等离子点状激发技术在儿童OSA扁桃体腺样体切除术联合围手术期快速康复中的应用

doi:10.6040/j.issn.1673-3770.0.2023.394

摘要/Abstract

摘要： 目的探讨等离子点状激发技术在儿童阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)行扁桃体腺样体切除术联合围手术期实施快速康复(enhanced recovery after surgery, ERAS)计划的应用疗效研究。方法纳入160例OSA患儿,所有患儿均行等离子扁桃体切除及腺样体消融术,围手术期均采用快速康复路径,根据住院号单双将其随机分为观察组(采用等离子点状激发技术)和对照组(采用常规等离子手术方式)各80例。评估2个组的围手术期相关指标。结果所有手术患儿术后疼痛程度均较轻,随着时间推移疼痛逐渐减轻,术后第7天绝大部分患儿疼痛均几乎消失;同时间点观察组患儿疼痛低于对照组(均P<0.01)。观察组手术时间(26.850±2.536)min、术中出血量(1.738±0.896)mL较对照组手术时间(29.188±2.960)min、术中出血量(4.838±2.923)mL降低,差异有统计学意义(均P<0.01);观察组术后经口进食能量达标率高于对照组(χ2=12.172,P<0.01)。对照组1例患儿在术后7 d出现一过性口咽部出血,经对症处理后好转,观察组术后无再发出血患儿,两组在术后低热、再发出血方面比较无统计学差异(P>0.05)。结论等离子点状激发技术应用于儿童OSA扁桃体腺样体切除可优化围手术期快速康复方案,降低术中出血,减少手术时间,减轻术后疼痛,值得临床应用推广。

关键词: 等离子点状激发技术, ERAS, 儿童阻塞性睡眠呼吸暂停, 腺样体扁桃体切除术, 围手术期

Abstract: Objective To explore the application efficacy of plasma pointlike excitation technology in children with obstructive sleep apnea(OSA)undergoing tonsillectomy and adenoidectomy combined with perioperative enhanced recovery after surgery(ERAS)program. Methods For this study, 160 children with OSA were included. All the children underwent plasma tonsillectomy and adenoid ablation, and then adopted the method of the enhanced recovery during the perioperative period. They were randomly divided into the observation group(receiving plasma pointlike excitation)and the control group(undergoing conventional plasma surgery)according to their admission numbers(odd and even), 80 cases in each group. Perioperative indicators were assessed for the two groups. Results The postoperative pain, mild in all the children, gradually decreased as time went by, and almost disappeared in most of the children on the 7th day after surgery. At the same time point, the pain was lower in the observation group than in the control group(P<0.01 for all). The observation group exhibited significant decreases in terms of surgical duration(26.850±2.536)min and intraoperative blood loss(1.738±0.896)mL when compared to the control group(29.188±2.960)min and(4.838±2.923)mL, and the differences between the two groups were statistically significant(P<0.01 for all). The compliance rate of postoperative oral energy intake was higher in the observation group than in the control group(χ2=12.172, P<0.01). One child in the control group had transient oropharyngeal bleeding for 7 days after the surgery, which was improved after symptomatic treatment. There was no recurrence of postoperative bleeding in the observation group. No statistically significant differences existed in either postoperative low fever or the recurrence of bleeding between the two groups(P>0.05). Conclusion The application of plasma pointlike excitation technology in tonsillectomy and adenoidectomy for OSA children can optimize the enhanced recovery after the operation, reduce intraoperative bleeding, shorten operative duration, and lower postoperative pain, so this technology is worthy of clinical application and promotion.

Key words: Plasma pointlike excitation technology, ERAS, Pediatric obstructive sleep apnea, Tonsillectomy and adenoidectomy, Perioperative

中图分类号:

R766.9

罗露,周恩,肖旭平,林志强,方志杰,吕晓虹. 等离子点状激发技术在儿童OSA扁桃体腺样体切除术联合围手术期快速康复中的应用[J]. 山东大学耳鼻喉眼学报, 2024, 38(5): 26-30.

LUO Lu, ZHOU En, XIAO Xuping, LIN Zhiqiang, FANG Zhijie, LYU Xiaohong. Application of plasma pointlike excitation technology in children with obstructive sleep apnea undergoing tonsillectomy and adenoidectomy combined with perioperative enhanced recovery after surgery program[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(5): 26-30.

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