Abstract:

Objective　Under the concept of enhanced recovery after surgery (ERAS), to explore the feasibility and safety of shortening the fasting time before surgery and early food and water intake after surgery in orthopedic children. Methods　Data of children aged 3-7 years who were admitted to Department of Orthopedics, Luohe Central Hospital from March 2019 to March 2021 were retrospectively analyzed. The 59 children admitted from March 2020 to March 2021 were enrolled in the treatment group, including 25 males and 34 females, aged (4.97±1.35) years, who adopted the method of preoperative fasting and postoperative food and water intake methods formulated under the ERAS concept. The 57 children admitted from March 2019 to February 2020 were enrolled in the control group, including 24 males and 33 females, aged (4.95±1.43) years, who received the traditional preoperative fasting and postoperative food and water intake methods. The preoperative fasting time and time of postoperative food and water intake were compared between the two groups. The scores of thirst and hunger, crying rate, intraoperative aspiration rate, and incidences of postoperative nausea and vomiting and abdominal distension were observed in the two groups. t test and χ² test were used. Results　The preoperative no eating time [(7.78±0.87) h] and no drinking time [(4.50±0.53) h] and the time of postoperative food and water intake [(2.31±0.46) h] in the treatment group were shorter than those in the control group [(12.50±1.49) h, (11.34±0.68) h, and (6.54±0.23) h], with statistically significant differences (t=20.921, 60.542, and 62.302, all P<0.001). The thirst scores [(2.57±1.18) points and (2.99±0.50) points], hunger scores [(5.94±0.39) points and (3.28±0.53) points], and crying rates [23.2% (14/59) and 16.9% (10/59)] of the treatment group before and after surgery were lower than those of the control group [(7.36±1.43)] points, (6.51±0.39) points, (7.79±0.50) points, (6.89±0.49) points, 50.9% (29/57), and 38.6% (22/57)], with statistically significant differences (all P<0.05). No aspiration occurred in both groups during surgery. There were no statistically significant differences in the incidences of nausea and vomiting [6.8% (4/59)] and abdominal distension [1.7% (1/59)] in the treatment group compared with those in the control group [14.0% (8/57) and 3.5% (2/57)] (χ²=1.645 and 0.379, P=0.200 and 0.538). Conclusion　Under the ERAS concept, the diet plan of shortening the fasting time before surgery and early food and water intake after surgery is safe and feasible in orthopedic children, which can reduce their discomfort and accelerate their recovery.

Key words:

Enhanced recovery after surgery, Bone disease, Children, No eating, No drinking

摘要：

目的　在加速康复外科理念下，探讨骨科患儿围手术期缩短术前禁饮食时间及术后早期进食水的可行性与安全性。方法　回顾性分析2019年3月至2021年3月漯河市中心医院骨科收治的3～7岁患儿资料。2020年3月至2021年3月收治59例患儿的为治疗组，其中男25例、女34例，年龄（4.97±1.35）岁，采用在加速康复外科理念下制订的术前禁饮食及术后进食水方法。2019年3月至2020年2月收治的57例患儿为对照组，其中男24例、女33例，年龄（4.95±1.43）岁，采用传统的术前禁饮食及术后进食水方法。对比两组术前禁饮食时间及术后进食水时间，观察两组患儿口渴及饥饿评分、哭闹率、术中误吸发生率、术后恶心呕吐和腹胀的发生率。采用t检验及χ²检验。结果　治疗组术前禁食时间［（7.78±0.87）h］、禁饮时间［（4.50±0.53）h］及术后进食水时间［（2.31±0.46）h］均短于对照组［（12.50±1.49）h、（11.34±0.68）h、（6.54±0.23）h］，差异均有统计学意义（t=20.921、60.542、62.302，均P<0.001）。治疗组手术前后的口渴评分［（2.57±1.18）分、（2.99±0.50）分］、饥饿评分［（5.94±0.39）分、（3.28±0.53）分］及哭闹率［23.2%（14/59）、16.9%（10/59）］均低于对照组［（7.36±1.43）分、（6.51±0.39）分、（7.79±0.50）分、（6.89±0.49）分、50.9%（29/57）、38.6%（22/57）］，差异均有统计学意义（均P<0.05）。两组患儿术中均未发生误吸。治疗组术后恶心呕吐发生率［6.8%（4/59）］、腹胀发生率［1.7%（1/59）］与对照组比较［14.0%（8/57）、3.5%（2/57）］，差异均无统计学意义（χ²=1.645、0.379，P=0.200、0.538）。结论　在加速康复外科理念下的围手术期骨科患儿术前缩短禁饮食时间与术后早期进食水的饮食方案安全可行，能减少患儿不适感，加速患儿康复。

关键词:

加速康复外科, 骨病, 儿童, 禁食, 禁水