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| 多模式围术期处理在小儿加速康复外科中的应用 |
| Application of multimodal perioperative treatment on enhanced recovery after surgery in pediatric surgery |
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| DOI：10.12089/jca.2018.08.010 |
| 中文关键词: 加速康复外科 小儿外科 围术期 多模式 |
| 英文关键词: Enhanced recovery after surgery Pediatric surgery Perioperative period Multi-mode |
| 基金项目: |
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| 中文摘要: |
目的 通过术前心理干预,采用合理的禁食禁饮方案,适当的麻醉前用药,优化麻醉方式,术后早期进食等一系列措施,研究多模式围术期处理在小儿加速康复外科(enhanced recovery after surgery,ERAS)中的应用。
方法 择期腹腔镜下行腹股沟区手术患儿127例,男111例，女16例，年龄1～3岁, ASA Ⅰ级。随机分为对照组(C组,n=59)和多模式组(M组,n=68)。C组常规术前访视,予以一般麻醉处理。M组进行术前亲善宣教、细致访视,术前禁食4～6 h,术前2 h予以5%葡萄糖5 ml/kg,术前1 h在以手术切口处皮肤为中心2 cm范围内涂抹一层厚约2 mm的复方利多卡因乳膏,上盖密封敷膜,术前30 min静脉注射咪达唑仑0.02 mg/kg,缝皮时切口局部浸润0.25%罗哌卡因2 ml,术后PACU内安慰,术后2 h根据患儿恢复情况早期进食。记录患儿与父母分离时的镇静评分、诱导时的面罩接受程度评分,术中全麻药的用量、拔喉罩时间、意识恢复时间、麻醉恢复时间,术后Ramsay镇静评分、苏醒期躁动评分,术后随访并记录患儿家长的满意度以及患儿不良反应发生情况。
结果 M组患儿与父母分离时的镇静评分、诱导时面罩接受程度评分明显高于C组(P<0.05)，术中丙泊酚、瑞芬太尼总量明显少于C组(P<0.05或P<0.01)，拔喉罩时间、意识恢复时间以及麻醉恢复时间明显短于C组(P<0.05或P<0.01)，术后Ramsay镇静评分明显高于C组(P<0.01)，苏醒期躁动评分明显低于C组(P<0.01)，术后家长满意度评分明显高于C组(P<0.05)。
结论 多模式围术期处理在小儿ERAS中有应用价值且安全可行。 |
| 英文摘要: |
Objective To investigate the application of multimodal perioperative treatment in enhanced recovery after surgery (ERAS) in pediatric surgeries by the means of preoperative education for children with perioperative psychological intervention, reasonable fasting scheme, appropriate medication before anesthesia, optimization of anesthesia, early postoperative feeding and other measures.
Methods A total of 127 pediatric patients, scheduled for laparoscopic inguinal surgery, 111 males and 16 females, aged 1 - 3 years, ASA physical status Ⅰ, were randomly divided into two groups: control group (group C, n = 59) and multimodal group (group M, n = 68). Group C received routine preoperative interview and traditional anesthesia treatment. Group M received preoperative education, meticulous interview, preoperative fasting 4 - 6 h, 5%GS 5 ml/kg at preoperative 2 h, compound lidocaine cream with a thickness of 2 mm covering the skin at the center of the surgical incision at preoperative 1 h, intravenous injection of midazolam 0.02 mg/kg at preoperative 30 min, local infiltration of the incision with 0.25% ropivacaine 2 ml when suturing, comfort in the PACU and early feeding according to the recovery of the children after surgery. The sedation score of children apart from their parents, the receipt score of face mask for inhalation induction, total amount of anaesthetics, postoperative recovery (laryngeal mask time, consciousness recovery time, anesthesia recovery time), Ramsay score, emergence agitation (EA) score, degrees of parental satisfaction and postoperative adverse effects caused by anesthesia were recorded.
Results Compared with group C, the sedation score of children apart from their parents and the tolerating score of face mask for inhalation induction of group M were significantly increased (P < 0.05). The total amount of propofol and remifentanil of group M were less than those of group C (P < 0.05 or P < 0.01). Laryngeal mask time, consciousness recovery time and anesthesia recovery time of group M were shorter than those of group C (P < 0.05 or P < 0.01). Compared with group C, Ramsay score of group M was significantly increased (P < 0.01), emergence agitation score of group M were decreased (P < 0.05 or P < 0.01). The degrees of parental satisfaction of group M were higher than that of group C (P < 0.05).
Conclusion The application of multimodal perioperative treatment in enhanced recovery after surgery in pediatric surgeries is effective, safe and feasible. |
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