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摘要: 小儿日间手术可最大限度地减少患儿与父母的分离，缓解患儿的焦虑情绪，降低医疗成本。然而，由于小儿特殊的解剖和生理学特点，麻醉术后易发生疼痛、恶心呕吐和谵妄等并发症。因此，术后管理是小儿日间手术顺利实施的重要环节之一，其规范化管理对于保障患儿安全，提高日间手术医疗质量起着至关重要的作用。本文就小儿日间手术术后常见并发症及出院标准相关研究进展进行综述。Abstract: Pediatric ambulatory surgery can minimize the separation of pediatric patients from their parents, relieve anxiety, and offer care at a reduced cost. However, children are prone to experiencing pain, nausea, vomiting, delirium, and other complications after anesthesia and ambulatory surgery due to their anatomical and physiological characteristics. So, standardized postoperative management is critical to ensure the safety of children and improve the medical quality of pediatric ambulatory surgery. This article reviews new progress in research on common postoperative complications and discharge criteria of pediatric ambulatory surgery.作者贡献：刘超群负责文献检索及初稿撰写；朱波、申乐和黄宇光负责论文审核及修订。利益冲突：无
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表 1 基于生理学标准的出院评分系统[27]
项目 具体描述 评分 意识水平 清醒定向，动作适当 2 在最小的刺激下能被唤醒，动作微弱 1 只对触觉刺激有反应，无动作 0 呼吸状态 能够咳嗽、深呼吸或哭泣 2 哭泣或咳嗽时声嘶 1 喘鸣、呼吸困难或气喘 0 氧合情况 呼吸室内空气脉搏氧饱和度大于95% 2 呼吸室内空气脉搏氧饱和度维持在90%~95% 1 吸氧时脉搏氧饱和度才大于90% 0 血流动力学稳定性 心率、血压在基础值15%以内 2 心率、血压超出基础值15%~30% 1 心率、血压超出基础值30%以上 0 术后疼痛 无或轻度不适 2 需静脉镇痛的中、重度疼痛 1 持续剧烈疼痛 0 术后恶心呕吐 无或轻度恶心、无呕吐 2 短暂呕吐或干呕 1 持续性中、重度恶心呕吐 0 切口部位 无血液或体液丢失 2 血液或体液丢失较小，无需干预 1 血液或体液持续丢失，需补充 0 
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[1] Bartier S, Gharzouli I, Kiblut N, et al. Tonsillectomy in children and in adults: changes in practice following the operating of a day-surgery unit with dedicated operating room[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2018, 135: 301-305. doi: 10.1016/j.anorl.2018.05.003 [2] Nicoll JH. Case operated on for radical cure of inguinal hernia[J]. Glasgow Med J, 1905, 64: 241-248. [3] Jarrett PEM. The International Association for Ambulatory Surgery (IAAS)[J]. Ambulatory Surgery, 2003, 10: 113. doi: 10.1016/j.ambsur.2003.10.001 [4] Nordin AB, Shah SR, Kenney BD. Ambulatory pediatric surgery[J]. Semin Pediatr Surg, 2018, 27: 75-78. doi: 10.1053/j.sempedsurg.2018.02.003 [5] Hall MJ, Schwartzman A, Zhang J, et al. Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010[J]. Natl Health Stat Report, 2017, 102: 1-15. http://www.cdc.gov/nchs/data/nhsr/nhsr102.pdf [6] 潘少川, 张金哲. 在门诊施行小儿疝修补术的体会[J]. 中华外科杂志, 1966, 14: 366. Pan SC, Zhang JZ. Experience of pediatric hernia repair in outpatient department[J]. Zhonghua Waike Zazhi, 1966, 14: 366. [7] Stanko D, Bergesio R, Davies K, et al. Postoperative pain, nausea and vomiting following adeno-tonsillectomy-a long-term follow-up[J]. Pediatric Anesthesia, 2013, 23: 690-696. doi: 10.1111/pan.12170 [8] Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regi-onal Anesthesia, Executive Committee, and Administrative Council[J]. J Pain, 2016, 17: 131-157. doi: 10.1016/j.jpain.2015.12.008 [9] Schultz-Machata AM, Weiss M, Becke K. What's new in pediatric acute pain therapy?[J]. Curr Opin Anaesthesiol, 2014, 27: 316-322. doi: 10.1097/ACO.0000000000000074 [10] Rodríguez MC, Villamor P, Castillo T. Assessment and management of pain in pediatric otolaryngology[J]. Int J Pediatr Otorhinolaryngol, 2016, 90: 138-149. doi: 10.1016/j.ijporl.2016.09.015 [11] Quinn BL, Sheldon LK, Cooley ME. Pediatric pain assessment by drawn faces scales: a review[J]. Pain Manag Nurs, 2014, 15: 909-918. doi: 10.1016/j.pmn.2014.03.004 [12] Zieliński J, Morawska-Kochman M, Zatoński T. Pain assessment and management in children in the postoperative period: A review of the most commonly used postoperative pain assessment tools, new diagnostic methods and the latest guidelines for postoperative pain therapy in children[J]. Adv Clin Exp Med, 2020, 29: 365-374. doi: 10.17219/acem/112600 [13] World Health Organization. WHO Guidelines on the Pharmacological Treatment of Persisting Pain in Children with Medical Illnesses[EB/OL]. (2012-05-04). [2020-11-17]. http://digicollection.org/hss/en/m/abstract/Js19116en/. [14] Stein AL, Baumgard D, Del Rio I, et al. Updates in Pediatric Regional Anesthesia and Its Role in the Treatment of Acute Pain in the Ambulatory Setting[J]. Curr Pain Headache Rep, 2017, 21: 11. doi: 10.1007/s11916-017-0614-z [15] Nishida T, Mihara T, Ka K. Predictors for incidence of increased time spent in hospital after ambulatory surgery in children: a retrospective cohort study[J]. J Anesth, 2018, 32: 98-103. doi: 10.1007/s00540-017-2437-9 [16] Watcha MF, Lee AD, Medellin E, et al. Clinical use of the pictorial Baxter retching faces scale for the measurement of postoperative nausea in children[J]. Anesth Analg, 2019, 128: 1249-1255. doi: 10.1213/ANE.0000000000003850 [17] Gan TJ, Belani KG, Bergese S, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting[J]. Anesth Analg, 2020, 131: 411-448. doi: 10.1213/ANE.0000000000004833 [18] Janicki PK, Vealey R, Liu J, et al. Genome-wide association study using pooled DNA to identify candidate markers mediating susceptibility to postoperative nausea and vomiting[J]. Anesthesiology, 2011, 115: 54-64. doi: 10.1097/ALN.0b013e31821810c7 [19] Klenke S, de Vries GJ, Schiefer L, et al. CHRM3 rs2165870 polymorphism is independently associated with postoperative nausea and vomiting, but combined prophylaxis is effective[J]. Br J Anaesth, 2018, 121: 58-65. doi: 10.1016/j.bja.2018.02.025 [20] Landau R, Janicki PK. Risk-tailored prophylaxis for postoperative nausea and vomiting; still a messy issue[J]. Br J Anaesth, 2018, 121: 1-4. doi: 10.1016/j.bja.2018.04.004 [21] Chaudhary NK, John RR, Boddu D, et al. Palonsosetron is a better choice compared with ondansetron for the prevention of chemotherapy-induced nausea and vomiting (CINV) in a resource-limited pediatric oncology center: results from a randomized control trial[J]. J Pediatr Hematol Oncol, 2019, 41: 294-297. doi: 10.1097/MPH.0000000000001357 [22] Gammal RS, Crews KR, Haidar CE, et al. Pharmacogenetics for safe codeine use in sickle cell disease[J]. Pediatrics, 2016, 138: e20153479. doi: 10.1542/peds.2015-3479 [23] Okumura LM, D'Athayde Rodrigues F, Ferreira MAP, et al. Aprepitant in pediatric patients using moderate and highly emetogenic protocols: a systematic review and meta-analyes of randomized controlled trials[J]. Br J Clin Pharmacol, 2017, 83: 1108-1117. doi: 10.1111/bcp.13193 [24] Dahmani S, Delivet H, Hilly J. Emergence delirium in children: an update[J]. Curr Opin Anaesthesiol, 2014, 27: 309-315. doi: 10.1097/ACO.0000000000000076 [25] Butz SF. Pediatric Ambulatory Anesthesia Challenges[J]. Anesthesiol Clin, 2019, 37: 289-300. doi: 10.1016/j.anclin.2019.01.002 [26] Moncel JB, Nardi N, Wodey E, et al. Evaluation of the pediatric post anesthesia discharge scoring system in an ambulatory surgery unit[J]. Paediatr Anaesth, 2015, 25: 636-641. doi: 10.1111/pan.12612 [27] Armstrong J, Forrest H, Crawford MW. A prospective observational study comparing a physiological scoring system with time-based discharge criteria in pediatric ambulatory surgical patients[J]. Can J Anaesth, 2015, 62: 1082-1088. doi: 10.1007/s12630-015-0428-6 -
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