摘要目的:探讨多学科协作下加速康复外科（enhanced recovery after surgery，ERAS）理念在喉癌手术中的应用价值。方法:选取烟台毓璜顶医院耳鼻咽喉头颈外科2016年5月至2017年6月收治的符合入组标准的80例喉癌患者，其中男76例，女4例，年龄45~75岁，采用随机数字表法依次分为ERAS组（40例）和对照组（40例），分别施以多学科协作下ERAS措施和传统的喉癌治疗措施。采用视觉模拟量表（VAS）、Kolcaba的舒适状况量表（general comfort questionnaire，GCQ）以及焦虑自评量表（self-rating anxiety scale，SAS）比较2组患者手术前后的症状体征、住院时间以及患者的心理状态。非正态分布数据采用Mann-Whitney U检验，分类数据采用χ2检验、Fisher精确概率法和协方差分析。采用重复测量方差分析对各组在不同时间点的比较进行评估。 结果:ERAS组因故退出研究2例，对照组退出6例，最终ERAS组38例以及对照组34例进行本次研究。2组患者的术后疼痛评分在术后6 h时最高，此后逐步下降，ERAS组术后不同时间段的疼痛评分均比对照组低，计算2组术后不同时间段之间的疼痛评分差值发现ERAS组术后24 h疼痛缓解程度较对照组明显，差异有统计学意义（ P值均<0.05）。ERAS组患者术前口渴评分［（0.15±0.36）分比（4.29±1.17）分］和饥饿评分［（0.38±0.49）分比（3.44±1.13）分］比对照组低，差异有统计学意义（ Z=-7.695、-7.426， P值均<0.001）。术后不良反应总例数（8比16）、经口进食时间［（4.06±4.42）d比（9.06±2.42）d］和术后住院时间［（5.91±0.97）d比（11.03±2.11）d］ERAS组均低于对照组（统计值分别为5.461、-4.558、-7.347， P值均<0.05），而术后尿管留置时间及颈部引流管留置时间2组差异无统计学意义（ P值均>0.05）。2组患者入院时舒适度及焦虑评分基本相同，出院前ERAS组患者舒适度显著高于对照组［（60.37±8.78）分比（50.38±8.08）分， Z=-4.370， P<0.001］。出院前ERAS组焦虑程度有所下降，而对照组出院前焦虑程度则明显上升，比ERAS组高，差异有统计学意义［（59.12±6.43）分比（52.62±6.25）分， Z=-4.179， P<0.001］。 结论:将ERAS理念应用于喉癌手术患者中，结合多学科协作，能够改善患者术前饥饿干渴以及术后疼痛和心理状态，缩短住院时间，减少术后不良反应。

abstractsObjective:To explore the application value of enhanced recovery after surgery (ERAS) with the multidisciplinary team (MDT) model in laryngeal cancer surgery.Methods:Eighty patients with laryngeal cancer treated in Department of Otorhinolaryngology Head and Neck Surgery of Yantai Yuhuangding Hospital from May 2016 to June 2017 were selected, including 76 males and 4 females, aged 45 to 75 years old. By random number table method, they were divided into ERAS group (40 cases) and control group (40 cases). Visual analogue scale (VAS), general comfort questionnaire (GCQ) and self-rating Anxiety Scale (SAS) were used to evaluate the symptoms and signs and psychological state of the two groups before and after operation. Mann Whitney U test was used for non-normal distribution data, and chi square test, Fisher exact probability method and covariance analysis were used for classification data. Repeated measures analysis of variance was used for the comparison of each group at different time points. Results:Two cases in the ERAS group and six cases in the control group withdrew from the study for some reason. Finally, 38 cases in the ERAS group and 34 cases in the control group were enrolled in this study. The postoperative pain scores of the two groups were the highest at 6 h after operation, and then gradually decreased. At different time points after operation, the pain scores of ERAS group were lower than those of the control group. At 24 h after operation, the pain relief degree of ERAS group was significantly higher than that of the control group, with a statistically significant difference ( P<0.05). Compared to control group, ERAS group had lower preoperative thirst score [(0.15±0.36) vs. (4.29±1.17), Z=-7.695, P<0.001] and hunger score [(0.38±0.49) vs. (3.44±1.13), Z=-7.426, P<0.001]. The total number of postoperative adverse reactions (8 vs.16), oral feeding time [(4.06±4.42) d vs. (9.06±2.42) d] and postoperative hospital stay [(5.91±0.97) d vs. (11.03±2.11)d] in ERAS group were lower than those in control group (statistics 5.461, -4.558, -7.347, P<0.05), but there was no significant difference in postoperative catheter indwelling time and neck drainage tube indwelling time between the two groups ( P>0.05). Before discharge, the comfort of ERAS group was significantly higher than that of control group [(60.37±8.78) vs. (50.38±8.08), Z=-4.370, P<0.001]. Before discharge, the anxiety level of ERAS group decreased, while that of the control group increased significantly, which was higher than that of ERAS Group [(59.12±6.43) vs. (52.62±6.25), Z=-4.179, P<0.001]. Conclusion:The application of multidisciplinary ERAS in laryngeal cancer surgery can improve preoperative hunger and thirst, postoperative pain and mental state, shorten the length of hospital stay and reduce postoperative adverse reactions.