加速康复外科技术应用于小儿咽部手术临床分析

The clinical application of enhanced recovery after surgery on pharyngeal surgery in children

目的探讨加速康复外科（enhanced recovery after surgery，ERAS）技术在小儿咽部手术中的应用效果。方法择期接受咽部手术的6～12岁患儿60例，按随机数字表法分为ERAS组和传统方法（conservative treatment surgery。CTS）组（每组30例）。其中ERAS组在术前宣教、麻醉处理、术后镇痛等方面给予具有循证医学证据支持的优化措施，CTS组采用常规围麻醉期处理。观察术后清醒时及术后2、8、24h时两组患儿血流动力学的变化、躁动评分、镇痛效果（VAS评分）、术后24h内是否需要补救镇痛、术后24h内恶心呕吐并发症的发生率、住院天数。结果两组患儿各时点的生命体征、手术时间差异无统计学意义（P〉0．05）；ERAS组各时点的躁动评分[（2．41±0．50）、（2．48±0．67）、（2．39±0．81）、（2．33±0．51）分]、VAS评分[（3.3±0．5）、（3．2±0．5）、（3．0±0．6）、（2．6±0．9）分]、术后补救镇痛率（30％）和术后恶心呕吐发生率（33．3％）均低于CTS组的躁动评分[（3．54±1．01）、（3．63±0．92）、（3．42±0．32）、（3．38±0．20）分]、VAS评分[（5．3±0．4）、（4．9±0．3）、（4．8±0．4）、（3．9±0．5）分]、术后补救镇痛率（50％）和术后恶心呕吐发生率（66．7％）（P〈0．05）。ERAS组住院时间[（5．5±0．8）d]也明显短于CTS组[（7．1±0．5）d]（P〈0．05）。结论ERAS技术能减轻咽部手术患儿的术后躁动与疼痛，缩短住院时间，促进患儿康复。

Objective To evaluate the effect of enhanced recovery after surgery （ERAS） on pharyngeal surgery in children. Methods Sixty childrens aged 6-12 y, scheduled for pharyngeal surgery, were randomly divided into two groups（n=30）： group ERAS and conservative treatment surgery group（group CTS）. Optimization measures by evidence based medicine for preoperative education, anesthetic management and postoperative analgesia were administered in group ERAS. Meanwhile, group CTS received conventional perioperative care. The hemodynamic index, sedation-agitation scale, and VAS scale were monitored during awaken from anesthesia and 2, 8, 24 h postoperatively. Rescue analgesia and postoperative complications were recorded 24 h after surgery. Hospital stays were also observed. Results There were no significant differences in hemodynamic index and operative time between the those two groups. Group ERAS was associated with a significantly lower sedation-agitation scale[（2.41±0.50）, （2.48±0.67）, （2.39±0.81）, （2.33±0.51）], VAS scale [（3.3±0.5）,（3.2±0.5）,（3.0±0.6）,（2.6±0.9）] and shorter hospital stay [（5.5±0.8） d] compared with group CTS[（3.54±1.01）, （3.63±0.92）,（3.42±0.32）,（3.38±0.20）],[（5.3±0.4）, （4.9±0.3）, （4.8±0.4）, （3.9±0.5）],[（7.1±0.5） d]. Group ERAS （30%） also received less rescue analgesia than group CTS （50%）. Incidence rate of postoperative nausea and vomiting was lower in group ERAS （33.3%） than group CTS （66.7%）, Conclusions ERAS is feasible and effective for pharyngeal surgery in children, with improvements of postoperative rehabilitation, postoperative pain, hospital stay and patients＇ satisfaction.