加速康复外科在鼻中隔偏曲矫正术中的应用研究  

Application of enhanced recovery after surgery in patients after endoscopic septoplasty

作　　者：吴喜福[1] 孔维封 王玮豪 周少丽[2] 徐惠清[1] 杨钦泰[1] WU Xifu;KONG Weifeng;WANG Weihao;ZHOU Shaoli;XU Huiqing;YANG Qintai(Department of Otolaryngology Head and Neck Surgery;Department of Anesthesia, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510630, China)

机构地区：[1]中山大学附属第三医院耳鼻咽喉头颈外科,广东广州510630 [2]中山大学附属第三医院麻醉科,广东广州510630

出　　处：《中国耳鼻咽喉头颈外科》2018年第5期241-245,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨加速康复外科(enhanced recovery after surgery,ERAS)在鼻中隔偏曲矫正术中的应用。方法将符合纳入和排除标准的鼻中隔偏曲患者32例随机分为加速康复外科组和对照组,采用Zung焦虑自评量表(selfrating anxiety,SAS)、视觉模拟量表(VAS)、MOS-SS睡眠量表(medical outcomes study sleep scale,MOS-SS)、Kolcaba舒适量表(general comfort questionnaire,GCQ)从患者接受全麻手术前情绪变化、术后鼻部疼痛、术后睡眠和舒适度进行比较。比较两组术后并发症、住院总时间、术后住院时间及住院总费用。结果 ERAS组和对照组术前SAS评分为(28.40±1.69)分、(40.00±3.48)分(P<0.05);ERAS组和对照组术后MOS-SS评分为(45.70±1.87)分、(26.70±1.19)分(P<0.05);ERAS组和对照组术后GCQ评分为(79.00±2.39)分、(61.70±1.89)分(P<0.05)。ERAS组术后2、24、48小时VAS评分分别为(0.90±0.20)分、(0.50±0.11)分和(0.50±0.25)分,明显低于对照组的(3.10±0.24)分、(2.30±0.25)分和(1.60±0.28)分(P均<0.05)。ERAS组较对照组并未增加恶心呕吐、出血、跌倒或误吸等风险(P>0.05),住院总时间[(4.68±0.60)天vs(7.12±0.71)天,P<0.05]和术后住院时间[(2.12±0.34)天vs(4.38±0.54)天,P<0.05]缩短,住院总费用[(7880.30±154.20)元vs(9010.00±216.80)元,P<0.05]降低。结论 ERAS能改善鼻中隔偏曲矫正患者围手术期的应激和生活质量、加速术后康复,缩短住院时间及节约住院费用。OBJECTIVE To determine the effects of enhanced recovery after surgery（ERAS） during perioperative period of endoscopic septoplasty. METHODS A total of 32 patients scheduled for endoscopic septoplasty under general anesthesia were enrolled and were randomly divided into ERAS group and control group. The patients’ preoperative anxiety, postoperative pain, sleep quality and comfort level were determined by comparing the results of Zung self-rating anxiety scale（SAS）, visual analogue scale（VAS）, medical outcomes study sleep scale（MOS-SS）and general comfort questionnaire（GCQ）. RESULTS ERAS group showed a lower score in SAS[（28.40±1.69）vs（40.00±3.48）, P〈0.05], a higher score in MOS-SS[（45.70±1.87） vs（26.70±1.19）, P〈0.05], a higher score in GCQ[（79.00±2.39） vs（61.70±1.89）, P〈0.05], a significant lower visual pain scores at 2 hours[（0.90±0.20） vs（3.10±0.24）, P〈0.05], 24 hours[（0.50±0.11） vs（2.30±0.25）,P〈0.05], 48 hours[（0.50±0.25） vs（1.60±0.28）, P〈0.05] after operation. The incidence of complications such as nausea,emesis, hemorrhage, aspiration and tumble in ERAS group were not increased compare with control group. ERAS group has a shorter hospital stay after surgery[（2.12±0.34）days vs（4.38±0.54）days, P〈0.05], total length of hospital stay[（4.68±0.60）days vs（7.12±0.71）days, P〈0.05] and hospitalization expenses[（7880.30±154.20）YUAN vs（9010.00±216.80）YUAN, P〈0.05]. CONCLUSION ERAS can optimize endoscopic septoplasty by attenuating stress of patients with enhanced recovery, lower hospital stay and hospitalization expenses.

关 键 词：鼻中隔 鼻成形术 围手术期医护 加速康复外科 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]