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Expert Consensus on Prehabilitation Management for Enhanced Recovery in Patients Undergoing Thoracic Surgery(2022)
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摘要: 预康复管理是加速术后康复的重要内容和启动环节。胸外科手术前多模式预康复可提高患者的围术期功能状态、改善手术预后的临床意义已得到广泛认可。但胸外科预康复的具体实施流程与内容尚缺乏指导规范，临床应用中也存在一定困惑。《基于加速术后康复的胸外科手术预康复管理专家共识(2022)》基于循证医学证据及多次专家讨论结果，在胸外科预康复适用范围、推荐应用时间、预康复前综合评估、具体实施内容及管理流程5个方面达成了初步共识，将为临床工作提供有益指导。Abstract: Prehabilitation is the important starting part of enhanced recovery after surgery (ERAS). Multimodal prehabilitation management before thoracic surgery can increase the perioperative functional capacity of patients and help to improve the prognosis, which has been widely recognized. However, there are no guide- lines or standards of specific contents and implementation process of thoracic prehabilitation, causing some confusion in clinical practice. Expert Consensus on Prehabilitation Management for Enhanced Recovery in Patients undergoing Thoracic Surgery (2022) helps to provide a feasible guideline for clinical prehabilitaion practice, which was based on evidence-based medicine and experts' discussion to reach a preliminary consensus on five aspects of prehabilitation in thoracic surgery, including the indication, recommended duration, comprehensive evaluation before prehabilitation, specific practice contents, and management process.
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Key words:
- prehabilitation /
- enhanced recovery after surgery /
- thoracic surgery /
- expert consensus
作者贡献：黄宇光、李单青牵头制订共识框架、终稿审核；刘子嘉负责组建专家共识工作组、查阅文献、撰写共识初稿；张路负责查阅文献、撰写共识初稿；刘洪生负责查阅文献、起草共识框架、修订共识初稿；其他成员参与讨论、投票，并负责对共识内容进行审校、补充和修订。利益冲突：共识制订工作组所有参与人员均声明不存在利益冲突共识编写组专家 (按姓氏首字母排序)仓静(复旦大学附属中山医院麻醉科)，陈伟(北京协和医院临床营养科)，陈丽霞(北京协和医院康复医学科)，黄宇光(北京协和医院麻醉科)，李单青(北京协和医院胸外科)，刘洪生(北京协和医院胸外科)，闵苏(重庆医科大学附属第一医院麻醉科)，王天龙(首都医科大学宣武医院麻醉手术科)参与共识投票专家 (按姓氏首字母排序)仓静(复旦大学附属中山医院麻醉科)，曹学照(中国医科大学附属第一医院麻醉科)，曾景阳(福建医科大学附属泉州第一医院麻醉科)，陈刚(新疆自治区人民医院麻醉科)，陈国忠(同济大学附属上海市第四人民医院麻醉科)，陈丽霞(北京协和医院康复医学科)，陈鹏(吉林大学中日联谊医院麻醉科)，陈伟(北京协和医院临床营养科)，陈向东(华中科技大学同济医学院附属协和医院麻醉科)，储勤军(郑州大学附属郑州中心医院麻醉科)，高金贵(河北医科大学第二医院麻醉科)，郭曲练(中南大学湘雅医院麻醉科)，黄文起(中山大学附属第一医院麻醉科)，黄宇光(北京协和医院麻醉科)，康军仁(北京协和医院临床营养科)，李天佐(首都医科大学附属北京世纪坛医院麻醉科)，李单青(北京协和医院胸外科)，梁鹏(四川大学华西医院麻醉科)，廖琴(中南大学湘雅三医院麻醉科)，刘洪生(北京协和医院胸外科)，刘子嘉(北京协和医院麻醉科)，栾国会(重庆市綦江区人民医院麻醉科)，罗放(华中科技大学同济医学院附属同济医院麻醉科)，律峰(重庆医科大学附属第一医院麻醉科)，马艳辉(首都医科大学宣武医院麻醉手术科)，马正良(南京大学医学院附属鼓楼医院麻醉科)，孟馥芬(新疆医科大学第三附属医院麻醉科)，孟海兵(勤联保障部队第九〇八医院麻醉科)，米卫东(解放军总医院第一医学中心麻醉科)，闵苏(重庆医科大学附属第一医院麻醉科)，聂煌(空军军医大学第一附属医院(西京医院)麻醉科)，彭勉(武汉大学中南医院麻醉科)，屈伸(宁夏医科大学总医院麻醉科)，申乐(北京协和医院麻醉科)，王东信(北京大学第一医院麻醉科)，王浩(复旦大学附属中山医院麻醉科)，王国年(哈尔滨医科大学附属肿瘤医院麻醉科)，王利利(山西医科大学第二医院麻醉科)，王天龙(首都医科大学宣武医院麻醉手术科)，王晓宁(首都医科大学附属北京世纪坛医院麻醉科)，吴浩(南京鼓楼医院麻醉科)，徐军美(中南大学湘雅二医院麻醉科)，徐亚军(复旦大学附属肿瘤医院麻醉科)，薛张纲(复旦大学附属中山医院麻醉科)，杨美蓉(上海市第一人民医院麻醉科)，叶伟光(首都医科大学宣武医院麻醉手术科)，于博(北京协和医院康复医学科)，张铁铮(北部战区总医院麻醉科)，张路(北京协和医院康复医学科)，郑观荣(胜利油田中心医院麻醉科)，周军(河南省人民医院麻醉科)执笔人: 刘子嘉，张路 -
表 1 胸外科手术患者术前肺功能风险评估分级
风险分层 ppo FEV1/ppo DLCO 建议 低风险 ppo FEV1和ppo DLCO均≥60%预测值 可行手术 中风险 ppo FEV1或ppo DLCO＜60%预测值，但均≥30%预测值 行简易运动试验(6 min步行试验、爬楼试验等) 高风险 ppo FEV1或ppo DLCO＜30%预测值 行心肺运动试验 ppo FEV1：术后预计第一秒用力呼气容积；ppo DLCO：术后预计肺一氧化碳弥散量 
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表 2 常见体力活动对应的MET值[28]
活动类别 轻度活动(＜3 MET) 中度活动(3~6 MET) 剧烈活动(＞6 MET) 步行 办公室/家中缓慢步行=2.0 步行4~5 km/h=3.3 慢跑5 km/h =7.0 慢跑 步行6.5 km/h=5.0 慢跑8 km/h =8.0 跑步 跑步9.5 km/h =10.0 家务 伏案工作=1.5 吸尘/擦地=3.0~3.5 搬重物=7.5 工作 吃饭/穿衣=2.0~2.5 耕种/整理干草=8.0 娱乐 绘画/手工/打牌=1.5 打羽毛球-休闲=4.5 篮球比赛=8.0 体育 台球=2.5 篮球-投篮=4.5 骑自行车20 km/h=8.0 钓鱼(坐)=2.5 骑自行车18 km/h=6.0 足球-休闲=7.0，比赛=10.0 跳舞=3.0~4.5 游泳(快速)=8.0~11.0 游泳(慢速)=6.0 网球单打=8.0 乒乓球=4.0 排球比赛=8.0 MET：代谢当量
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