加速康复外科在婴幼儿唇腭裂修复手术中的应用  

Application of enhanced recovery after surgery in infant cleft lip and palate repair surgery

作　　者：郑晓霞[1] 吴佳璇 游志坚 杜瑞明[1] ZHENG Xiaoxia;WU Jiaxuan;YOU Zhijian;DU Ruiming(The Second Affiliated Hospital of Shantou University Medical College,Shantou 515041,China;Liuzhou People's Hospital,Liuzhou 545006,China)

机构地区：[1]汕头大学医学院第二附属医院,广东汕头515041 [2]柳州市人民医院,广西柳州545006

出　　处：《汕头大学医学院学报》2021年第2期79-83,共5页Journal of Shantou University Medical College

摘　　要：目的:探讨加速康复外科(enhanced recovery after surgery,ERAS)在婴幼儿唇腭裂修复术中的应用效果。方法:选择2018年9月—2020年4月在汕头大学医学院第二附属医院接受唇腭裂修复术治疗的患儿200例,年龄6个月~3岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,按随机数字表法分为传统方法组(C组)、术前优化处理组(Q组)、术中优化处理组(Z组)、术后优化处理组(H组)和ERAS组,每组40例。每组患儿实施不同的麻醉方案。观察记录各组患者苏醒即刻及术后2、8、16、24 h时的生命体征、躁动评分(5点躁动分级法)、FLACC疼痛评分、术后24 h内补救镇痛、恶心呕吐及伤口渗血的严重程度等。结果:与ERAS组比较,其他组患儿术后各时间点的躁动评分和FLACC评分、伤口渗血严重程度、术后补救镇痛率均较高,住院时间较长,差异均有统计学意义(P<0.05);与C组比较,Q组、Z组、H组患儿术后各时间点的躁动评分较低、伤口渗血严重程度较轻、住院时间较短,差异均有统计学意义(P<0.05);与Z组和H组比较,C组和Q组患儿术后各时点的FLACC评分和术后补救镇痛率较高,差异均有统计学意义(P<0.05)。结论:ERAS能降低唇腭裂患儿术后躁动的发生率和伤口渗血的严重程度,减轻疼痛,缩短住院时间,有利于患儿的康复。Objective:To investigate the application effect of enhanced recovery after surgery(ERAS)in children cleft lip and palate repair.Methods:From September 2018 to April 2020,200 children who underwent cleft lip and palate repair in the Second Affiliated Hospital of Shantou University Medical College,aged 6 months to 3 years,American Association of Anesthesiologists(ASA)classificationⅠ-Ⅱ.They were randomly divided into 5 groups:traditional method group(group C),preoperative optimization group(group Q),intraoperative optimization group(group Z),postoperative optimization group(group H),ERAS group,40 cases in each group.Each group was given different anesthesia.The hemodynamic changes,restlessness score(5-point restlessness grading method),FLACC pain score,whether remedial analgesia is needed within 24 h after awakening and 2,8,16,and 24 h after the operation of the patients in each group,the incidence of nausea and vomiting and the severity of wound bleeding were observed and recorded.Results:Compared with the ERAS group,the restlessness score,FLACC score,the severity of wound bleeding and the postoperative salvage analgesia rate of the children in the other groups were higher at all time points after the operation,the hospital stay was longer,and the differences were all statistically significant(P<0.05).Compared with group C,children in group Q,group Z,and group H had lower restlessness scores,less severe wound bleeding,and shorter hospital stay at various time points after surgery,and the differences were all statistically significant(P<0.05).Compared with group Z and H,the FLACC score and postoperative salvage analgesia rate of children in group C and Q were higher at all time points after surgery,and the differences were all statistically significant(P<0.05).Conclusion:ERAS can reduce the incidence of postoperative restlessness and the severity of wound bleeding in children with cleft lip and palate,reduce pain,shorten the length of hospitalization,and help children recover.

关 键 词：婴幼儿麻醉 唇腭裂修复术 加速康复外科 

分 类 号：R614[医药卫生—麻醉学]