加速康复外科在儿童OSAS围手术期中的应用

Use of enhanced recovery after surgery in children with obstructive sleep apnea syndrome during the perioperative period

目的探讨加速康复外科(ERAS)在阻塞性睡眠呼吸暂停综合征(OSAS)患儿围手术期中的应用效果。方法将鼻内镜下腺样体消融+双侧扁桃体切除术的1 968例患儿,随机分为ERAS组1 040例和传统组928例,ERAS组于ERAS模式下进行围手术期处理,传统组进行传统的围手术期处理。比较术后住院时间、并发症发生率、两组疼痛评分、精神状态与术后饮食量。结果传统组、ERAS组术后住院时间分别为(3.5±1.2)、(2.3±0.8) d,两组比较(t=-5.529,P=0.001)。传统组、ERAS组并发症发生率分别为1.29%(12/928)、0.19%(2/1040)(χ2=8.413,P=0.004)。传统组围手术期处理术后2、12和24 h痛觉评分分别为(2.42±0.89)、(3.40±0.82)、(3.12±0.62)分,ERAS组分别为(1.69±0.58)、(2.32±0.69)、(2.13±0.42)分,差异均有统计学意义(P均<0.01)。传统组术后6、12和24 h精神状态评分分别为(5.42±0.89)、(3.40±0.82)、(3.12±0.75)分,ERAS组分别为(3.36±0.57)、(2.55±0.50)、(1.65±0.45)分,差异均有统计学意义(P均<0.01)。传统组术后6、12和24 h冷流质饮食量分别为(2.0±1.2)、(16.5±2.6)、(24.0±13.0)(mL/kg),ERAS组术后6、12和24 h冷流质饮食量分别为(5.0±1.8)、(26.5±5.8)、(68±26)(mL/kg),差异均有统计学意义(P均<0.01)。结论 ERAS用于OSAS患儿围手术期效果确切。

Objective To explore the effects of enhanced recovery after surgery（ ERAS） in children with obstructive sleep apnea syndrome（ OSAS） during the perioperative period. Methods A total of 1 968 children who underwent adenoidal ablation and bilateral tonsillectomy under nasal endoscopy were randomly divided into the ERAS group（ 1 040 patients） and the traditional group（ 928 patients）. The ERAS group was treated with the ERAS mode during the perioperative period,whereas the traditional group was treated with the traditional perioperative management. The postoperative hospital stay,incidence of complications,pain scores,mental status,and postoperative diet between the two groups were compared. Results The postoperative hospital stays were significantly shorter in the ERAS group than in the traditional group [（ 2.3±0.8） days vs（ 3.5±1.2） days]; t =-5.529,P = 0.001）. The complication rate was lower in the ERAS group than in the traditional group [0.19% vs 1.29%; χ^2= 8.413,P = 0.004）. The pain scores were 2.42±0.89,3. 40 ± 0. 82,and 3. 12 ± 0. 62 at 2,12,and 24 h after perioperative management in the traditional group,whereas the corresponding values in the ERAS group were 1.69±0.58,2.32±0.69,and 2.13±0.42（ all P〈0.01）. The mental status scores at 6,12,and 24 h were 5.42±0.89,3.40±0.82,and 3.12±0.75,respectively,in the traditional group and 3.36±0.57,2.55±0.50,and 1.65±0.45,respectively,in the ERAS group（ all P〉0.01）. The cold fluid diets at 6,12,and 24 h after surgery were2.0± 1.2,16.5±2.6,and 24.0±13.0 mL,respectively,in the traditional group and 5.0±1.8,26.5±5.8,and 68±26 mL,respectively,in the ERAS group（ all P〈0.01）. Conclusion ERAS is effective for children with OSAS undergoing nasal endoscopic adenoidectomy ablation and tonsil resection during the perioperative period.