论文部分内容阅读
目的总结先天性食管闭锁患儿围手术期监护及临床特点,以加强围手术期管理。方法对2005—2013年广州市妇女儿童医疗中心收治的先天性食管闭锁患儿围手术期的临床资料进行回顾性分析。结果研究期间收治的182例食管闭锁患儿中21例放弃治疗,纳入分析161例。术前66例需机械通气,机械通气组早产儿比例及合并心脏畸形患儿比例均高于非机械通气组(63.6%比29.5%,57.6%比16.8%,P<0.05)。术后每隔1 h采用CRIES评分法进行1次疼痛评估,≥4分者137例(85.1%),1~3分24例(14.9%)。术后1周内开奶患儿(59例)住院时间和机械通气时间与术后1周后开奶患儿(102例)比较差异无统计学意义(P>0.05)。体重增长良好组(74例)住院时间短于体重增长不良组(87例)[(18.1±4.2)天比(25.3±10.9)天,P<0.05]。术后使用奥美拉唑组(53例)吻合口漏发生率与未使用奥美拉唑组(108例)差异无统计学意义(P>0.05),但吻合口漏持续时间缩短[(7.2±4.3)天比(13.1±6.8)天,P<0.05]。结论先天性食管闭锁患儿中早产及合并心脏畸形者需呼吸支持的比率较高,营养状态良好可缩短住院时间,术后使用奥美拉唑抑酸可缩短食管吻合口漏持续时间。
Objective To summarize the perioperative monitoring and clinical features of children with congenital esophageal atresia to enhance perioperative management. Methods The clinical data of perioperative patients with congenital esophageal atresia admitted to Guangzhou Women and Children Medical Center from 2005 to 2013 were analyzed retrospectively. Results Twenty-one of 182 esophageal atresia cases treated during the study period were discontinued and 161 were included in the analysis. The preoperative 66 patients required mechanical ventilation, the proportion of premature infants with mechanical ventilation and the proportion of children with heart malformation were higher than those without mechanical ventilation (63.6% vs 29.5%, 57.6% vs 16.8%, P <0.05). One CRI score was used to evaluate the pain at 1 hour postoperatively. 137 cases (85.1%) had ≥4 points and 24 cases (14.9%) had 1-3 points. There was no significant difference in hospitalization time and mechanical ventilation time between the two groups (59 cases) and the one-week group (102 cases) after one week. The hospitalized patients with good weight gain (74 cases) had shorter hospital stay than those with poor weight gain (87 cases) [(18.1 ± 4.2) days vs (25.3 ± 10.9) days, P <0.05]. The incidence of anastomotic leakage in the omeprazole group (n = 53) was not significantly different from that in the non-used omeprazole group (n = 108) (P> 0.05), but the duration of anastomotic leakage was shorter ± 4.3) day ratio (13.1 ± 6.8) days, P <0.05]. Conclusions In patients with congenital esophageal atresia, the rate of respiratory support is higher in those with premature delivery and complicated with cardiac malformations, and good nutritional status can shorten the length of hospital stay. Omeprazole acid suppression after operation can shorten the duration of esophageal anastomotic leakage.