加速康复外科在胃肠外科手术中的应用

doi:10.6040/j.issn.1671-7554.0.2019.228

摘要/Abstract

摘要： 加速康复外科(ERAS)这一理念,一经提出便受到广泛关注,并在临床中得到了广泛推广和应用。在胃肠外科领域,ERAS是得到了广泛的推崇;ERAS的目的是应用一系列已被循证医学证据证实有效的优化管理措施,从而降低患者的住院费用,缩短患者的住院时间,实现加快术后康复的目标。而且ERAS的理念将外科、麻醉、护理、心理等相关学科进行了有机的结合,体现了整体医学模式在现代外科中的应用。本文结合相关文献和笔者的个人经验将ERAS理念在胃肠外科肿瘤手术中的应用进展做一综述。

关键词: 加速康复外科, 胃肠外科, 胃癌, 结直肠癌, 应用进展

Abstract: Enhanced recovery after surgery(ERAS)has been widely promoted and applied in clinical practice since its introduction. In the field of gastrointestinal surgery, ERAS is also widely respected. The objective of ERAS is to reduce hospitalization costs, shorten hospitalization time and speed up postoperative rehabilitation, by applying a series of effective optimization management measures which have been proved by evidence-based medicine. Moreover, ERAS combines surgery, anesthesia, nursing, psychology and other related disciplines organically, so that it reflects the application of holistic medical model in modern surgery. Based on relevant literature and authors personal experience, this article reviews the application of ERAS in gastrointestinal surgery.

Key words: Enhanced recovery after surgery, Gastrointestinal surgery, Gastric cancer, Colorectal cancer, Application progress

中图分类号:

R574

李乐平,崔怀平,商亮. 加速康复外科在胃肠外科手术中的应用[J]. 山东大学学报 (医学版), 2019, 57(9): 5-11.

LI Leping, CUI Huaiping, SHANG Liang. Application of enhanced recovery after surgery in gastrointestinal surgery[J]. Journal of Shandong University (Health Sciences), 2019, 57(9): 5-11.

参考文献

[1] Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome[J]. Am J Surg, 2002, 183(6): 630-641.
[2] Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth, 1997, 78(5): 606-617.
[3] 宋云, 龚杰, 彭璐. 加速康复外科理念在胃肠外科中的应用进展[J]. 西部医学, 2018, 30(7): 1082-1087. SONG Yun, GONG Jie, PENG Lu. Progress in application of enhanced recovery after surgery in gastrointestinal surgery[J]. Medical Journal of West China,2018, 30(7): 1082-1087.
[4] 江志伟, 李宁, 黎介寿. 快速康复外科的概念及临床意义[J]. 中国实用外科杂志, 2007, 27(2): 131-133.
[5] 江志伟, 李宁, 黎介寿. 应用快速康复外科理念进行胃肠癌手术时的营养管理[C] // 中国临床肿瘤学教育专辑(2007), 南京军区南京总医院, 2007: 291-295.
[6] 李民, 李幼生, 李宁, 等. 加速康复外科与围手术期液体治疗[J]. 实用临床医药杂志, 2007, 11(9): 4-6. LI Min, LI Yousheng, LI Ning, et al. Fast-track Surgery and liquid treatment during perioperative stage[J]. Journal of Clinical Medicine in Practice, 2007, 11(9): 4-6.
[7] 中华医学会肠外肠内营养学分会加速康复外科协作组.结直肠手术应用加速康复外科中国专家共识(2015版)[J]. 中华普通外科学文献(电子版), 2015, 9(5): 335-337.
[8] 中国研究型医院学会肝胆胰外科专业委员会. 肝胆胰外科术后加速康复专家共识(2015版)[J]. 中华消化外科杂志, 2016, 15(1): 1-6. Chinese Research Hospital Association, Society for Hepatopancreatobiliary Surgery. Expert consensus on enhanced recovery after hepatopancreatobiliary surgery(2015 edition)[J]. Chinese Journal of Digestive Surgery,2016, 15(1): 1-6.
[9] 中国加速康复外科专家组. 中国加速康复外科围手术期管理专家共识(2016)[J]. 中华外科杂志, 2016, 54(6): 413-418.
[10] 中国研究型医院学会机器人与腹腔镜外科专业委员会.胃癌胃切除手术加速康复外科专家共识(2016版)[J]. 中华消化外科杂志, 2017, 16(1): 14-17. Robotic and Laparoscopic Surgery Committee of Chinese Research Hospital Association. Expert consensus on enhanced recovery after gastrectomy for gastric cancer(2016 edition)[J]. Chinese Journal of Digestive Surgery, 2017, 16(1): 14-17.
[11] 张莹, 王帅. 研究加强围手术期心理干预对外科手术患者不良情绪的影响[J].实用临床护理学电子杂志, 2018, 3(8): 67-68.
[12] Zhong JX, Kang K, Shu XL. Effect of nutritional support on clinical outcomes in perioperative malnourished patients:a meta-analysis[J]. Asia Pac J Clin Nutr, 2015, 24(3): 367-378.
[13] Braga M, Ljungqvist O, Soeters P, et a1. ESPEN Guidelines on Parenteral Nutrition: surgery[J]. Clin Nutr, 2009, 28(4): 378-386.
[14] Holte K, Nielsen KG, Madsen JL, et a1. Physiologic effects of bowel preparation[J]. Dis Colon Rectum, 2004, 47(8): 1397-1402.
[15] Panis Y. Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation[J]. British Journal of Surgery, 2010, 91(9): 1125-1130.
[16] Smith I, Kranke P, Murat I, et a1. Perioperative fasting in adults and children:guidelines from the European Society of Anaesthesiology[J]. Eur J Anaesthesiol, 2011, 28(8): 556-569.
[17] American Society of Anesthesiologists Committee. 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 Committee on Standards and Practice Parameters[J]. Anesthesiology, 2011, 114(3): 495-511.
[18] 毕默佳. 两种术前禁饮食方案的Meta分析[J].中国实用护理杂志, 2012, 28(25): 73-75.
[19] 曹战江, 于健春, 康维明, 等. 术前口服葡萄糖溶液对胃肠术后胰岛素抵抗及炎症反应的影响[J]. 中华内分泌外科杂志, 2015, 9(4): 305-308. CAO Zhanjiang, YU Jianchun, KANG Weiming, et al. Preoperative oral carbohydrate alleviates postoperative insulin resistance and inflammatory reaction[J].Chin J Endocr Surg, 2015, 9(4): 305-308.
[20] 徐建玲, 杨芳芳, 金孝岠. 加速康复外科理念下的术前口服碳水化合物的临床研究进展[J]. 国际麻醉学与复苏杂志, 2018, 39(11): 1063-1066. XU Jianling, YANG Fangfang, JIN Xiaoju. Recent clinical advances in preoperative oral carbohydrate for enhanced recovery after surgery concept[J]. International Journal of Anesthesiology and Resuscitation, 2018, 39(11): 1063-1066.
[21] Brawler DW,Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project[J]. Am J Surg, 2005, 189(4): 395-404.
[22] Wang F, Chen XZ, Liu J, et al. Short-term versus long-term administration of single prophylactic antibiotic in elective gastric tumor surgery[J]. Hepatogastroenterology, 2012, 59(118): 1784-1788.
[23] 李维伟. 腹腔镜胃癌根治术与开腹手术的临床效果对比[J]. 中国卫生标准管理, 2018, 9(13): 74-75. LI Weiwei. Clinical effect comparison between laparoscopic radical gastrectomy and laparotomy[J]. China Health Standard Management, 2018, 9(13): 74-75.
[24] 中华医学会外科学分会腹腔镜与内镜外科学组, 中国研究型医院学会机器人与腹腔镜外科专业委员会. 腹腔镜胃癌手术操作指南(2016版)[J]. 中华消化外科杂志, 2016, 15(9): 851-857. Section of Laparoscopic & Endoscopic Surgery, Branch of Surgery, Chinese Medical Association; Robotic and Laparoscopic Surgery Committee of Chinese Research Hospital Association. Guideline for laparoscopic gastrectomy for gastric cancer(2016 edition)[J]. Chinese Journal of Digestive Surgery,2016, 15(9): 851-857.
[25] 刘国晓, 申伟松, 陈凛, 等. 机器人与腹腔镜胃癌手术临床疗效对比的Meta分析[J].中华胃肠外科杂志, 2016, 19(3): 328-333. LIU Guoxiao, SHEN Weisong, CHEN Lin, et al. Robotic versus laparoscopic gastrectomy for gastric cancer: a meta-analysis[J]. Chinese Journal of Gastrointestinal Surgery, 2016, 19(3): 328-333.
[26] 陈钶, 牟一平, 徐晓武, 等. 胃癌根治术后常规留置胃管必要性的荟萃分析[J]. 中华医学杂志, 2012, 92(26): 1841-1844. CHEN Ke, MOU Yiping, XU Xiaowu, et al. Necessity of routine nasogastric decompression after gastrectomy for gastric cancer: a Meta-analysis[J]. National Medical Journal of China, 2012, 92(26): 1841-1844.
[27] Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery[J]. Cochrane Database Syst Rev, 2007,(3): CD004929.
[28] 彭淼, 李显蓉. 不置胃管在快速康复外科结直肠癌围手术期有效性和安全性的Meta分析[J]. 实用医学杂志, 2015, 31(7): 1171-1175. PENG Miao, LI Xianrong. Efficiency and safety of non-nasogastric tube on fast-track surgery patients with colorectal cancer: Meta- analysis and systematic review[J]. The Journal of Practical Medicine, 2015, 31(7): 1171-1175.
[29] 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及路径管理指南(2018版)[J]. 中国实用外科杂志, 2018, 38(1): 1-20.
[30] Liu HP, Zhang YC, Zhang YL, et al. Drain versus no-drain after gastrectomy for patients with advanced gastric cancer: systematic review and mela-analysis[J]. Dig Surg, 2011, 28(3): 178-189.
[31] 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(2): 115-143.
[32] 冷希胜, 韦军民, 刘连新, 等. 普通外科围手术期疼痛处理专家共识[J]. 中华普通外科杂志, 2015, 30(2): 166-173.
[33] Yang F, Wei L, Huo X, et al. Effects of early postoperative enteral nutrition versus usual care on serum albumin, prealbumin, transferrin, time to first flatus and postoperative hospital stay for patients with colorectal cancer: A systematic review and meta-analysis[J]. Contemp Nurse, 2018, 54(6): 561-577.
[34] Hur H, Si Y, Kang WK, et al. Effects of Early Oral Feeding on Surgical Outcomes and Recovery After Curative Surgery for Gastric Cancer: Pilot Study Results[J]. World J Surg, 2009, 33(7): 1454-1458.
[35] 孟成, 于洋, 王智浩, 等. 加速康复外科在胃癌根治术中临床价值的前瞻性研究[J]. 中华消化外科杂志, 2015, 14(1): 52-56.

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