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区域麻醉和手术体积在接受子修复的儿童:一个多中心的审查

Dimitra Lotakis¹, Jack P Vernamonti¹, Tiffany N Wright²

¹University of Michigan Health, C.S. Mott Children's Hospital, Ann Arbor, Michigan.

The Journal of surgical research

|December 20, 2024

概括

区域麻醉技术,如冷和直立脊柱导管 (ESCs) 显著减少停留时间和阿片类药物在儿科乳腺挖掘手术中的使用. 外科医生的体积也会影响结果,而高体积的中心可能会出现更多的并发症.

科学领域:

儿科外科手术儿科外科手术
胸部外科手术胸部外科手术
麻醉学麻醉学
疼痛管理疼痛管理

背景情况:

乳房挖掘术的Nuss手术是儿科中常见的一种胸部手术.
已知区域麻醉方法和手术体积会影响患者的治疗结果.
麻醉技术和外科手术体积对结果的独立关系尚未得到充分描述.

研究的目的:

调查区域麻醉和手术体积与停留时间 (LOS),术后阿片类药物使用,手术室利用率和Nuss手术患者并发症之间的关联.
为了比较不同区域麻醉技术的有效性,特别是冷和勃起器脊柱导管 (ESCs).

主要方法:

这是一项9个中心对21岁或更年轻的患者进行的回顾性评估,这些患者在2016年至2020年期间接受了Nuss手术.
大批量中心和外科医生被定义为年度手术的上四分之一.
用混合效应线性/逻辑回归模型分析了结果. 还进行了对ESC利用率的单中心分析.

主要成果:

结冷处理独立地与较短的LOS (-2.1天) 和减少术后阿片类药物使用 (-120MME) 相关,但增加了手术时间 (+45分钟).
较高的个人外科医生体积与减少的LOS相关 (-0.3天),而高体积中心显示并发症增加 (OR 2.2).
在单个中心使用勃起脊柱导管 (ESC) 与较短的LOS (2对3天) 有关.

结论:

包括冷和ESC在内的区域麻醉方法与改善的结果有关,例如减少LOS和阿片类药物消费.
虽然冷处理无关体积都显示出好处,但ESC也显示出与改善结果的积极关联.
疼痛缓解方法的重大制度差异限制了直接比较,因此需要严格的前性研究来比较ESC和冷.

关键词:

通过冷除,可以进行冷除.这是Nuss程序.疼痛管理疼痛管理胸部挖掘器 (pectus excavatum) 是一个挖掘器.外科手术的结果外科手术的体积.

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