加速康复外科在儿童腺样体扁桃体切除围术期的临床研究

目的 对比加速康复外科（ERAS）和常规康复外科在儿童腺样体扁桃体切除术中应用效果。方法 符合纳入标准的606例腺样体扁桃体肥大患儿,随机分为ERAS组（n = 314）和常规组（n = 292）,对患儿术后疼痛、饮食量、睡眠时间、术后住院时间和并发症发生率进行比较。结果 ERAS组术后6、12、24 h视觉模拟评分法（VAS）评分分别为2（1,2）分、2（2,3）分、2（1,3）分,常规组为3（2,3）分、4（3,5）分、3（3,4）分,差异均有统计学意义（P均< 0.05）;ERAS组术后6、12、24 h冷流质饮食量分别为100（85,115）ml、535（500,565）ml、1365（1225,1490）ml,常规组为40（35,45）ml、337.5（295,370）ml、505（460,535）ml,差异均有统计学意义（P均< 0.05）;ERAS组手术当晚、术后第1日睡眠时间分别为8（7,9）h、10（9,11）h,常规组为6（5,8）h、8（7,9）h,差异均有统计学意义（P均< 0.05）。ERAS组和常规组术后住院天数分别为2（2,3）d、3（3,4）d,术后并发症发生率分别为0.64%、3.42%,差异均有统计学意义（P均< 0.05）。结论 ERAS能减轻儿童腺样体扁桃体切除术后疼痛,提高患儿术后舒适度,缩短住院时间。

Clinical application of enhanced recovery after surgery in children undergoing adenotonsillectomy

Objective To compare the clinical efficacy of enhanced recovery after surgery （ERAS） and conventional recovery after surgery in children undergoing adenotonsillectomy. Methods A total of 606 children eligible for adenotonsillectomy were recruited and randomly divided into the ERAS （n = 314） and conventional groups （n = 292）. Postoperative pain, diet, sleep duration, length of postoperative hospital stay and incidence of complications were statistically compared between two groups. Results In the ERAS group, the visual analogue scale （VAS） scores at 2, 12, and 24 h after surgery were 2（1, 2）, 2（2, 3） and 2（1, 3）, significantly lower compared with 3（2, 3）, 4（3, 5） and 3（3, 4） in the conventional group （all P < 0.05）. In the ERAS group, the quantity of cold fluid diet at 6, 12, and 24 h after surgery was 1100（85, 115）, 535（500, 565） and 1365（1225, 1490） ml, significantly higher than 40（35, 45）, 337.5（295, 370） and 505（460, 535） ml in the conventional group （all P < 0.05）. In the ERAS group, the sleep duration on the evening of surgery and 1 d after surgery was 8（7, 9） and 10（9, 11） h, significantly longer compared with 6（5, 8） and 8（7, 9） h in the conventional group （all P < 0.05）. In the ERAS group, the length of postoperative hospital stay was significantly shorter than that in the conventional group （2（2, 3） vs. 3（3, 4）, P < 0.05）. The incidence of postoperative complications in the ERAS group was significantly lower compared with that in the conventional group （0.64% vs. 3.42%, P < 0.05）. Conclusion ERAS can mitigate postoperative pain, improve postoperative comfort and shorten the length of hospital stay in pediatric patients after adenotonsillectomy.