先天性食管裂孔疝合并贫血围手术期管理策略的对照研究 1

目的探讨先天性食管裂孔疝合并贫血围手术期的治疗策略。 方法采用1：1匹配的病例对照研究方法，收集2008年7月至2018年4月就诊于新疆维吾尔自治区人民医院40例先天性食管裂孔疝合并贫血患儿的病历资料。采用配对t检验比较不同的围手术期管理策略（A组患儿Hb＞70 g/L，B组患儿Hb＞90 g/L时行手术治疗。）对先天性食管裂孔疝合并贫血治疗效果的影响。观察并比较两组年龄、体重、性别、术前血红蛋白（Hb）、贫血治疗费用、术前营养情况、手术时间、术中出血量、术后住院时间、术后3个月的血红蛋白等临床结果。A组患儿中有4例消化道出血症状，以呕吐为主诉就诊的10例，以贫血为主诉就诊者10例。其中Ⅰ型14例，Ⅱ型4例，Ⅲ型2例；维吾尔族8例，哈萨克族7例，汉族5例。B组患儿中5例有消化道出血症状，以呕吐为主诉就诊者12例，以贫血为主诉就诊者8例，其中Ⅰ型15例，Ⅱ型3例，Ⅲ型2例，维吾尔族5例，汉族15例。两组患者术前资料组间差异无统计学意义（P＞0．05）（表1）。 结果两组患儿的年龄、体重、性别、营养情况，无统计学差异（P＞0.05）。所有患儿术前均给予常规纠正贫血治疗，对所有贫血患儿的行悬浮红细胞输注治疗，A组患儿在Hb＞70 g/L、B组患儿在Hb＞90 g/L时均顺利完成腹腔镜下食管裂孔疝修补术+Nissen胃底折叠术。A组术前纠正贫血时间（5±1.2）d，相关费用（2200±12.5）元，B组术前纠正贫血时间（8±1.5）d，相关费用（2600±13.4）元（P＜0.05），中出血量、术后住院天数无统计学差异（P＞0.05）。术后随访3个月，两组患儿Hb无统计学差异（P＞0.05），且所有患儿术后恢复良好，无严重并发症发生。 结论先天性食管裂孔疝合并贫血患儿适当放宽手术指征，尽早完成手术根治先天性食管裂孔疝是治疗贫血的有效措施。

A Controlled Study Of Perioperative Management Strategies For Congenital Hiatal Hernia With Anemia

Obstract Perioperative management strategy for congenital hiatal hernia with anemia. MethodsA 1：1 matched case-control study method was used to collect medical records of 40 children with congenital hiatal hernia complicated with anemia in the People's Hospital of Xinjiang Uygur Autonomous Region from July 2008 to April 2018. Paired t-test was used to compare different perioperative management strategies (group A children with Hb ＞70 g/L, and group B children with Hb ＞90 g/L underwent surgery.) The effect of treatment on congenital hiatal hernia with anemia Impact. Observe and compare the clinical results of the two groups such as age, weight, gender, preoperative hemoglobin (Hb), anemia treatment cost, preoperative nutrition, operative time, intraoperative blood loss, postoperative hospital stay, 3 months postoperative hemoglobin, etc. In group A, there were 4 cases of gastrointestinal bleeding symptoms, 10 cases presented with vomiting as the main complaint, and 10 cases presented with anemia as the main complaint. Among them, 14 were type Ⅰ, 4 were type Ⅱ, and 2 were type Ⅲ; 8 were Uyghur, 7 were Kazakh, and 5 were Han. In group B, 5 cases had gastrointestinal bleeding symptoms, 12 cases presented with vomiting as the main complaint, 8 cases presented with anemia as the main complaint, of which 15 were type Ⅰ, 3 were type Ⅱ, 2 were type Ⅲ, and 5 were Uyghurs. Cases, 15 cases of Han nationality. There was no statistically significant difference in the preoperative data between the two groups (P＞0.05) (Table 1). ResultsThere was no statistical difference in the age, weight, sex, and nutritional status of the two groups of children (P＞0.05). All children were given routine treatment to correct anemia before the operation. Suspension red blood cell infusion was performed for all children with anemia. Children in group A were treated with Hb >70 g/L and children in group B were treated with Hb ＞90 g/L. Successfully completed laparoscopic hiatus hernia repair + Nissen fundoplication. The time to correct anemia before operation in group A was (5±1.2) d, and the related expenses were (2200±12.5) yuan, and the time to correct anemia before operation in group B was (8±1.5) d, and the related expenses were (2600±13.4) yuan (P＜0.05) There was no significant difference in the amount of bleeding and the number of days of hospitalization after surgery (P＞0.05). After 3 months of follow-up, there was no significant difference in Hb between the two groups (P＞0.05), and all the children recovered well after the operation without serious complications. ConclusionsIn children with congenital hiatal hernia and anemia, appropriate relaxation of the surgical indications and completion of the operation as soon as possible is an effective measure for the treatment of anemia.