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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
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  • 收稿日期:  2018-08-29
  • 刊出日期:  2019-11-30

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