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中国加速康复外科临床实践指南(2021)(一)

中华医学会外科学分会 中华医学会麻醉学分会

中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021)(一)[J]. 协和医学杂志, 2021, 12(5): 624-631. doi: 10.12290/xhyxzz.20210001
引用本文: 中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021)(一)[J]. 协和医学杂志, 2021, 12(5): 624-631. doi: 10.12290/xhyxzz.20210001
Chinese Society of Surgery, Chinese Society of Anesthesiology. Clinical Practice Guidelines for ERAS in China (2021)(Ⅰ)[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(5): 624-631. doi: 10.12290/xhyxzz.20210001
Citation: Chinese Society of Surgery, Chinese Society of Anesthesiology. Clinical Practice Guidelines for ERAS in China (2021)(Ⅰ)[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(5): 624-631. doi: 10.12290/xhyxzz.20210001

中国加速康复外科临床实践指南(2021)(一)

doi: 10.12290/xhyxzz.20210001
详细信息

    通信作者:赵玉沛  电话:010-69155810,E-mail:zhao8028@263.net; 黄宇光  电话:010-69152026,E-mail:garybeijing@163.com

  • 中图分类号: R459.4;R6

Clinical Practice Guidelines for ERAS in China (2021)(Ⅰ)

More Information
  • [编者按] 近年来加速康复外科(enhanced recovery after surgery,ERAS)的理念及路径在我国得到迅速普及和广泛应用。临床实践表明,ERAS理念及相关路径的实施必须以循证医学及多学科协作为基础,既要体现以快速康复为主要目的的核心理念,也要兼顾患者基础疾病、手术类别、围术期并发症等具体情况,更需要开展深入的临床研究以论证ERAS相关路径的可行性及必要性。在上述背景下,中华医学会外科学分会和麻醉学分会于2018年共同发表了《加速康复外科中国专家共识暨路径管理指南(2018)》,分别制定了肝胆手术、胰十二指肠切除术、胃手术、结直肠手术等领域的ERAS管理路径[1]。指南发表 3年以来,对于普及ERAS理念、指导临床实践起到了良好的促进作用。
    为体现近年来ERAS领域知识更新与学科进步,中华医学会外科学分会和麻醉学分会联合对2018版指南进行修订,以问题为导向,以循证为基础,通过对近年文献的复习总结并结合临床经验对ERAS领域的若干热点逐一评述并提出推荐意见,在与国际相关指南接轨的同时兼顾我国国情及临床实际,这对更好地规范实施ERAS路径,必将起到重要的指导作用。
    本指南依据GRADE系统进行证据质量评估及推荐强度分级,证据等级分为高、中、低三级,推荐强度包括强烈推荐和一般性推荐两级[2]。本指南包括总论及各论两部分,前者述评ERAS的一般性原则,后者分别针对肝胆手术、胰腺手术、胃和减重手术及结直肠手术ERAS相关的具体问题展开讨论。总论部分已涉及的共性问题,各论部分从简。
    利益冲突: 所有作者均声明不存在利益冲突
  • [1] 中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识暨路径管理指南(2018)[J]. 中华麻醉学杂志, 2018, 38: 8-33. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201801001.htm
    [2] Guyatt GH, Oxman AD, Kunz R, et al. Going from evidence to recommendations[J]. BMJ, 2008, 336: 1049-1051. doi:  10.1136/bmj.39493.646875.AE
    [3] Sun Y, Wang Y, Mao Y, et al. The safety and feasibility of enhanced recovery after surgery in patients undergoing pancreaticoduodenectomy: an updated meta-analysis[J]. Biomed Res Int, 2020, 2020: 7401276. http://www.researchgate.net/publication/341274088_The_Safety_and_Feasibility_of_Enhanced_Recovery_after_Surgery_in_Patients_Undergoing_Pancreaticoduodenectomy_An_Updated_Meta-Analysis
    [4] Inoue Y, Katoh T, Masuda S, et al. Perioperative complications of abdominal surgery in smokers[J]. J Anesth, 2020, 34: 712-718. doi:  10.1007/s00540-020-02815-6
    [5] Kaka AS, Zhao S, Ozer E, et al. Comparison of clinical outcomes following head and neck surgery among patients who contract to abstain from alcohol vs patients who abuse alcohol[J]. JAMA Otolaryngol Head Neck Surg, 2017, 143: 1181-1186. doi:  10.1001/jamaoto.2017.0553
    [6] Roshanov PS, Walsh M, Devereaux PJ, et al. External validation of the revised cardiac risk index and update of its renal variable to predict 30-day risk of major cardiac complications after non-cardiac surgery: rationale and plan for analyses of the VISION study[J]. BMJ Open, 2017, 7: e013510. doi:  10.1136/bmjopen-2016-013510
    [7] Cappellini MD, Musallam KM, Taher AT. Iron deficiency anemia revisited[J]. J Intern Med, 2020, 287: 153-170. doi:  10.1111/joim.13004
    [8] Aglio LS, Abd-El-Barr MM, Orhurhu V, et al. Preemptive analgesia for postoperative pain relief in thoracolumbosacral spine operations: a double-blind, placebo-controlled randomized trial[J]. J Neurosurg Spine, 2018, 29: 647-653. doi:  10.3171/2018.5.SPINE171380
    [9] Hall DE, Arya S, Schmid KK, et al. Association of a frailty screening initiative with postoperative survival at 30, 180, and 365 days[J]. JAMA Surg, 2017, 152: 233-240. doi:  10.1001/jamasurg.2016.4219
    [10] Ripollés-Melchor J, Carli F, Coca-Martínez M, et al. Committed to be fit. The value of preoperative care in the perioperative medicine era[J]. Minerva Anestesiol, 2018, 84: 615-625. http://www.researchgate.net/profile/Jose_Garcia-Erce/publication/323226137_Committed_to_be_fit_The_value_of_preoperative_care_in_the_perioperative_medicine_era/links/5af466c8aca2720af9c57468/Committed-to-be-fit-The-value-of-preoperative-care-in-the-perioperative-medicine-era.pdf
    [11] American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. Postoperative delirium in older adults: best practice statement from the American Geriatrics Society[J]. J Am Coll Surg, 2015, 220: 136. e1-148. e1. http://www.aast.org/Assets/33c25842-3e3d-4464-991f-fa4e5b3dd06e/636076542943070000/geri-delerium-best-practice-pdf
    [12] de la Motte L, Kehlet H, Vogt K, et al. Preoperative methylprednisolone enhances recovery after endovascular aortic repair: a randomized, double-blind, placebo-controlled clinical trial[J]. Ann Surg, 2014, 260: 540-548. doi:  10.1097/SLA.0000000000000895
    [13] Levett D, Grimmett C. Psychological factors, prehabilitation and surgical outcomes: evidence and future directions[J]. Anaesthesia, 2019, 74: 36-42. doi:  10.1111/anae.14507
    [14] Weimann A, Braga M, Carli F, et al. ESPEN guideline: clinical nutrition in surgery[J]. Clin Nutr, 2017, 36: 623-650. doi:  10.1016/j.clnu.2017.02.013
    [15] Key NS, Khorana AA, Kuderer NK, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update[J]. J Clin Oncol, 2020, 38: 486-520. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_PM31550210
    [16] Feldheiser A, Aziz O, Baldini G, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice[J]. Acta Anaesthesiol Scand, 2016, 60: 289-334. doi:  10.1111/aas.12651
    [17] Chan MY, Foo CC, Poon JT, et al. Laparoscopic colorectal resections with and without routine mechanical bowel preparation: a comparative study[J]. Ann Med Surg (Lond), 2016, 9: 72-76. doi:  10.1016/j.amsu.2016.07.004
    [18] 《抗菌药物临床应用指导原则》修订工作组. 抗菌药物临床应用指导原则[EB/OL ]. (2015)[2021-07-01]. http://www.nhc.gov.cn/ewebeditor/uploadfile/2015/09/20150928170007470.pdf.
    [19] Wade RG, Burr NE, Mccauley G, et al. The comparative efficacy of chlorhexidine gluconate and povidone-iodine antiseptics for the prevention of infection in clean surgery: a systematic review and network meta-analysis[J]. Ann Surg, 2020. doi:  10.1097/SLA.0000000000004076.
    [20] Li Y, Wang B, Zhang LL, et al. Dexmedetomidine comb-ined with general anesthesia provides similar intraoperative stress response reduction when compared with a combined general and epidural anesthetic technique[J]. Anesth Analg, 2016, 122: 1202-1210. doi:  10.1213/ANE.0000000000001165
    [21] Yang S, Xiao W, Wang S, et al. Parecoxib shortens the duration of acute postoperative pain after laparoscopic-assisted vaginal hysterectomy[J]. Front Pharmacol, 2019, 10: 689. doi:  10.3389/fphar.2019.00689
    [22] Stephensen BD, Reid F, Shaikh S, et al. C-reactive protein trajectory to predict colorectal anastomotic leak: PREDICT Study[J]. Br J Surg, 2020, 107: 1832-1837. doi:  10.1002/bjs.11812
    [23] 中华医学会麻醉学分会老年人麻醉学组, 国家老年疾病临床医学研究中心, 国家老年麻醉联盟. 中国老年患者围手术期麻醉管理指导意见(2020版)(二)[J]. 中华医学杂志, 2020, 100: 2565-2578. doi:  10.3760/cma.j.cn112137-20200503-01407
    [24] 中华医学会麻醉学分会老年人麻醉学组, 国家老年疾病临床医学研究中心, 中华医学会精神病学分会, 等. 中国老年患者围术期脑健康多学科专家共识(二)[J]. 中华医学杂志, 2019, 99: 2252-2269. doi:  10.3760/cma.j.issn.0376-2491.2019.29.004
    [25] Feng S, Yang S, Xiao W, et al. Effects of perioperative goal-directed fluid therapy combined with the application of alpha-1 adrenergic agonists on postoperative outcomes: a systematic review and meta-analysis[J]. BMC Anesthesiology, 2018, 18: 113. doi:  10.1186/s12871-018-0564-y
    [26] Sun Z, Honar H, Sessler DI, et al. Intraoperative core temperature patterns, transfusion requirement, and hospital duration in patients warmed with forced air[J]. Anesthesiology, 2015, 122: 276-285. doi:  10.1097/ALN.0000000000000551
    [27] Kang ZQ, Huo JL, Zhai XJ. Effects of perioperative tight glycemic control on postoperative outcomes: a meta-analysis[J]. Endocr Connect, 2018, 7: R316-R327. doi:  10.1530/EC-18-0231
    [28] Weindelmayer J, Mengardo V, Veltri A, et al. Should we still use prophylactic drain in gastrectomy for cancer? A systematic review and meta-analysis[J]. Eur J Surg Oncol, 2020, 46: 1396-1403. doi:  10.1016/j.ejso.2020.05.009
    [29] Navarro LH, Bloomstone JA, Auler JO Jr, et al. Perioperative fluid therapy: a statement from the international Fluid Optimization Group[J]. Perioper Med (Lond), 2015, 4: 3. doi:  10.1186/s13741-015-0014-z
    [30] Joosten A, Delaporte A, Mortier J, et al. Long-term impact of crystalloid versus colloid solutions on renal function and disability-free survival after major abdominal surgery[J]. Anesthesiology, 2019, 130: 227-236. doi:  10.1097/ALN.0000000000002501
    [31] Joosten A, Delaporte A, Ickx B, et al. Crystalloid versus colloid for intraoperative goal-directed fluid therapy using a closed-loop sysm: a randomized, double-blinded, controlled trial in major abdominal surgery[J]. Anesthesiology, 2018, 128: 55-66. doi:  10.1097/ALN.0000000000001936
    [32] Lovich-Sapola J, Smith CE, Brandt CP. Postoperative pain control[J]. Surg Clin N Am, 2015, 95: 301-318. doi:  10.1016/j.suc.2014.10.002
    [33] Gan TJ, Belani KG, Bergese S, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting[J]. Anesth Analg, 2020, 131: 411-448. doi:  10.1213/ANE.0000000000004833
    [34] Yang R, Tao W, Chen YY. et al. Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy: a meta-analysis[J]. Int J Surg, 2016, 36: 274-282. doi:  10.1016/j.ijsu.2016.11.017
    [35] Munoz M, Acheson AG, Bisbe E, et al. An international consensus statement on the management of postoperative anaemia after major surgical procedures[J]. Anaesthesia, 2018, 73: 1418-1431. doi:  10.1111/anae.14358
    [36] Nelson G, Bakkum-Gamez J, Kalogera E, et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update[J]. Int J Gynecol Cancer, 2019, 29: 651-668. doi:  10.1136/ijgc-2019-000356
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出版历程
  • 收稿日期:  2021-09-17
  • 录用日期:  2021-09-20
  • 刊出日期:  2021-09-30

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