| Background and purposeEnhanced recovery after surgery(ERAS)is a concept first proposed by Danish surgeon Kehlet H,which refers to a series of perioperative optimization measures with evidence-based medical evidence to reduce or reduce the psychological and physical traumatic stress of patients.The benefits of the ERAS approach include shorter hospital stays,reduced postoperative pain and analgesia needs,faster recovery of gastrointestinal function,reduced complications and readmission rates,and increased patient satisfaction.At present,researches of ERAS at home and abroad mainly focus on the related fields of adult surgery,and most of the ERAS management schemes implemented in pediatric groups are improved by referring to the successful experience of adults.Moreover,there are few relevant studies and clinical practices,which are not enough to form the consensus and guidelines of ERAS implementation supported by high-level evidence-based medicine.Children,especially infants and young children,are a special group with underdeveloped physiological structures and functions,immature minds,and more complex stress responses to surgical trauma Acute appendicitis is one of the most common causes of acute abdominal disease in children.The symptoms are not typical,children's expression is unclear and it is difficult to diagnose and treat,development is incomplete and easy to perforate,inflammation is easy to spread and develop into sepsis.Therefore,the diagnosis and treatment of pediatric appendicitis needs to be more accurate and more comprehensive,and optimizing perioperative management measures to reduce the stress response of children is especially important to promote the early recovery of patients after surgery.In this study,patients with appendicitis with relatively simple operation and good prognosis were selected,and the concept of rapid rehabilitation surgery was applied to the perioperative period of acute appendicitis in children to explore its feasibility and safety.Materials and methods1 Research materials and groupingA retrospective analysis was made on 128 cases of acute appendicitis in our hospital in recent two years.Among them,58 children who were admitted to hospital from June 2017 to May 2018 and received conventional laparoscopic surgery were set as the control group,and 70 children who received rapid rehabilitation guidance combined with laparoscopic surgery after admission from June 2018 to May 2019 were set as the observation group.To evaluate the value of the concept of rapid rehabilitation surgery in the perioperative period of acute appendicitis in children.2 Observation indicators2.1 Preoperative observation indexesGeneral information:age,weight,sex.Laboratory data:leukocyte,c-reactive protein,calcitonin,electrolyte,hemoglobin,albumin.Clinical classification:simple,suppurative.2.2 Intraoperative observation indexesOperation time,intraoperative blood loss.2.3 Postoperative observation indexesLaboratory data:leukocyte,c-reactive protein,calcitonin,electrolyte,hemoglobin,albumin.Recent complications:sore throat,nausea and vomiting,urethral discomfort,incision infection,abdominal residual infection.Long-term complications:intestinal obstruction.Others:feeding time,out of bed activity time,ventilation time,defecation time,hospitalization days,hospitalization expenses,satisfaction.3 Statistical analysisAll data were analyzed by SPSS17.0 statistical software,and the measurement data were expressed as mean ± standard deviation and t test.Counting data the counting data were represented by frequency and rate,and X2 test was used.The theoretical frequency 1?T<5 was calculated by X2 continuity correction formula.The theoretical frequency T<1 was calculated by Fisher's exact probability method.P<0.05 was considered statistically significant.Results1.Preoperative observation indicators:general information:there were no statistical differences in age,weight and gender between the observation group and the control group;Laboratory data:there were no significant differences in white blood cells,c-reactive protein,calcitonin,hemoglobin and albumin between the observation group and the control group.Clinical classification:there was no statistical difference between the observation group and the control group.2.Intraoperative observation indexes:there was no statistical difference between the observation group and the control group in operation time and intraoperative blood loss.3.Postoperative observation indexes:the time of feeding,time of getting out of bed,time of exhaust and defecation in the observation group was earlier than that in the control group,and the length of hospitalization,total hospitalization expenses and satisfaction were better than that in the control group.Postoperative complications such as sore throat,urethral discomfort,nausea and vomiting,and intestinal obstruction were less in the observation group than in the control group.There was no significant difference between the observation group and the control group in incision infection and abdominal residual infection.The mean changes of leukocyte,c-reactive protein and calcitonin in the observation group were slightly larger than those in the control group,but the overall difference was not significant.The ratio of abnormal hemoglobin(<90g/L),albumin(<35g/L),Na+ concentration(<135mmol/L,>145mmol/L),K+concentration(<3.5mmol/L,>5.5mmol/L)and Ca2+concentration(<2.25mmol/L)in the control group was higher than that in the observation group.ConclusionThe improved perioperative management measures under the guidance of the concept of rapid rehabilitation surgery can accelerate the recovery process of the body of the children,shorten the hospitalization time,and improve the hospitalization satisfaction of the children and their families without increasing the complications.Rapid rehabilitation surgery combined with laparoscopy for the treatment of acute appendicitis in children is safe and effective,and is recommended for mild and moderate cases of acute appendicitis. |
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