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Expert Consensus on Anesthesia Management of Enhanced Recovery after Adult Ambulatory Surgery
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摘要: 中国日间手术合作联盟定义的日间手术是指患者在一日(24 h)内完成入、出院的手术或操作(不含门诊手术), 对于特殊病例由于病情需要延期住院的患者, 住院最长时间不超过48 h。加速康复外科是以循证医学证据为基础的围手术期优化措施, 有助于减少手术应激与炎症反应, 促进患者快速康复, 提高患者围手术期安全性和舒适性。基于日间手术住院时间短、床位周转率高的特点, 加速康复外科理念下的麻醉管理为日间手术安全、舒适和高效发展奠定了基础。Abstract: The definition of ambulatory surgery by the China Ambulatory Surgery Alliance refers to an operation (excluding outpatient surgery) completed within one day (24 h). For the patients with special conditions who have to prolong hospital stays, the length of hospital stays should not exceed 48 h.Enhanced recovery after surgery (ERAS) is a series of optimized perioperative treatments with evidence-based medicine that can reduce perioperative stress and inflammatory responses, promote rapid recovery, and improve patients' perioperative safety and comfort. Ambulatory surgery has the advantages of short hospital stay and high rate of bed rotation. Based on these characteristics, optimized anesthesia management under the concept of ERAS can enhance the safety, comfort, and efficacy of ambulatory surgery.利益冲突 无
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首字母 名称 描述 S 打鼾 是否鼾声响亮(响度超过说话或在紧闭房门外可闻及) T 疲倦 是否经常觉得疲惫、乏力或白天觉得困倦 O 呼吸暂停 是否有任何人发现在睡眠时呼吸停止 P 血压 是否接受过/正在接受降压治疗 B 体质量指数 ＞35 kg/m2 A 年龄 ＞50岁 N 颈围 ＞40 cm G 性别 男性 
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表 3 常用预防术后恶心呕吐药物的使用剂量和时间
药物 成人剂量 给药时间 昂丹司琼 4 mg(静脉滴注)/8 mg(口服) 手术结束时 多拉司琼 12.5 mg(静脉滴注) 手术结束时 格拉司琼 0.35~3 mg(静脉滴注) 手术结束时 托烷司琼 2 mg(静脉滴注) 手术结束时 帕洛诺司琼 0.075 mg(静脉滴注) 诱导时 阿瑞匹坦 40 mg(口服) 诱导时 地塞米松 4~5 mg(静脉滴注) 诱导时 氟哌利多 0.625~1.25 mg(静脉滴注) 手术结束时 氟哌啶醇 0.5~＜2 mg(肌肉注射/静脉滴注) 手术结束时 东莨菪碱 皮肤药贴 术前1 d晚上/术前2 h 茶苯海明 1 mg/kg(静脉滴注) - 甲强龙 40 mg(静脉滴注) - 异丙嗪 6.25~12.5 mg(静脉滴注) - 雷莫司琼 0.3 mg(静脉滴注) 手术结束时 -：未说明
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表 4 与风险相关的成人术后恶心呕吐防治策略
措施 低危 中危 高危 预防措施 药物A+药物B (或TIVA) 药物A+药物B (或TIVA) 药物A+药物B+TIVA，根据个体情况决定用药方案 治疗措施 药物C/药物D(药物C无效时使用) 药物C无效时使用) 药物C无效时使用) A：地塞米松，4 mg；B：昂丹司琼，4 mg；C：氟哌利多，1 mg；D：茶苯海明，1 mg/kg；TIVA：全静脉麻醉
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表 5 改良Aldrete评分表
项目 得分 入室 30 min 60 min 90 min 出室 活动 自主或遵嘱活动四肢 2 自主或遵嘱活动二肢和有限制地抬头 1 不能活动肢体或抬头 0 呼吸 能深呼吸和有效咳嗽，呼吸频率和幅度正常 2 呼吸困难或受限，但有浅而慢的自主呼吸，可能用口咽通气道 1 呼吸暂停或微弱呼吸，需呼吸器治疗或辅助呼吸 0 血压 麻醉前±20%以内 2 麻醉前±(20%~49%) 1 麻醉前±50%以上 0 意识 完全清醒 2 可唤醒，嗜睡 1 无反应 0 血氧饱和度 呼吸空气≥92% 2 呼吸氧气≥92% 1 呼吸氧气＜92% 0 总分
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