加速康复外科策略在悬雍垂腭咽成形术患者麻醉管理中的应用

Application of Anesthesia Management in UPPP surgery under ERAS strategy

目的探讨围术期加速康复外科(Enhanced Recovery After Surgery,ERAS)策略在悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)患者麻醉管理中的应用效果。方法选择2018年1月~2020年12月择期行悬雍垂腭咽成形术患者58例,男32例,女26例,年龄18至60岁。ASAI级或Ⅱ级,随机分为两组,ERAS组(E组,n=29)和对照组(C组,n=29)。ERAS组基本要素包括:术前积极宣教,术前CPAP治疗,预防性用药防止术后恶心呕吐,术前2h摄入含糖饮料,麻醉方式选择手术部位切口局部浸润麻醉复合全身麻醉,精准麻醉管理(包括Narcotrend麻醉深度监测,有创动脉监测,中心静脉压监测,血气监测,连续呼气未CO_(2)监测,体温管理及监测,优化液体管理),多模式镇痛(术前非甾体类药超前镇痛+术中手术切口局部浸润麻醉+术后常规使用自控静脉镇痛泵加入少量阿片类和非甾体类药物+后期结合口服非甾体类药物的多模式镇痛方案),术后早期进食及下床活动等。C组实施常规围术期处理及麻醉方法。记录两组患者全麻醉苏醒时间,气管拔管时间,术后恢复室滞留时间,术中补液量,术后2h,6h,12h,24hVAS评分及PCIA有效按压次数,术后ICU住院时间,术后平均住院时间,住院费用,术后并发症等。结果与C组比较,E组患者术后全麻醉苏醒时间,气管拔管时间,恢复室滞留时间,术后ICU住院时间,术后平均住院时间均明显缩短(P<0.05);与C组比较,E组患者术中补液量明显减少(P<0.05);与C组比较,E组患者术后2h,6h,12h,24hVAS评分明显降低(P<0.05);与C组比较,E组并发症恶心呕吐明显减少(P<0.05),E组出血病例数少于C组,但差异无统计学意义;两组住院费用差异无统计学意义。结论悬雍垂腭咽成形术患者围术期ERAS策略麻醉管理可以明显改善术后恢复质量,促进患者康复。

Objective To explore the application of Anesthsia Management in UPPP surgery under ERAS strategy.Methods Fifty-eight patients in UPPP surgery from January 2018 to December 2020.32 mals,26 females,aged 18-60 years,falling into ASA physical statusⅠorⅡ,were randomly decided into the conventional recovery after surgery group(group C,n=29).and the ERAS group(group E,n=29),record the general anesthesia awake time,the extubation time,the retention time in the recovery room,the intra-operative fluid volume,the VAS scorses at 2h,6h,12h,24h after surgery and the effective compression of PCIA at different time points after surgery,postoperative length of ICU hospital stay,postoperative length of hospital stay,the hospitalization expense,the postoperative complication.Result The general anesthesia awake time,the extubation time,the retention time in the recovery room,the postoperative length of ICU hospital stay,the postoperative length of hospital stay in the group E were obviously less than that in the group C(P<0.05);the intra-operative fluid volume in group E were significantly less than that in group C(P<0.05);the VAS scorses at 2h,6h,12h and 24h after surgery in the group E were obviously less than that in the group C(P<0.05);the postoperative complications nausea and vomiting in the group E were obviously less than that in the group C(P<0.05),the postoperative complications hemorrhage in the group E were less than that in the group C,but they were no significant differences;there were no significant differences in the hospitalization expense.Conclusion The Anesthesia Management in UPPP surgery under ERAS strategy can significantly improve the quality of postoperative recovery and speed up the recovery of patients.