加速康复外科方案在围术期麻醉管理中的应用进展
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摘要
加速康复外科是围术期多模式管理的路径,由麻醉医生、外科医生、护理人员、营养师及康复治疗师多个学科成员协同参与,旨在减轻患者围术期的应激反应,以利于手术前后机体和器官功能的维护,从而达到早期康复的目的。加速康复外科整合了围术期一系列干预措施,以维持生理功能,并促进术后康复,其核心目标是减少创伤和应激,以达到减轻患者痛苦、减少并发症、缩短住院时间和降低住院费用,最终实现加速患者康复的目的,是围术期医学发展的方向。麻醉管理作为其中不可或缺的重要组成部分,麻醉医师的专业水准和执行能力对加速康复外科的成败至关重要。
Enhanced recovery after surgery is the path of perioperative multi-modal management.It is coordinated by anesthesiologists,surgeons,nursing staff,nutritionists and rehabilitation physician to reduce the perioperative stress response of patients.Maintenance of the body and organ functions before and after surgery to achieve early rehabilitation.Enhanced recovery after surgery integrates a series of interventions during the perioperative period to maintain physiological function and promote postoperative recovery.Its core goal is to reduce trauma and stress,to reduce pain and complications of patient,shorten hospital stay and reduce hospitalization costs.The ultimate goal is to accelerate patients recovery. So it is the direction of perioperative medical development. As an indispensable part of anesthesia management,the professionalism and ability of anesthesiologists will be critical to accelerating the success of rehabilitation surgery.
Enhanced recovery after surgery is the path of perioperative multi-modal management.It is coordinated by anesthesiologists,surgeons,nursing staff,nutritionists and rehabilitation physician to reduce the perioperative stress response of patients.Maintenance of the body and organ functions before and after surgery to achieve early rehabilitation.Enhanced recovery after surgery integrates a series of interventions during the perioperative period to maintain physiological function and promote postoperative recovery.Its core goal is to reduce trauma and stress,to reduce pain and complications of patient,shorten hospital stay and reduce hospitalization costs.The ultimate goal is to accelerate patients recovery. So it is the direction of perioperative medical development. As an indispensable part of anesthesia management,the professionalism and ability of anesthesiologists will be critical to accelerating the success of rehabilitation surgery.
引文
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[19]孙艳霞,柴芳,潘楚雄,等.目标导向液体治疗对腹部手术后转归的影响:meta分析[J].中华麻醉学杂志,2017,37(5):558-564.doi:10.3760/cma.j.issn.0254-1416.2017.05.013.
[20]Reydellet L,Blsco V,Mercier MF,et al.Impact of a goal-directed therapy protocol on postoperative fluid balance in patients undergoing liver transplantation:a retrospective study[J].Ann Fr Anesth Reanim,2014,33(4):e47-54.doi:10.1016/j.annfar.2013.12.016.
[21]Corcoran T,Rhodes JE,Clarke S,et al.Perioperative fluid management strategies in major surgery:a stratified meta-analysis[J].Anesth Analy,2012,114(3):640-651.doi:10.1213/ANE.0b013e318240d6eb.
[22]Taniquchi H,Sasaki T,Fujita H,et al.Effects of goal-directed fluid therapy on enhanced postoperative recovery:An interventional comparative observational study with a historical control group on oesophagectomy combined with ERAS program[J].Clin Nutr ESPEN,2018,23:184-193.doi:10.1016/j.clnesp.2017.10.002.
[23]Austin PN.Forced-air warmers and surgical site infections in patients undergoing knee or hip arthroplasty[J].Annu Rev Rurs Res,2017,35(1):179-199.
[24]Madrid E,Urrútia G,Roquéi Figuls M,et al.Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults[J].Cochrane Database Syst Rev,2016,21(4):CD009016.doi:10.1002/14651858.CD009016.pub2.
[25]石学银,邹最.加速康复外科的麻醉管理[J].中华消化外科杂志,2015,14(1):38-42.doi:10.3760/cma.j.issn.1673-9752.2015.01.009.
[26]Nimmo SM,Foo ITH,Paterson HM.Enhanced recovery after surgery:pain management[J].J Surg Oncol,2017,116(5):583-591.doi:10.1002/jso.24814.
[27]Horosz B,Nawrocka K,Malec-Milewska M.Anaesthetic perioperative management according to the ERAS protocol[J].Anaesthesiol Intensive Ther,2016,48(1):49-54.doi:10.5603/AIT.2016.0006.
[28]Guay J,Nishimori M,Kopp S.Epidural local anaesthetics versus opioidbased analgesic regimens for postoperative gastrointestinal paralysis,vomiting and pain after abdominal surgery[J].Cochrane Database Syst Rev,2016,7:CD001893.doi:10.1002/14651858.CD001893.pub2.
[29]Banerjee P,Rogers BA.Systematic review of high-volume multimodal wound infiltration in total knee arthroplasty[J].Orthopedics,2014,37(6):403-412.doi:10.3928/01477447-20140528-07.
[30]饶竹青,董世阳,王灿琴,等.罗哌卡因切口浸润对肝癌患者术后镇痛及快速康复的影响[J].临床麻醉学杂志,2016,32(12):1169-1172.doi:10.3969/j.issn.1004-5805.2016.12.008.
[31]Walter CJ,Maxwell-Armstrong C,Pinkney TD,et al.A randomized controlled trial of the efficacy of ultrasound-guided transversus abdominis plane(TAP)block in laparoscopic colorectal surgery[J].Surg Endosc,2013,27(7):2366-2372.doi:10.1007/s00464-013-2791-0.
[32]黄东升,马晓东,周大春.超声引导腹横肌平面阻滞用于半结肠切除术后的镇痛效果[J].中华医学杂志,2014,94(21):1623-1626.doi:10.3760/cma.j.issn.0376-2491.2014.21.006.
[33]Gan TJ,Meyer TA,Apfel CC,et al.Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting[J].Anesth Analg,2007,105(6):1615-1628.doi:10.1213/01.ane.0000295230.55439.f4.
[34]Gan TJ,Diemunsch P,Habib AS,et al.Consensus guidelines for the management of postoperative nausea and vomiting[J].Anesth Analg,2014,118(1):85-113.doi:10.1213/ANE.0000000000000002.
[2]Lassen K,Soop M,Nygren J,et al.Consensus review of optimal perioperative care in colorectal surgery:Enhance Recovery After Surgery(ERAS)Group recommendations[J].Arch Surg,2009,144(10):961-969.doi:10.1001/archsurg.2009.170.
[3]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.doi:10.3760/cma.j.issn.0529-5815.2016.06.004.
[4]Kehlet H.Multimodal approach to control postoperative pathophysiology and rehabilitation[J].Br J Anaesth,1997,78(5):606-617.doi:10.1093/bja/78.5.606.
[5]Mcleod RS,Aarts MA,Chung F,et al.Development of an enhanced recovery after surgery guideline and implementation strategy based on the Knowledge-to-action cycle[J].Ann Surg,2015,262(6):1016-1025.doi:10.1097/SLA.0000000000001067.
[6]Ljungqvist O,Scott M,Fearon KC.Enhanced recovery after surgery:a review[J].JAMA Surg,2017,152(3):292-298.doi:10.1001/jamasurg.2016.4952.
[7]Fearon KC,Ljungqvist O,Von Meyenfeldt M,et al.Enhanced recovery after surgery:a consensus review of clinical care for patients undergoing colonic resection[J].Clin Nutr,2005,24(3):466-477.doi:10.1016/j.clnu.2005.02.002.
[8]Nelson G,Kiyang LN,Chuck A,et al.Cost impact analysis of enhanced recovery after surgery program implementation in Alberta colon cancer patients[J].Curr Oncol,2016,23(3):e221-227.doi:10.3747/co.23.2980.
[9]Ljungqvist O.ERAS-enhanced recovery after surgery:moving evidencebased perioperative care to practice[J].JPEN,2014,38(5):559-566.doi:10.1177/0148607114523451.
[10]黎介寿.对Fast-track Surgery(快通道外科)内涵的再认识[J].中华医学杂志,2007,87(8):515-517.doi:10.3760/j.issn:0376-2491.2007.08.004.
[11]Berberat PO,Ingold H,Gulbinas A,et al.Fast track-different implications in pancreatic surgery[J].J Gastrointest Surg,2007,11(7):880-887.doi:10.1007/s11605-007-0167-2.
[12]Awad S,Varadhan KK,Ljungqvist O,et al.A meta-analysis of randomised controlled trials on preoperative oralcarbohydrate treatment in elective surgery[J].Clin Nutr,2013,32(1):34-44.doi:10.1016/j.clnu.2012.10.011.
[13]Yagmurdur H,Gunal S,Yildiz H,et al.The effects of carbohydrate-rich drink on perioperative discomfort,insulin response and arterial pressure in spinal anesthesia[J].J Res Med Sci,2011,16(11):1483-1489.
[14]Gustafsson UO,Scott MJ,Schwenk W,et al.Guidelines for perioperative care in elective colonic surgery:Enhanced Recovery After Surgery(ERAS)Society recommendations[J].Clin Nutr,2012,31(6):783-800.doi:10.1016/j.clnu.2012.08.013.
[15]Pasero C,Belden J.Evidence-based perianesthesia care:accelerated posto-perative recovery programs[J].J Perianesth Nurs,2006,21(3):168-176.doi:10.1016/j.jopan.2006.03.010.
[16]White PF,Rawal S,Latham P,et al.Use of a continuous local anesthetic infusion for pain management after median sternotomy[J].Anesthesiology,2003,99(4):918-923.doi:10.1097/00000542-200310000-00026.
[17]Futier E,Constantin JM,Paugam-Burtz C,et al.A trial of intraoperative low-tidal-volume ventilation in abdominal surgery[J].N Engl J Med,2013,369(5):428-437.doi:10.1056/NEJMoa1301082.
[18]Macafee DA,Allison SP,Lobo DN.Some interactions between gastrointestinal function and fluid and electrolyte homeostasis[J].Curr Opin Clin Nutr Metab Care,2005,8(2):197-203.doi:10.1097/00075197-200503000-00015.
[19]孙艳霞,柴芳,潘楚雄,等.目标导向液体治疗对腹部手术后转归的影响:meta分析[J].中华麻醉学杂志,2017,37(5):558-564.doi:10.3760/cma.j.issn.0254-1416.2017.05.013.
[20]Reydellet L,Blsco V,Mercier MF,et al.Impact of a goal-directed therapy protocol on postoperative fluid balance in patients undergoing liver transplantation:a retrospective study[J].Ann Fr Anesth Reanim,2014,33(4):e47-54.doi:10.1016/j.annfar.2013.12.016.
[21]Corcoran T,Rhodes JE,Clarke S,et al.Perioperative fluid management strategies in major surgery:a stratified meta-analysis[J].Anesth Analy,2012,114(3):640-651.doi:10.1213/ANE.0b013e318240d6eb.
[22]Taniquchi H,Sasaki T,Fujita H,et al.Effects of goal-directed fluid therapy on enhanced postoperative recovery:An interventional comparative observational study with a historical control group on oesophagectomy combined with ERAS program[J].Clin Nutr ESPEN,2018,23:184-193.doi:10.1016/j.clnesp.2017.10.002.
[23]Austin PN.Forced-air warmers and surgical site infections in patients undergoing knee or hip arthroplasty[J].Annu Rev Rurs Res,2017,35(1):179-199.
[24]Madrid E,Urrútia G,Roquéi Figuls M,et al.Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults[J].Cochrane Database Syst Rev,2016,21(4):CD009016.doi:10.1002/14651858.CD009016.pub2.
[25]石学银,邹最.加速康复外科的麻醉管理[J].中华消化外科杂志,2015,14(1):38-42.doi:10.3760/cma.j.issn.1673-9752.2015.01.009.
[26]Nimmo SM,Foo ITH,Paterson HM.Enhanced recovery after surgery:pain management[J].J Surg Oncol,2017,116(5):583-591.doi:10.1002/jso.24814.
[27]Horosz B,Nawrocka K,Malec-Milewska M.Anaesthetic perioperative management according to the ERAS protocol[J].Anaesthesiol Intensive Ther,2016,48(1):49-54.doi:10.5603/AIT.2016.0006.
[28]Guay J,Nishimori M,Kopp S.Epidural local anaesthetics versus opioidbased analgesic regimens for postoperative gastrointestinal paralysis,vomiting and pain after abdominal surgery[J].Cochrane Database Syst Rev,2016,7:CD001893.doi:10.1002/14651858.CD001893.pub2.
[29]Banerjee P,Rogers BA.Systematic review of high-volume multimodal wound infiltration in total knee arthroplasty[J].Orthopedics,2014,37(6):403-412.doi:10.3928/01477447-20140528-07.
[30]饶竹青,董世阳,王灿琴,等.罗哌卡因切口浸润对肝癌患者术后镇痛及快速康复的影响[J].临床麻醉学杂志,2016,32(12):1169-1172.doi:10.3969/j.issn.1004-5805.2016.12.008.
[31]Walter CJ,Maxwell-Armstrong C,Pinkney TD,et al.A randomized controlled trial of the efficacy of ultrasound-guided transversus abdominis plane(TAP)block in laparoscopic colorectal surgery[J].Surg Endosc,2013,27(7):2366-2372.doi:10.1007/s00464-013-2791-0.
[32]黄东升,马晓东,周大春.超声引导腹横肌平面阻滞用于半结肠切除术后的镇痛效果[J].中华医学杂志,2014,94(21):1623-1626.doi:10.3760/cma.j.issn.0376-2491.2014.21.006.
[33]Gan TJ,Meyer TA,Apfel CC,et al.Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting[J].Anesth Analg,2007,105(6):1615-1628.doi:10.1213/01.ane.0000295230.55439.f4.
[34]Gan TJ,Diemunsch P,Habib AS,et al.Consensus guidelines for the management of postoperative nausea and vomiting[J].Anesth Analg,2014,118(1):85-113.doi:10.1213/ANE.0000000000000002.