目的 探讨加速康复外科技术在小儿咽部手术中的应用效果。方法 择期接受咽部手术的6~12岁小儿患者60例，分为加速康复（ERAS）组和传统方法（CTS）组。其中ERAS组在术前宣教、麻醉处理、术后镇痛等方面给予具有循证医学证据支持的优化措施，CTS组采用常规围麻醉处理。观察术后清醒时，术后2h，8h，24h两组患者血流动力学的变化；各时间点两组患者的躁动评分、镇痛效果（VAS评分）及术后24 h内是否需要补救镇痛；术后24 h内两组患者恶心呕吐并发症的发生率；比较两组患者的住院天数。结果 两组患儿各时点的生命体征、手术时间无统计学差异；ERAS组各时点的躁动评分（2.4±0.5，2.5±0.7，2.4±0.8，3.4±0.3）和VAS评分（3.3±0.5，3.2±0.5，3.0±0.6，2.6±0.9）、术后补救镇痛率（30%）、术后恶心呕吐发生率（33.3%）均低于CTS组的躁动评分（3.5±1.0，3.6±0.9，2.3±0.5，3.4±0.2）、VAS评分（5.3±0.4，4.9±0.3，4.8±0.4，3.9±0.5）、术后补救镇痛率（50%）、术后恶心呕吐发生率（66.7%），住院时间（5.5±0.8）也明显短于CTS组（7.1±0.5）。结论 加速康复外科技术能减轻咽部手术患儿术后躁动与疼痛，缩短住院天数，促进患儿康复。
Abstract Objective: To evaluate the effect of Enhanced Recovery after Surgery on pharyngeal surgery in children. Methods: 60 children aged 6-12 years, scheduled for pharyngeal surgery, were divided into two groups: Enhanced Recovery after Surgery (ERAS) group and Conservative treatment surgery (CTS) group. Optimization measures by evidence based medicine for preoperative education, anesthetic management and postoperative analgesia were administered in ERAS group. Meanwhile CTS group received conventional perioperative care. The hemodynamic index, Sedation-Agitation Scale, and VAS Scale were monitored during awaken from anesthesia and 2 h, 8 h, 24 h postoperatively. Rescue analgesia and postoperative complications were recorded 24 h after surgery. Hospital stay were also observed. Results: There are no significant differences in hemodynamic index and operative time between the two groups. ERAS group is associated with a significantly lower Sedation-Agitation Scale(2.4±0.5，2.5±0.7，2.4±0.8，3.4±0.3) and VAS Scale(3.3±0.5，3.2±0.5，3.0±0.6，2.6±0.9), and shorter hospital stay(5.5±0.8) compared with CTS group((3.5±1.0，3.6±0.9，2.3±0.5，3.4±0.2), (5.3±0.4，4.9±0.3，4.8±0.4，3.9±0.5), (7.1±0.5)). Also ERAS group (30%) need less rescue analgesia than CTS group (50%). Incidence of postoperative nausea and vomiting was lower in ERAS group (33.3%) than CTS group (66.7%). Conclusion: Enhanced Recovery after Surgery is feasible and effective for pharyngeal surgery in children, with improvements of postoperative rehabilitation, postoperative pain, hospital stay and patients’ satisfaction.
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