Enhanced Recovery after Surgery in Gynecology:Current Practice and Future Perspective
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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。Abstract: Enhanced recovery after surgery (ERAS) aims at reducing surgical stress and accelerating patients' postoperative recovery by optimizing perioperative management, which has been widely applied in multiple fields such as colorectal surgery, orthopedics, and urology, and has gained attention from gynecologists over the last decade. It has been showed that ERAS can reduce postoperative pain, bring down the incidence of postoperative nausea and vomiting, promote the recovery of bowel function, save hospitalization expenses, and improve patient satisfaction in both benign and malignant gynecological conditions. The successful implementation of ERAS requires close collaboration among multiple disciplines as well as rigorous and scientific prospective study providing high-quality evidence support, so as to promote the continuous improvement of ERAS program and bring maximum benefits to patients.利益冲突 无
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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 -
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