围手术期加速康复理念在漏斗胸中的应用进展

Research advances in enhanced recovery after surgery for pediatric pectus excavatum during perioperative period

加速康复外科(enhanced recovery after surgery,ERAS)理念在成人外科领域已得到推广并取得良好效果。近年来ERAS理念被引入小儿外科,但由于儿童疾病谱的特殊性以及对麻醉、手术的耐受性与成人不同,ERAS在儿童外科的应用面临挑战。就漏斗胸而言,患儿围手术期的疼痛、腹胀、心理或进食障碍等,严重影响手术后的加速康复;同时漏斗胸患儿往往年龄偏大,在临床处理上更接近成人,因此,能否借鉴成人外科在ERAS方面的经验用于漏斗胸患儿的围手术期加速康复,是近年来国内外关注的热点。本文就儿童漏斗胸围手术期镇痛、心理疏导以及术后加速康复策略进行综述。

Enhanced recovery after surgery(ERAS)has been popular during adult surgery.Recently people have shifted their attention to children.Children’s special disease spectrum and tolerance to anesthesia and surgery are different from those of adults.Thus it has challenged the focus of ERAS approach.The incidence of adverse reactions such as pain,bloating,psychological or eating disorders remains high during perioperative period of surgery for pediatric pectus excavatum(PE).Thus postoperative recovery is poor.Also PE children tend to be older and closer to adults in clinical management.Whether it can learn from the experience of adult surgery in ERAS and promote the accelerated rehabilitation of pediatric PE is a hot topic in recent years.This review summarized the concrete steps of promoting accelerated rehabilitation during perioperative period of pediatric PE in terms of analgesia,psychological counseling and postoperative rehabilitation.