加速康复外科在44例悬雍垂腭咽成形术中的应用

目的 探讨加速康复外科(ERAS)理念在悬雍垂腭咽成形术(UPPP)围术期的应用价值。 方法 选取84例重度成人阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者,随机分为ERAS组44例,对照组40例,均接受UPPP。 ERAS组患者采用一系列优化措施,对照组行传统的围术期处理。依据焦虑抑郁量表(HADS)、MOS-SS睡眠量表、视觉模拟量表(VAS),对比ERAS组患者心理干预前后情绪变化、两组术后睡眠质量和不适症状程度。比较两组患者术前在院等待时间、术后住院时间及并发症的发生率。 结果 ERAS组患者心理干预前后HADS评分为5(3, 9.75)、3(2, 5.75)分,两组患者术后MOS-SS评分为(46.09±4.86)、(33.43±4.44)分, 两组患者围术期体质量下降(2.30±0.65)、(5.12±0.78)kg,差异均有统计学意义(P<0.05);ERAS组患者术前在院等待时间、术后住院时间及术后咽痛、咽异物感、吞咽障碍、咽干的VAS评分均少于对照组,差异均有统计学意义(P<0.05);两组患者术后出血、恶心呕吐及鼻咽反流等并发症发生率之间的差异无统计学意义(P>0.05)。 结论 将个体化的ERAS方案贯穿于成人重度OSAHS患者围术期,可为UPPP手术创造良好的机体条件,减少患者的生理和心理应激,改善就医体验,促进术后康复。

Application of enhanced recovery after surgery in 44 cases of uvulopalatopharyngoplasty

Objective To explore the application value of enhanced recovery after surgery(ERAS)in the perioperative period of uvulopalatopharyngoplasty(UPPP). Methods A total of 84 patients with severe obstructive sleep apnea hypopnea syndrome(OSAHS)were randomly divided into the ERAS group(n=44)and control group(n=40). Both groups underwent UPPP. The ERAS group received a series of optimization measures, and the control group received traditional perioperative management. All patients filled in the hospital anxiety and depression scale(HADS), MOS-SS sleep scale and visual analog scale(VAS). The emotional changes of patients in the ERAS group before and after psychological intervention were recorded. The postoperative sleep quality, degree of discomfort symptoms, waiting time before hospitalization, hospitalization time after surgery and incidence of complications were compared between the two groups. Results The HADS scores reduced from 5(3, 9.75)to 3(2, 5.75)in the ERAS group. The postoperative MOS-SS score was(46.09±4.86)in the ERAS group and(33.43±4.44)in the control group, the perioperative weight loss was(2.30±0.65)kg and(5.12±0.78)kg, respectively, and the differences were statistically significant(P<0.05). The ERAS group had shorter preoperative waiting time and postoperative hospitalization time, and lower VAS scores of postoperative pharyngeal pain, pharyngeal foreign body sensation, dysphagia and dry throat than the control group(P<0.05). There were no statistically significant differences in the incidences of postoperative bleeding, nausea, vomiting, and nasopharyngeal reflux between the two groups(P>0.05). Conclusion The personalized ERAS program can create good physical conditions for UPPP in severe OSAHS patients, reduce their physical and psychological stress, improve medical experience, and promote postoperative recovery.