快速康复外科围手术期护理的研究现状与挑战
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摘要
快速康复外科(FTS)是将围手术期的护理、麻醉和外科等学科的最新循证研究证据结合起来,采用多模式策略达到加速康复进程的目的。近年来,国际上快速康复外科的指南已逐渐本土化,国内关于外科与麻醉方面相关的研究越来越多,而护理领域的研究还处于起步阶段,护理专科贡献不明显,缺少系统化、程序化的护理质量管理评估体系,导致该理念的运用较被动。另外,快速康复外科理念中多项围手术期措施颠覆了传统的医疗护理常规,这给快速康复外科理念的实践带来很大的困难。护士应积极拓展研究领域,探索适合中国国情的护理规范。笔者就快速康复外科理念在我国围手术期护理的研究现状及面临的挑战进行了系统分析和综述。
The fast track surgery(FTS) uses a multimode strategy to accelerate the recovery process combining the latest research evidence about the perioperative nursing, anesthesiology and surgery. In recent years, the guidance of international FTS has gradually been localized, and there are more and more research related to surgery and anesthesia in our country.But the nursing research is still in the early stage. Not obvious about the contribution of nursing, and lacking the systematic and procedural nursing quality evaluation system, which lead to the passive application of FTS. In addition, a number of perioperative measures in FTS subvert the traditional nursing, which has brought great diffi culties to the practice of FTS. Nurses should expand research areas actively and explore suitable nursing norms. In this paper, the current status and challenges of perioperative nursing about the FTS concept in China are systematically analyzed and reviewed.
The fast track surgery(FTS) uses a multimode strategy to accelerate the recovery process combining the latest research evidence about the perioperative nursing, anesthesiology and surgery. In recent years, the guidance of international FTS has gradually been localized, and there are more and more research related to surgery and anesthesia in our country.But the nursing research is still in the early stage. Not obvious about the contribution of nursing, and lacking the systematic and procedural nursing quality evaluation system, which lead to the passive application of FTS. In addition, a number of perioperative measures in FTS subvert the traditional nursing, which has brought great diffi culties to the practice of FTS. Nurses should expand research areas actively and explore suitable nursing norms. In this paper, the current status and challenges of perioperative nursing about the FTS concept in China are systematically analyzed and reviewed.
引文
[1]江志伟,李宁,黎介寿.快速康复外科的概念及临床意义[J].中国实用外科杂志,2007,27(2):131-133.
[2]中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016)[J].中华外科杂志,2016,54(6):413-418.
[3]Dong Q,Zhang K,Cao S,et al.Fast-track surgery versus conventional perioperative management of lung cancerassociated pneumonectomy:a randomized controlled clinical trial[J].World Journal of Surgical Oncology,2017,15(1):20.
[4]中国研究型医院学会肝胆胰外科专业委员会.肝胆胰外科术后加速康复专家共识(2015版)[J].消化肿瘤杂志,2016,8(4):220-225.
[5]高红.快速康复外科理念在髋关节置换围手术期的应用评价[J].全科护理,2017,15(31):3919-3921
[6]崔玉洁.快速康复外科理念在骨科病人围手术期护理管理中的应用[J].循证护理,2017,3(4):315-317.
[7]Aarts MA,Okrainec A,GlicksmanA,etal.Adoption of enhanced recovery after surgery(ERAS)strategies for colorectal surgery at academic teaching hospitals and impact on total length ofhospital stay[J].Surgical Endoscopy,2012,26(2):442-450.
[8]M Soop,J Nygren,P Myrenfors,A Thorell,O Ljungqvist.Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance[J].American journal of physiology.Endocrinology and metabolism,2001,280(4):E576-83.
[9]Koea JB,Young Y,Gunn K.Fast track liver resection:the effect of acomprehensive care package and analgesia with single dose intrathecalmorphine with gabapentin or continuous epidural analgesia[J].HPB Surg,2009,2009(5):271986.
[10]Wilmore DW,Kehlet H.Management of patients in fast track surger[J].British Medical Journal,2001,322(7284):473.
[11]陈荣珠,王桂红,荚卫东,等.综合保温措施在肝癌手术患者快速康复外科中的应用[J].实用肝脏病杂志,2014,17(4):384-388.
[12]刘子嘉,黄宇光.临床麻醉在快速康复外科方面新进展[J].中国医学科学院学报.2015,37(6):750-754.
[13]田文华,张彩玲.快速康复外科理念应用于胃肠道肿瘤手术麻醉中的效果研究[J].中国医学工程,2017,25(11):80-82.
[14]Andersen L,Gaarn-Larsen L,KristensenB,et al.Subacute pain and function after fast-track hip and knee arthroplasty[J].Anaesthesia,2009,64(5):508-513.
[15]程莉,金圆圆.快速康复外科理念在妇科围手术期护理中的研究与发展现状[J].全科护理,2017,15(36):4506-4509.
[16]中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016)[J].中华外科杂志,2016,54(6):413-418.
[17]朱斌,黄建宏.加速康复外科在我国发展现状、挑战与对策[J].中国实用外科杂志,2017,37(1):26-29.
[18]古燕芳.PDCA循环改进手术室标准化护理方案的效果分析[J].齐鲁护理杂志,2016,22(22):90-92.
[19]陈玉枝.护理质量指标的设计与应用[J].中国护理管理,2014,14(12):1240-1243.
[20]王金垚,杨蓉,杨婕,等.我国加速康复外科临床对照研究的文献计量学分析[J].护理研究,2017,31(31):4033-4035.
[2]中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016)[J].中华外科杂志,2016,54(6):413-418.
[3]Dong Q,Zhang K,Cao S,et al.Fast-track surgery versus conventional perioperative management of lung cancerassociated pneumonectomy:a randomized controlled clinical trial[J].World Journal of Surgical Oncology,2017,15(1):20.
[4]中国研究型医院学会肝胆胰外科专业委员会.肝胆胰外科术后加速康复专家共识(2015版)[J].消化肿瘤杂志,2016,8(4):220-225.
[5]高红.快速康复外科理念在髋关节置换围手术期的应用评价[J].全科护理,2017,15(31):3919-3921
[6]崔玉洁.快速康复外科理念在骨科病人围手术期护理管理中的应用[J].循证护理,2017,3(4):315-317.
[7]Aarts MA,Okrainec A,GlicksmanA,etal.Adoption of enhanced recovery after surgery(ERAS)strategies for colorectal surgery at academic teaching hospitals and impact on total length ofhospital stay[J].Surgical Endoscopy,2012,26(2):442-450.
[8]M Soop,J Nygren,P Myrenfors,A Thorell,O Ljungqvist.Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance[J].American journal of physiology.Endocrinology and metabolism,2001,280(4):E576-83.
[9]Koea JB,Young Y,Gunn K.Fast track liver resection:the effect of acomprehensive care package and analgesia with single dose intrathecalmorphine with gabapentin or continuous epidural analgesia[J].HPB Surg,2009,2009(5):271986.
[10]Wilmore DW,Kehlet H.Management of patients in fast track surger[J].British Medical Journal,2001,322(7284):473.
[11]陈荣珠,王桂红,荚卫东,等.综合保温措施在肝癌手术患者快速康复外科中的应用[J].实用肝脏病杂志,2014,17(4):384-388.
[12]刘子嘉,黄宇光.临床麻醉在快速康复外科方面新进展[J].中国医学科学院学报.2015,37(6):750-754.
[13]田文华,张彩玲.快速康复外科理念应用于胃肠道肿瘤手术麻醉中的效果研究[J].中国医学工程,2017,25(11):80-82.
[14]Andersen L,Gaarn-Larsen L,KristensenB,et al.Subacute pain and function after fast-track hip and knee arthroplasty[J].Anaesthesia,2009,64(5):508-513.
[15]程莉,金圆圆.快速康复外科理念在妇科围手术期护理中的研究与发展现状[J].全科护理,2017,15(36):4506-4509.
[16]中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016)[J].中华外科杂志,2016,54(6):413-418.
[17]朱斌,黄建宏.加速康复外科在我国发展现状、挑战与对策[J].中国实用外科杂志,2017,37(1):26-29.
[18]古燕芳.PDCA循环改进手术室标准化护理方案的效果分析[J].齐鲁护理杂志,2016,22(22):90-92.
[19]陈玉枝.护理质量指标的设计与应用[J].中国护理管理,2014,14(12):1240-1243.
[20]王金垚,杨蓉,杨婕,等.我国加速康复外科临床对照研究的文献计量学分析[J].护理研究,2017,31(31):4033-4035.