 仉建国 田野 赵宏 赵宇 李书纲 沈建雄 李默晗

蔡思逸, 邱贵兴, 王以朋, 仉建国, 田野, 赵宏, 赵宇, 李书纲, 沈建雄, 李默晗. 青少年特发性脊柱侧凸术后快速康复管理方案及效果评价[J]. 协和医学杂志, 2019, 10(6): 594-599. doi: 10.3969/j.issn.1674-9081.2019.06.008
引用本文: 蔡思逸, 邱贵兴, 王以朋, 仉建国, 田野, 赵宏, 赵宇, 李书纲, 沈建雄, 李默晗. 青少年特发性脊柱侧凸术后快速康复管理方案及效果评价[J]. 协和医学杂志, 2019, 10(6): 594-599. doi: 10.3969/j.issn.1674-9081.2019.06.008
Si-yi CAI, Gui-xing QIU, Yi-peng WANG, Jian-guo ZHANG, Ye TIAN, Hong ZHAO, Yu ZHAO, Shu-gang LI, Jian-xiong SHEN, Mo-han LI. Enhanced Recovery after Surgery Program in the Perioperation of Adolescent Idiopathic Scoliosis and Its Effect Evaluation[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(6): 594-599. doi: 10.3969/j.issn.1674-9081.2019.06.008
Citation: Si-yi CAI, Gui-xing QIU, Yi-peng WANG, Jian-guo ZHANG, Ye TIAN, Hong ZHAO, Yu ZHAO, Shu-gang LI, Jian-xiong SHEN, Mo-han LI. Enhanced Recovery after Surgery Program in the Perioperation of Adolescent Idiopathic Scoliosis and Its Effect Evaluation[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(6): 594-599. doi: 10.3969/j.issn.1674-9081.2019.06.008

青少年特发性脊柱侧凸术后快速康复管理方案及效果评价

doi: 10.3969/j.issn.1674-9081.2019.06.008
详细信息
    通讯作者:

    沈建雄 电话:010-69152801, E-mail:sjxpumch@163.com

  • 中图分类号: R459.4;R687

Enhanced Recovery after Surgery Program in the Perioperation of Adolescent Idiopathic Scoliosis and Its Effect Evaluation

More Information
    Corresponding author: SHEN Jian-xiong Tel: 86-10-69152801, E-mail:sjxpumch@163.com
  • 摘要:   目的  总结青少年特发性脊柱侧凸术后快速康复(enhanced recovery after surgery, ERAS)综合措施, 评价其对术后康复的影响。  方法  2007年1月至2017年1月在北京协和医院骨科住院接受外科矫形治疗的青少年特发性脊柱侧凸患者连续队列中最初100例(第1~100例, 传统组)和最后100例(第1193~1292例, ERAS组)患者入选本研究。ERAS组围手术期采用包括术前、术中及术后的快速康复诊疗方案, 回顾性比较两组术后康复情况, 包括总住院日、术后住院日、异体输血量、出院时疼痛评分、30 d内并发症发生率及1年内非计划再手术发生率。  结果  两组患者一般临床资料及1年内非计划再手术率无统计学差异, 传统组患者的总住院日及术后住院日均显著长于ERAS组[总住院日:传统组(17.18±2.67)d, ERAS组(11.35±1.49)d, P < 0.05;术后住院日:传统组(9.34±0.52)d, ERAS组(7.19±0.71)d, P < 0.05];传统组异体输血人数及异体红细胞输血量均多于ERAS组[异体输血人数:传统组41%(41/100), ERAS组20%(20/100), P < 0.05;异体红细胞输血量:传统组(1.43±0.39)U, ERAS组(0.59±0.12)U, P < 0.05];传统组出院时疼痛评分[(3.40±0.63)分]略高于ERAS组[(3.00±0.47)分], 但差异无统计学意义。  结论  青少年特发性脊柱侧凸围手术期实施加速康复诊疗方案, 可在不增加患者并发症和非计划再手术发生率的情况下, 减少住院时间及输血量, 加快患者康复。
    利益冲突  无
  • 表  1  青少年特发性脊柱侧凸患者传统组和ERAS组一般临床资料

    组别 女性(%) 年龄(x±s,岁) BMI(x±s,kg/m2) 手术节段(x±s,个)
    传统组(n=100) 88 14.5±2.1 18.13±4.31 10.69±3.20
    ERAS组(n=100) 87 14.1±3.1 19.15±3.49 10.28±2.84
    P 0.14 0.83 0.11 0.51
    ERAS:加速康复外科; BMI:体质量指数
    下载: 导出CSV

    表  2  青少年特发性脊柱侧凸患者传统组和ERAS组临床结局比较

    组别 总住院日(x±s,d) 术后住院日(x±s,d) 术后输血人数(n) 输血量(x±s,U) 30 d内并发症发生率(%) 非计划再手术发生率(%) 出院时疼痛评分(x±s,分) 出院满意度(x±s,分)
    传统组(n=100) 17.18±2.67 9.34±0.52 41 1.43±0.39 6 3 3.40±0.63 95.14±6.87
    ERAS组(n=100) 11.35±1.49 7.19±0.71 20 0.59±0.12 9 2 3.00±0.47 94.86±7.92
    P 0.00 0.00 0.001 0.0008 0.42 0.65 0.69 0.27
    ERAS:同表 1
    下载: 导出CSV
  • [1] Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth, 1997, 78:11. http://www.ncbi.nlm.nih.gov/pubmed/9175983
    [2] Adamina M, Kehlet H, Tomlinson GA, et al. Enhanced recovery pathways optimize health outcomes and resource utilization:A meta-analysis of randomized controlled trials in colorectal surgery[J]. Surgery, 2011, 149:830-840. doi:  10.1016/j.surg.2010.11.003
    [3] Aasvang EK, Luna IE, Kehlet H. Challenges in postdis-charge function and recovery:the case of fast-track hip and knee arthroplasty[J]. Br J Anaesth, 2015, 115:861-866. http://www.ncbi.nlm.nih.gov/pubmed/26209853
    [4] Tambe AD, Panikkar SJ, Millner PA, et al. Current concepts in the surgical management of adolescent idiopathic scoliosis[J]. Bone Joint J, 2018, 100-B:415-424. doi:  10.1302/0301-620X.100B4.BJJ-2017-0846.R2
    [5] 邱贵兴.特发性脊柱侧凸的PUMC(协和)分型系统[J].中华骨科杂志, 2003, 23:8. http://doi.med.wanfangdata.com.cn/qk/zhgkzz98200301001
    [6] Mandelbaum BR, Tolo VT, McAfee PC, et al. Nutritional deficiencies after staged anterior and posterior spinal reconstructive surgery[J]. Clin Orthop Relat Res, 1988, 234:5-11. http://www.onacademic.com/detail/journal_1000039199830110_f52c.html
    [7] Lalueza MP, Colomina MJ, Bago J, et al. Analysis of nutritional parameters in idiopathic scoliosis patients after major spinal surgery[J]. Eur J Clin Nutr, 2005, 59:720-722. doi:  10.1038/sj.ejcn.1602126
    [8] 仉建国, 王炜, 邱贵兴, 等.术前肺功能检查在脊柱侧凸手术治疗中的作用[J].中华外科杂志, 2004, 42:3. http://www.cqvip.com/Main/Detail.aspx?id=10879258
    [9] Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications[J]. Cochrane Database Syst Rev, 2003, (4):CD004423.
    [10] Gordon ZL, Son-Hing JP, Poe-Kochert C, et al. Bipolar sealer device reduces blood loss and transfusion requirements in posterior spinal fusion for adolescent idiopathic scoliosis[J]. J Pediatr Orthop, 2013, 33:700-706. http://www.ncbi.nlm.nih.gov/pubmed/23812158
    [11] Pastorelli F, Di Silvestre M, Plasmati R, et al. The prevention of neural complications in the surgical treatment of scoliosis:the role of the neurophysiological intraoperative monitoring[J]. Eur Spine J, 2011, 20 Suppl 1:S105-S114. http://www.ncbi.nlm.nih.gov/pubmed/21416379
    [12] 张圣洁, 徐梅, 赵琳, 等.脊柱侧弯患者术后使用经静脉自控镇痛的效果及影响因素分析[J].护理学报, 2011, 18:45-47. http://d.wanfangdata.com.cn/Periodical/nfhlxb201120016
    [13] 张谊, 高娜.脊柱侧弯术后应用病人自控镇痛泵镇痛的护理研究[J].护理研究, 2007, 33:3031-3032. http://d.wanfangdata.com.cn/Periodical/sxhlzz200733012
    [14] 蔡思逸, 沈建雄, 邱贵兴, 等.综合全程血液管理措施对骨科手术患者异体输血的影响[J].协和医学杂志, 2015, 6:286-290. http://d.wanfangdata.com.cn/Periodical/xhyx201504013
    [15] 黄宇光.手术患者临床用血的挑战与对策[J].中国输血杂志, 2010, 23:764-765. http://www.cqvip.com/QK/97865X/201010/35843348.html
    [16] Liang SJ, Chua S, Fan Y, et al. Does intraoperative cell salvage system effectively decrease the need for allogeneic transfusions in scoliotic patients undergoing posterior spinal fusion? A prospective randomized study[J]. Eur Spine J, 2015, 24:270-275. doi:  10.1007/s00586-014-3282-2
    [17] Nahtomi-Shick OKJ, Winters BD, Breder CD, et al. Does intraoperative fluid management in spine surgery predict intensive care unit length of stay?[J]. J Clin Anesth, 2001, 13:208-212. doi:  10.1016/S0952-8180(01)00244-6
    [18] 于健春.围手术期营养支持合理优化选择[J].中国实用外科杂志, 2012, 2:110-112. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgsywkzz201202004
    [19] 陈亚萍, 梁艳彩.脊柱侧弯患者术后腹胀的观察及其影响因素分析[J].护理学杂志, 2011, 26:48-49. http://qikan.cqvip.com/Qikan/Article/Detail?id=39500798
    [20] Blanco JS, Perlman SL, Cha HS, et al. Multimodal painmanagement after spinal surgery for adolescent idiopathic scoliosis[J]. Orthopedics, 2013, 36:33-35. http://europepmc.org/abstract/med/23379574
    [21] Daffner SD, Beimesch CF, Wang JC. Geographic and demographic variability of cost and surgical treatment of idiopathic scoliosis[J]. Spine (Phila Pa 1976), 2010, 35:1165-1169. http://www.ncbi.nlm.nih.gov/pubmed/20421853/
    [22] Erickson MA, Morrato EH, Campagna EJ, et al. Variability in spinal surgery outcomesamong children's hospitals in theUnited States[J].J Pediatr Orthop, 2013, 33:80-90. doi:  10.1097/BPO.0b013e318269c537
    [23] Yoshihara YD. Nationaltrends in spinal fusion for pediatricpatients with idiopathic scoliosis:demographics, blood transfusions, and in-hospital outcomes[J]. Spine, 2014, 39:1144-1150. http://europepmc.org/abstract/med/24732849
    [24] Blanco JS, Perlman SL, Cha HS, et al. Multimodal painmanagement after spinal surgery for adolescent idiopathic scoliosis[J]. Orthopedics, 2013, 36:33-35. http://europepmc.org/abstract/med/23379574
    [25] Yoshihara H, Paulino C, Yoneoka D. Predictors of increased hospital stay in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion:analysis of national database[J]. Spine Deform, 2018, 6:226-230. http://europepmc.org/abstract/MED/29735130
    [26] 向娜, 李杨.青少年特发性脊柱侧凸患者术后疼痛评估与控制的研究进展[J].解放军护理杂志, 2016, 22:29-32. http://www.cqvip.com/QK/83642X/201622/671057456.html
    [27] Fletcher ND, Shourbaji N, Mitchell PM, et al. Clinical and economic implications ofearly discharge following posteriorspinal fusion for adolescentidiopathic scoliosis[J]. J Child Orthop, 2014, 8:257-263. http://europepmc.org/abstract/med/24770995
    [28] Austin E, Sanders BA, Lindsay M, et al. Clinically significant psychological and emotional distress in 32% of adolescent idiopathic scoliosis patients[J]. Spine Deform, 2018, 6:435-440. http://europepmc.org/abstract/MED/29886916
    [29] Muhly WT, Sankar WN, Ryan K, et al. Rapid recovery pathway after spinal fusion for idiopathic scoliosis[J]. Pediatrics, 2016, 137:1-10. http://europepmc.org/abstract/MED/27009035
    [30] Sanders JO. CORR Insights®:patient factors are associated with poor short-term outcomes after posterior fusion for adolescent idiopathic scoliosis[J]. Clin Orthop Relat Res, 2015, 473:295-296.
    [31] Hassan N, Halanski M, Wincek J, et al. Blood management in pediatric spinal deformity surgery:review of a 2-year experience[J]. Transfusion, 2011, 51:2133-2141. http://www.ncbi.nlm.nih.gov/pubmed?term=HUNTINGTON+JOHN[au]
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  • 收稿日期:  2018-08-13
  • 刊出日期:  2019-11-30

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