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加速康复外科在妇科手术领域的进展

任远 刘海元 孙大为

任远, 刘海元, 孙大为. 加速康复外科在妇科手术领域的进展[J]. 协和医学杂志, 2019, 10(6): 621-626. doi: 10.3969/j.issn.1674-9081.2019.06.013
引用本文: 任远, 刘海元, 孙大为. 加速康复外科在妇科手术领域的进展[J]. 协和医学杂志, 2019, 10(6): 621-626. doi: 10.3969/j.issn.1674-9081.2019.06.013
Yuan REN, Hai-yuan LIU, Da-wei SUN. Enhanced Recovery after Surgery in Gynecology:Current Practice and Future Perspective[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(6): 621-626. doi: 10.3969/j.issn.1674-9081.2019.06.013
Citation: Yuan REN, Hai-yuan LIU, Da-wei SUN. Enhanced Recovery after Surgery in Gynecology:Current Practice and Future Perspective[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(6): 621-626. doi: 10.3969/j.issn.1674-9081.2019.06.013

加速康复外科在妇科手术领域的进展

doi: 10.3969/j.issn.1674-9081.2019.06.013
详细信息
    通讯作者:

    孙大为 电话:010-69155749, E-mail:sundw1118@aliyun.com

  • 中图分类号: R713

Enhanced Recovery after Surgery in Gynecology:Current Practice and Future Perspective

More Information
  • 摘要: 加速康复外科(enhanced recovery after surgery, ERAS)旨在通过优化围手术期处理, 减轻手术应激, 缩短患者术后恢复时间, 现已广泛应用于结直肠外科、骨科、泌尿外科等领域, 并逐渐被妇科医生所重视。已有研究表明, 无论在妇科良性疾病还是恶性肿瘤手术中, ERAS均能够减轻患者术后疼痛、降低术后恶心呕吐发生率、促进术后肠道功能恢复, 缩短住院日及降低住院费用, 提高患者满意度, 同时不增加术后并发症及再次住院发生率。ERAS的实施需要多学科紧密协作, 同时需要设计严谨科学的前瞻性研究提供高质量的证据支持, 推动其不断发展和完善, 使患者实际获益。
    利益冲突  无
  • 表  1  2016年美国ERAS协会制订的妇科/肿瘤ERAS指南主要内容[5-6]

    术前 术中 术后
    1.入院前予患者ERAS宣教(包括至少术前4周戒烟戒酒) 1.使用短效麻醉药 1.VTE高风险患者术后继续抗凝治疗28 d
    2.纠正术前贫血及营养不良 2.采用两种以上止吐剂预防术后恶心及呕吐 2.术后24 h内停止静脉补液
    3.取消常规肠道准备 3.尽量采用微创手术方式 3.术后当天开始经口饮食
    4.术前6 h禁食固体食物、2h禁食清流质,术前2h摄入含糖饮料 4.尽量避免放置鼻胃管,如有放置,在患者麻醉苏醒前拔除 4.术后适当应用缓泻剂
    5.避免常规给予抗焦虑药物 5.术中优化液体管理(目标导向性补液,首选平衡盐溶液) 5.术后咀嚼口香糖促进肠道功能恢复
    6.停用激素补充治疗及口服避孕药 6.术中体温监测 6.维持术后血糖180~200 mg/dl以下,必要时应用胰岛素,但需警惕低血糖
    7.VTE高风险患者术前接受预防性抗凝治疗,同时穿着弹力袜 7.多模式镇痛 7.多模式镇痛
    8.切皮前60 min预防性给予抗生素 8.避免常规放置引流管 8.术后24h内拔除尿管
    9.多模式镇痛 9.鼓励患者术后24 h内开始离床活动
    ERAS:加速康复外科;VTE:静脉血栓栓塞症
    下载: 导出CSV
  • [1] Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth, 1997, 78:606-617. https://pubmed.ncbi.nlm.nih.gov/9175983/
    [2] Nicholson A, Lowe MC, Parker J, et al. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients[J]. Br J Surg, 2014, 101:172-188. doi:  10.1002/bjs.9394
    [3] Nelson G, Kiyang LN, Crumley ET, et al. Implementation of Enhanced Recovery After Surgery (ERAS) Across a Provincial Healthcare System:The ERAS Alberta Colorectal Surgery Experience[J]. World J Surg, 2016, 40:1092-1103. doi:  10.1007/s00268-016-3472-7
    [4] Bell A, Relph S, Sivashanmugarajan V, et al. Enhanced recovery programmes:do these have a role in gynaecology?[J]. J Obstet Gynaecol, 2013, 33:539-541.
    [5] Nelson G, Altman AD, Nick A, et al. Guidelines for pre-and intra-operative care in gynecologic/oncology surgery:Enhanced Recovery After Surgery (ERAS®) Society recommendations-Part Ⅰ[J]. Gynecol Oncol, 2016, 140:313-322.
    [6] Nelson G, Altman AD, Nick A, et al. Guidelines for postoperative care in gynecologic/oncology surgery:Enhanced Recovery After Surgery (ERAS®) Society recommendations-Part Ⅱ[J]. Gynecol Oncol, 2016, 140:323-332.
    [7] Ferguson SE, Malhotra T, Seshan VE, et al. A prospective randomized trial comparing patient-controlled epidural anal-gesia to patient-controlled intravenous analgesia on postoperative pain control and recovery after major open gynecologic cancer surgery[J]. Gynecol Oncol, 2009, 114:111-116.
    [8] Hubner M, Blanc C, Roulin D, et al. Randomized clinical trial on epidural versus patient-controlled analgesia for laparoscopic colorectal surgery within an enhanced recovery pathway[J]. Ann Surg, 2015, 261:648-653.
    [9] Massicotte L, Chalaoui KD, Beaulieu D, et al. Comparison of spinal anesthesia with general anesthesia on morphine requirement after abdominal hysterectomy[J]. Acta Anaesthesiol Scand, 2009, 53:641-647. doi:  10.1111/j.1399-6576.2009.01930.x
    [10] Carney J, McDonnell JG, Ochana A, et al. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy[J]. Anesth Analg, 2008, 107:2056-2060. https://www.ncbi.nlm.nih.gov/pubmed/19020158/
    [11] Ravndal C, Vandrevala T. Preemptive Local Anesthetic in Gynecologic Laparoscopy and Postoperative Movement-Evoked Pain:A Randomized Trial[J]. J Minim Invasive Gynecol, 2016, 23:775-780. https://www.ncbi.nlm.nih.gov/pubmed/26997419
    [12] Khan JS, Margarido C, Devereaux PJ, et al. Preoperative celecoxib in noncardiac surgery:A systematic review and meta-analysis of randomised controlled trials[J]. Eur J Anaesthesiol, 2016, 33:204-214. https://pubmed.ncbi.nlm.nih.gov/26760402/
    [13] Xiromeritis P, Kalogiannidis I, Papadopoulos E, et al. Improved recovery using multimodal perioperative analgesia in minimally invasive myomectomy:a randomised study[J]. Aust N Z J Obstet Gynaecol, 2011, 51:301-306. https://www.ncbi.nlm.nih.gov/pubmed/21806591
    [14] Wick EC, Grant MC, Wu CL. Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques:A Review[J]. JAMA Surg, 2017, 152:691-697. https://pubmed.ncbi.nlm.nih.gov/28564673/
    [15] Chatterjee S, Rudra A, Sengupta S. Current concepts in the management of postoperative nausea and vomiting[J]. Anesthesiol Res Pract, 2011, 2011:748031. https://www.hindawi.com/journals/arp/2011/748031/
    [16] Pauls RN, Crisp CC, Oakley SH, et al. Effects of dexamethasone on quality of recovery following vaginal surgery:a randomized trial[J]. Am J Obstet Gynecol, 2015, 213:711-718. https://www.sciencedirect.com/science/article/pii/S0002937815005384
    [17] Ottesen M, Sorensen M, Rasmussen Y, et al. Fast track vaginal surgery[J]. Acta Obstet Gynecol Scand, 2002, 81:138-146.
    [18] Yoong W, Sivashanmugarajan V, Relph S, et al. Can enhanced recovery pathways improve outcomes of vaginal hysterectomy? Cohort control study[J]. J Minim Invasive Gynecol, 2014, 21:83-89. https://www.ncbi.nlm.nih.gov/pubmed/23850899
    [19] Dickson E, Argenta PA, Reichert JA. Results of introducing a rapid recovery program for total abdominal hysterectomy[J]. Gynecol Obstet Invest, 2012, 73:21-25. https://experts.umn.edu/en/publications/results-of-introducing-a-rapid-recovery-program-for-total-abdomin
    [20] de Lapasse C, Rabischong B, Bolandard F, et al. Total laparoscopic hysterectomy and early discharge:satisfaction and feasibility study[J]. J Minim Invasive Gynecol, 2008, 15:20-25. https://www.ncbi.nlm.nih.gov/pubmed/18262139
    [21] Nilsson L, Wodlin NB, Kjolhede P. Risk factors for postoperative complications after fast-track abdominal hysterectomy[J]. Aust N Z J Obstet Gynaecol, 2012, 52:113-120. doi:  10.1111/j.1479-828X.2011.01395.x
    [22] Relph S, Bell A, Sivashanmugarajan V, et al. Cost effectiveness of enhanced recovery after surgery programme for vaginal hysterectomy:a comparison of pre and post-implementation expenditures[J]. Int J Health Plann Manage, 2014, 29:399-406. https://www.ncbi.nlm.nih.gov/pubmed/23661616
    [23] de Lapasse C, Rabischong B, Bolandard F, et al. Total laparoscopic hysterectomy and early discharge:satisfaction and feasibility study[J]. J Minim Invasive Gynecol, 2008, 15:20-25. https://www.ncbi.nlm.nih.gov/pubmed/18262139
    [24] Kroon UB, Radstrom M, Hjelthe C, et al. Fast-track hysterectomy:a randomised, controlled study[J]. Eur J Obstet Gynecol Reprod Biol, 2010, 151:203-207.
    [25] Dickson EL, Stockwell E, Geller MA, et al. Enhanced Recovery Program and Length of Stay After Laparotomy on a Gynecologic Oncology Service:A Randomized Controlled Trial[J]. Obstet Gynecol, 2017, 129:355-362. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636638/
    [26] Nelson G, Ramirez PT, Ljungqvist O, et al. Enhanced Recovery Program and Length of Stay After Laparotomy on a Gynecologic Oncology Service:A Randomized Controlled Trial[J]. Obstet Gynecol, 2017, 129:1139. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636638/
    [27] Marx C, Rasmussen T, Jakobsen DH, et al. The effect of accelerated rehabilitation on recovery after surgery for ovarian malignancy[J]. Acta Obstet Gynecol Scand, 2006, 85:488-492. https://www.ncbi.nlm.nih.gov/pubmed/16612713
    [28] Gerardi MA, Santillan A, Meisner B, et al. A clinical pathway for patients undergoing primary cytoreductive surgery with rectosigmoid colectomy for advanced ovarian and primary peritoneal cancers[J]. Gynecol Oncol, 2008, 108:282-286. https://www.ncbi.nlm.nih.gov/pubmed/18023851
    [29] Chapman JS, Roddy E, Ueda S, et al. Enhanced Recovery Pathways for Improving Outcomes After Minimally Invasive Gynecologic Oncology Surgery[J]. Obstet Gynecol, 2016, 128:138-144. https://www.ncbi.nlm.nih.gov/pubmed/27275797
    [30] Bergstrom JE, Scott ME, Alimi Y, et al. Narcotics reduction, quality and safety in gynecologic oncology surgery in the first year of enhanced recovery after surgery protocol implementation[J]. Gynecol Oncol, 2018, 149:554-559. https://www.ncbi.nlm.nih.gov/pubmed/29661495
    [31] Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery:A Review[J]. JAMA Surg, 2017, 152:292-298.
    [32] Savaridas T, Serrano-Pedraza I, Khan SK, et al. Reduced medium-term mortality following primary total hip and knee arthroplasty with an enhanced recovery program. A study of 4, 500 consecutive procedures[J]. Acta Orthop, 2013, 84:40-43. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584601/
    [33] Gustafsson UO, Oppelstrup H, Thorell A, et al. Adherence to the ERAS protocol is Associated with 5-Year Survival After Colorectal Cancer Surgery:A Retrospective Cohort Study[J]. World J Surg, 2016, 40:1741-1747. doi:  10.1007/s00268-016-3460-y
    [34] Kjolhede P, Borendal WN, Nilsson L, et al. Impact of stress coping capacity on recovery from abdominal hysterectomy in a fast-track programme:a prospective longitudinal study[J]. BJOG, 2012, 119:998-1006, discussion 1006-1007.
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  • 收稿日期:  2018-08-29
  • 刊出日期:  2019-11-30

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