留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码
中华医学会麻醉学分会“成人日间手术加速康复外科麻醉管理专家共识”工作小组. 成人日间手术加速康复外科麻醉管理专家共识[J]. 协和医学杂志, 2019, 10(6): 562-569. doi: 10.3969/j.issn.1674-9081.2019.06.003
引用本文: 中华医学会麻醉学分会“成人日间手术加速康复外科麻醉管理专家共识”工作小组. 成人日间手术加速康复外科麻醉管理专家共识[J]. 协和医学杂志, 2019, 10(6): 562-569. doi: 10.3969/j.issn.1674-9081.2019.06.003
Working Group of 'Expert Consensus on Anesthesia Management of Enhanced Recovery after Ambulatory Surgery'. Expert Consensus on Anesthesia Management of Enhanced Recovery after Adult Ambulatory Surgery[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(6): 562-569. doi: 10.3969/j.issn.1674-9081.2019.06.003
Citation: Working Group of "Expert Consensus on Anesthesia Management of Enhanced Recovery after Ambulatory Surgery". Expert Consensus on Anesthesia Management of Enhanced Recovery after Adult Ambulatory Surgery[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(6): 562-569. doi: 10.3969/j.issn.1674-9081.2019.06.003

成人日间手术加速康复外科麻醉管理专家共识

doi: 10.3969/j.issn.1674-9081.2019.06.003
详细信息
    通讯作者:

    马正良  E-mail:13611586781@163.com

  • 中图分类号: R459.4;R614

Expert Consensus on Anesthesia Management of Enhanced Recovery after Adult Ambulatory Surgery

More Information
  • 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。
    利益冲突  无
  • 表  1  睡眠呼吸暂停综合征筛查量表(STOP-Bang量表)[8-9]

    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
    下载: 导出CSV

    表  2  术后恶心呕吐危险因素评分(Apfel简易风险评分)[55]

    危险因素 得分
    女性 1
    非吸烟者 1
    恶心呕吐或晕动病史 1
    术后使用阿片类药物 1
    总分 4
    下载: 导出CSV

    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
    下载: 导出CSV

    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
    下载: 导出CSV

    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
    下载: 导出CSV
  • [1] Kehlet H. Enhanced Recovery After Surgery (ERAS):good for now, but what about the future?[J]. Can J Anaesth, 2015, 62:99-104. doi:  10.1007/s12630-014-0261-3
    [2] Carli F. Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs:implications of the stress response[J]. Can J Anaesth, 2015, 62:110-119. doi:  10.1007/s12630-014-0264-0
    [3] Cakir H, van Stijn MF, Lopes Cardozo AM, et al. Adherence to Enhanced Recovery After Surgery and length of stay after colonic resection[J]. Colorectal Dis, 2013, 15:1019-1025. doi:  10.1111/codi.12200
    [4] Grant MC, Yang D, Wu CL, et al. Impact of Enhanced Recovery After Surgery and Fast Track Surgery Pathways on Healthcare-associated Infections:Results From a Systematic Review and Meta-analysis[J]. Ann Surg, 2017, 265:68-79. doi:  10.1097/SLA.0000000000001703
    [5] 欧阳文, 李天佐, 周星光.日间手术麻醉专家共识[J].临床麻醉学杂志, 2016, 32:1017-1022. http://www.cnki.com.cn/Article/CJFDTotal-LCMZ201610030.htm
    [6] Andrews JC, Schünemann HJ, Oxman AD, et al. GRADE guidelines:15. Going from evidence to recommendation-determinants of a recommendation's direction and strength[J]. J Clin Epidemiol, 2013, 66:726-735. doi:  10.1016/j.jclinepi.2013.02.003
    [7] Kesänen J, Leino-Kilpi H, Lund T, et al. Increased preoperative knowledge reduces surgery-related anxiety:a randomised clinical trial in 100 spinal stenosis patients[J]. Eur Spine J, 2017, 26:2520-2528. doi:  10.1007/s00586-017-4963-4
    [8] Chung F, Yegneswaran B, Liao P, et al. Validation of the Berlin Questionnaire and American Society of Anesthesio-logists Checklist as Screening Tools for Obstructive Sleep Apnea in Surgical Patients[J]. Anesthesiology, 2008, 108:822-830. doi:  10.1097/ALN.0b013e31816d91b5
    [9] Madhusudan P, Wong J, Prasad A, et al. An update on preoperative assessment and preparation of surgical patients with obstructive sleep apnea[J]. Curr Opin Anaesthesiol, 2018, 31:89-95. doi:  10.1097/ACO.0000000000000539
    [10] Kristensen SD, Knuuti J, Saraste A, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery:cardiovascular assessment and management:The Joint Task Force on non-cardiac surgery:cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA)[J]. Eur Heart J, 2014, 35:2383-2431. doi:  10.1093/eurheartj/ehu282
    [11] Ro YS, Shin SD, Song KJ, et al. Association of Exercise and Metabolic Equivalent of Task (MET) Score with Survival Outcomes after Out-of-Hospital Cardiac Arrest of Young and Middle Age[J]. Resuscitation, 2017, 115:44-51. doi:  10.1016/j.resuscitation.2017.03.041
    [12] 中华医学会麻醉学分会"麻醉门诊建设专家指导意见"工作小组.麻醉科门诊建设专家指导意见[J].中华麻醉学杂志, 2019, 39:7-13. http://rs.yiigle.com/CN131073201901/1130596.htm
    [13] Holte K, Nielsen KG, Madsen JL, et al. Physiologic Effects of Bowel Preparation[J]. Dis Colon Rectum, 2004, 47:1397-1402. doi:  10.1007/s10350-004-0592-1
    [14] Slim K, Vicaut E, Launay-Savary MV, et al. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery[J]. Ann Surg, 2009, 249:203-209. doi:  10.1097/SLA.0b013e318193425a
    [15] Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate therapy[J]. Curr Opin Anaesthesiol, 2015, 28:364-369. doi:  10.1097/ACO.0000000000000192
    [16] Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists TaskForce on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration[J]. Anesthesiology, 2017, 126: 376-393.
    [17] Amer MA, Smith MD, Herbison GP, et al. Network meta-analysis of the effect of preoperative carbohydrate loading on recovery after elective surgery[J]. Br J Surg, 2017, 104:187-197. doi:  10.1002/bjs.10408
    [18] Fawcett WJ, Thomas M. Pre-operative fasting in adults and children:clinical practice and guidelines[J]. Anaesthesia, 2019, 74:83-88. doi:  10.1111/anae.14500
    [19] Walker KJ, Smith AF. Premedication for anxiety in adult day surgery[J]. Cochrane Database Syst Rev, 2009, (4):CD002192.
    [20] Kassie GM, Nguyen TA, Kalisch Ellett LM, et al. Preoperative medication use and postoperative delirium:a systematic review[J]. BMC Geriatr, 2017, 17:298-307. doi:  10.1186/s12877-017-0695-x
    [21] Naja Z, Ziade MF, Lönnqvist PA. Nerve stimulator guided pudendal nerve block decreases posthemorrhoidectomy pain[J].Can J Anaesth, 2005, 52:62-68. doi:  10.1007/BF03018582
    [22] Wiegel M, Moriggl B, Schwarzkopf P, et al. Anterior suprascapular nerve block versus interscalene brachial plexus block for shoulder surgery in the outpatient Setting:A randomized controlled patient-and assessor-blinded trial[J].Reg Anesth Pain Med, 2017, 42:310-318. doi:  10.1097/AAP.0000000000000573
    [23] Löser S, Herminghaus A, Hüppe T, et al. General anesthesia for ambulatory surgery:Clinical pharmacological considerations on the practical approach[J]. Anaesthesist, 2014, 63:865-870. doi:  10.1007/s00101-014-2364-1
    [24] Kumar G, Stendall C, Mistry R, et al. A comparison of total intravenous anaesthesia using propofol with sevoflurane or desflurane in ambulatory surgery:systematic review and meta-analysis[J]. Anaesthesia, 2014, 69:1138-1150. doi:  10.1111/anae.12713
    [25] Ladha K, Vidal Melo MF, Mclean DJ, et al. Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications:hospital based registry study[J]. BMJ, 2015, 351:h3646.
    [26] Staehr-Rye AK, Meyhoff CS, Scheffenbichler FT, et al. High intraoperative inspiratory oxygen fraction and risk of major respiratory complications[J]. Br J Anaesth, 2017, 119:140-149. doi:  10.1093/bja/aex128
    [27] Mccracken GC, Montgomery J. Postoperative nausea and vomiting after unrestricted clear fluids before day surgery[J]. Eur J Anaesthesiol, 2018, 35:337-342. doi:  10.1097/EJA.0000000000000760
    [28] Holte K, Klarskov B, Christensen DS, et al. Liberal Versus Restrictive Fluid Administration to Improve Recovery After Laparoscopic Cholecystectomy[J]. Ann Surg, 2004, 240:892-899. doi:  10.1097/01.sla.0000143269.96649.3b
    [29] Miller TE, Roche AM, Mythen M. Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)[J]. Can J Anaesth, 2015, 62:158-168. doi:  10.1007/s12630-014-0266-y
    [30] Pearse RM, Harrison DA, Macdonald N, et al. Effect of a Perioperative, Cardiac OutputGuided Hemodynamic Therapy Algorithm on Outcomes Following Major Gastrointestinal Surgery:A Randomized Clinical Trial and Systematic Review[J]. JAMA, 2014, 311:2181-2190. doi:  10.1001/jama.2014.5305
    [31] Meng LZ, Yu WF, Wang TL et al. Blood Pressure Targets in Perioperative Care[J]. Hypertension, 2018, 72:806-817. doi:  10.1161/HYPERTENSIONAHA.118.11688
    [32] Poterman M, Vos JJ, Vereecke HE, et al. Differential effects of phenylephrine and norepinephrine on peripheral tissue oxygenation during general anaesthesia:A randomised controlled trial[J]. Eur J Anaesthesiol, 2015, 32:571-580. doi:  10.1097/EJA.0000000000000247
    [33] 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
    [34] Simomons JW, Dobyns JB, Psiste J. Enhanced Recovery After Surgery:Intraoperative Fluid Management Strategies[J]. Surg Clin North Am, 2018, 98:1185-1200. doi:  10.1016/j.suc.2018.07.006
    [35] Lira A, Pinsky MR. Choices in fluid type and volume during resuscitation:impact on patient outcomes[J]. Ann Intensive Care, 2014, 4:38-50. doi:  10.1186/s13613-014-0038-4
    [36] Scott AV, Stonemetz JL, Wasey JO, et al. Compliance with Surgical Care Improvement Project for body temperature management (SCIP Inf-10) is associated with improved clinical outcomes[J]. Anesthesiology, 2015, 123:116-125. doi:  10.1097/ALN.0000000000000681
    [37] NICE. Hypothermia: prevention and management in adults having surgery[EB/OL]. http://www.nice.org.uk/guidance/cg65,2016.
    [38] 国家麻醉专业质量控制中心, 中华医学会麻醉学分会.围手术期患者低体温防治专家共识(2017)[J].协和医学杂志, 2017, 8:352-358. http://www.cnki.com.cn/Article/CJFDTotal-XHYX201706008.htm
    [39] Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery[J]. Cochrane Database Syst Rev, 2007, (3):CD004929. https://pubmed.ncbi.nlm.nih.gov/17636780/
    [40] Okrainec A, Aarts MA, Conn LG, et al. Compliance with Urinary Catheter Removal Guidelines Leads to Improved Outcome in Enhanced Recovery After Surgery Patients[J]. J Gastrointest Surg, 2017, 21:1390-1317. doi:  10.1007/s11605-017-3434-x
    [41] Beverly A, Kaye AD, Ljungqvist O, et al. Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery (ERAS) Guidelines[J]. Anesthesiol Clin, 2017, 35:115-143. doi:  10.1016/j.anclin.2017.01.018
    [42] Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of Postoperative Pain:A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists Committee on Regional Anesthesia, Executive Committee, and Administrative Council[J]. J Pain, 2016, 17:131-157. doi:  10.1016/j.jpain.2015.12.008
    [43] Fornasari D, Allegri M, Gerboni S, et al. A "novel" association to treat pain:tramadol/dexketoprofen. The first drug of a "new pharmacological class"[J]. Acta Biomed, 2017, 88:17-24.
    [44] Moskovitz BL, Benson CJ, Patel AA, et al. Analgesic treatment for moderate-to-severe acute pain in the United States:patients' perspectives in the Physicians Partnering Against Pain (P3) survey[J]. J Opioid Manag, 2011, 7:277-286. doi:  10.5055/jom.2011.0069
    [45] Arendt-Nielsen L, Olesen AE, Staahl C, et al. Analgesic efficacy of peripheral kappa-opioid receptor agonist CR665 compared to oxycodone in a multi-modal, multi-tissue experimental human pain model:selective effect on visceral pain[J]. Anesthesiology, 2009, 111:616-624. doi:  10.1097/ALN.0b013e3181af6356
    [46] Hah J, Mackey SC, Schmidt P, et al. Effect of Perioperative Gabapentin on Postoperative Pain Resolution and Opioid Cessation in a Mixed Surgical Cohort:A Randomized Clinical Trial[J]. JAMA Surg, 2018, 153:303-311. doi:  10.1001/jamasurg.2017.4915
    [47] Assouline B, Tramèr MR, Kreienbühl L, et al. Benefit and harm of adding ketamine to an opioid in a patient-controlled analgesia device for the control of postoperative pain:systematic review and meta-analyses of randomized controlled trials with trial sequential analyses[J]. Pain, 2016, 157:2854-2864. doi:  10.1097/j.pain.0000000000000705
    [48] Olesen AE, Staahl C, Arendt-Nielsen L, et al. Different effects of morphine and oxycodone in experimentally evoked hyperalgesia:a human translational study[J]. Br J Clin Pharmacol, 2010, 70:189-200. doi:  10.1111/j.1365-2125.2010.03700.x
    [49] Schnabel A, Reichl SU, Weibel S, et al. Efficacy and safety of dexmedetomidine in peripheral nerve blocks[J]. Eur J Anaesthesiol, 2018, 35:745-758. doi:  10.1097/EJA.0000000000000870
    [50] Vigneault L, Turgeon AF, CôtéD, et al. Perioperative intravenous lidocaine infusion for postoperative pain control:a meta-analysis of randomized controlled trials[J]. Can J Anaesth, 2011, 58:22-37. doi:  10.1007/s12630-010-9407-0
    [51] Bruna Esteban M, Vorwald P, Ortega Lucea S, et al. Enhanced recovery after surgery in gastric resections[J]. Cir Esp, 2017, 95:73-82. doi:  10.1016/j.ciresp.2016.10.013
    [52] Sardana V, Burzynski J, Scuderi GR. Adductor Canal Block or Local Infiltrate Analgesia for Pain Control After Total Knee Arthroplasty? A Systematic Review and Meta-Analysis of Randomized Controlled Trials[J]. J Arthroplasty, 2019, 34:183-189. doi:  10.1016/j.arth.2018.09.083
    [53] Richman JM, Liu SS, Courpas G, et al. Does continuous peripheral nerve block provide superior pain control to opioids? A meta-Analysis[J]. Anesth Analg, 2006, 102:248-257. doi:  10.1213/01.ANE.0000181289.09675.7D
    [54] Gan TJ, Diemunsch P, Habib AS, et al. Consensus Guidelines for the Management of Postoperative Nausea and Vomiting[J]. Anesth Analg, 2014, 118:85-113. doi:  10.1213/ANE.0000000000000002
    [55] Apfel CC, Heidrich FM, Jukar-Rao S, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting[J]. Br J Anaesth, 2012, 109:742-753. doi:  10.1093/bja/aes276
    [56] Castelino T, Fiore JF, Niculiseanu P. The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery:A systematic review[J]. Surgery, 2016, 159:991-1003. doi:  10.1016/j.surg.2015.11.029
    [57] Todd OM, Gelrich L, Maclullich AM, et al. Sleep Disruption at Home As an Independent Risk Factor for Postoperative Delirium[J]. J Am Geriatr Soc, 2017, 65:949-957. doi:  10.1111/jgs.14685
    [58] Koffel E, Kroenke K, Bair MJ, et al. The bidirectional relationship between sleep complaints and pain:Analysis of data from a randomized trial[J]. Health Psychol, 2016, 35:41-49. doi:  10.1037/hea0000245
    [59] Loke YK, Brown JW, Kwok CS, et al. Association of obstructive sleep apnea with risk of serious cardiovascular events:a systematic review and meta-analysis[J]. Circ Cardiovasc Qual Outcomes, 2012, 5:720-728. doi:  10.1161/CIRCOUTCOMES.111.964783
    [60] Dolan R, Huh J, Tiwari N, et al. A prospective analysis of sleep deprivation and disturbance in surgical patients[J]. Ann Med Surg (Lond), 2016, 6:1-5. doi:  10.1016/j.amsu.2015.12.046
    [61] Scarpa M, Pinto E, Saraceni E, et al. Randomized clinical trial of psychological support and sleep adjuvant measures for postoperative sleep disturbance in patients undergoing oesophagectomy[J]. Br J Surg, 2017, 104:1307-1314. doi:  10.1002/bjs.10609
  • 加载中
表(5)
计量
  • 文章访问数:  982
  • HTML全文浏览量:  171
  • PDF下载量:  600
  • 被引次数: 0
出版历程
  • 收稿日期:  2019-10-16
  • 刊出日期:  2019-11-30

目录

    /

    返回文章
    返回

    【温馨提醒】近日,《协和医学杂志》编辑部接到作者反映,有多名不法人员冒充期刊编辑发送见刊通知,鼓动作者添加微信,从而骗取版面费的行为。特提醒您,本刊与作者联系的方式均为邮件通知或电话,稿件进度通知邮箱为:mjpumch@126.com,编辑部电话为:010-69154261,请提高警惕,谨防上当受骗!如有任何疑问,请致电编辑部核实。谢谢!