山东大学耳鼻喉眼学报 ›› 2018, Vol. 32 ›› Issue (5): 19-22.doi: 10.6040/j.issn.1673-3770.1.2018.011

• 加速康复外科在耳鼻咽喉头颈外科的应用论著 • 上一篇    下一篇

加速康复外科在儿童OSAS围手术期中的应用

刘大炜,张宇,李成林,陈秀梅,宋西成   

  1. 2015WS027)第一作者:刘大炜。 E-mail:258718256@qq.com 通讯作者:宋西成。 E-mail:songxicheng@126.comDOI:10.6040/j.issn.1673-3770.1.2018.011加速康复外科在儿童OSAS围手术期中的应用刘大炜, 张宇, 李成林, 陈秀梅, 宋西成(青岛大学附属烟台毓璜顶医院耳鼻咽喉头颈外科, 山东 烟台 264000
  • 收稿日期:2018-07-30 出版日期:2018-09-20 发布日期:2018-09-20
  • 通讯作者: 宋西成. E-mail:songxicheng@126.com
  • 基金资助:
    烟台市重点研发计划(2015WS027)

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

LIU Dawei, ZHANG Yu, LI Chenglin, CHEN Xiumei, SONG Xicheng   

  1. Otolaryngology and neck surgery, Yantai Yuxuanding Hospital, Qingdao University, Yantai 264000, Shandong, China
  • Received:2018-07-30 Online:2018-09-20 Published:2018-09-20

摘要: 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。

关键词: 阻塞性睡眠呼吸暂停综合征, 加速康复外科, 围手术期, 儿童

Abstract: 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%; χ2=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 were 2.0±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.

Key words: Child, Enhanced recovery after surgery, Obstructive sleep apnea syndrome, Perioperative period

中图分类号: 

  • R714.253
[1] Wilmore DW, Kehlet H. Management of patients in fast track surgery[J]. BMJ, 2001, 332(7284):473-476.
[2] Kehlet H, Wilmore DW. M ultimodal strategies to improve surgical outcome[J]. AM J Surg, 2002, 183(6):630-641.
[3] 中华耳鼻咽喉头颈外科杂志编委会,中华医学会耳鼻咽喉科学分会.儿童阻塞性睡眠呼吸暂停低通气综合征诊疗指南草案(乌鲁木齐)[J]. 中华耳鼻咽喉头颈外科杂志,2007,42(2):83-84. Editorial Board of Chinese Journal of Otorhinolaryngology Head-and Neck Surgery; Chinese Otorhinolaryngology of Chinese Medical Association. Draft of guidelines for the diagnosis and treatment of pediatric sleep apnea hypopnea syndrome(Urumqi)[J]. Chin J Otorhinolaryngol Head Neck Surg, 2007, 42(2):83-84.
[4] Mitchell P. Understanding a young childs pain[J]. Lancet, 1999, 354(9191):1708.
[5] Nelson G, Kalogera E, Dowdy SC. Enhanced recovery pathways in gynecologic oncology[J]. Gynecol Oncol, 2014, 135(3):586-594.
[6] Stowers MD, Manuopangai L, Hill AG, et al. Enhanced recovery after surgery in elective hip and knee arthroplasty reduces length of hospital stay[J]. ANZ J Surg, 2016, 86(6):475-479.
[7] 江志伟,黎介寿.快速康复外科-优化的临床路径[J].中华胃肠外科杂志,2012, 15(1):12-13. JIANG Zhiwei, LI jieshou. Fast track surgery: optimized clinical pathways[J]. Chin J Gastrointest Surg, 2012, 15(1):12-13.
[8] Darido EF, Farrell TM. Fast-track concepts in majar open upper abdominal and thoraco abdominal surgery: areview[J].World J Surg, 2011, 35(12):2594-2595.
[9] Stowers MD, Lemanu DP, Hill AG. Health economics in Enhanced Recovery after Surgery programs[J]. Can J Anaesth, 2015, 62(2):219-230.
[10] 陆政昊,张维汉,杨昆,等.胃肿瘤手术病人术前口服糖水临床研究[J].中国实用外科杂志,2015,35(8):876-878. LU Zhenghao, ZHANG Weihan, YANG Kun, et al. Clinical study on preoperative oral carbohydrate for patients performed gastric neoplasms resection[J]. Chin J Pract Surg, 2015, 35(8):876-878.
[11] Smith I, Kranke P, Murat I, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology[J]. Eur J Anaesthesiol, 2011, 28(8):556-569.
[12] Svanfeldt M, Thorell A, Hausel J, et al. Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics[J]. Br J Surg, 2007, 94(11):1342-1350.
[13] 左云霞,刘斌,杜怀清,等.成人与小儿手术麻醉前禁食指南(2014)[M]. // 中国麻醉学指南与专家共识. 北京:人民卫生出版社,2014: 75-90.
[14] 黎介寿.营养支持治疗与加速康复外科[J].肠外与肠内营养,2015,22(2):65-67.
[15] Xu W, Daneshmand S, Bazargani ST, et al. Postoperative Pain Management after Radical Cystectomy: Comparing Traditional versus Enhanced Recovery Protocol Pathway[J]. J Urol, 2015, 194(5):1209-1213.
[16] Vlug MS, Wind J, Hollmann MW, et al. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery:a randomized clinical trial(LAFA-study)[J]. Ann Surg, 2011, 254(6):868-875.
[17] Wang XX, Zhou Q, Pan DB, et al. Dexamethasone versus ondansetron in the prevention of postoperative nausea and vomi ting in patients undergoing laparoscopic surgery: a metaanalysis of randomized controlled trials[J]. BMC Anesthesiol, 2015, 15:118-126. doi: 10.1186/s12871-015-0100-2.
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[2] 戚敏, 李红, 王倩, 涂翠芳, 杨钦泰, 徐惠清. 加速康复外科理念在功能性内镜鼻窦手术围手术期护理的初步应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 13 -18 .
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