加速康复外科理念下的麻醉管理

doi:10.6040/j.issn.1671-7554.0.2019.755

摘要/Abstract

摘要： 加速康复外科(ERAS)理念目前被广泛应用于临床外科各个专业。ERAS可有效地降低术后并发症发生率、促进患者术后康复以及缩短住院时间,使得越来越多的手术患者因此获益。优化围术期管理是ERAS的核心,良好的围术期麻醉管理是ERAS重要的组成部分,术前宣教与评估、术中生命体征的监测、术中体温和液体管理、术后镇痛与并发症防治等措施在ERAS进程中发挥着重要作用。随着ERAS理念的不断发展和完善,对麻醉管理也提出进一步的要求和挑战。

关键词: 加速康复外科, 麻醉管理, 围术期医学

Abstract: Enhanced recovery after surgery(ERAS)is now widely used in various surgical disciplines. ERAS can effectively reduce the incidence of postoperative complications, improve recovery of patients and shorten the length of hospital stay. Therefore, more and more patients have benefited from it. Currently ERAS is becoming an important force to promote the development of perioperative medicine. Optimizing perioperative management is the core of ERAS, which requires multidisciplinary cooperation. Recent years, anesthesia medicine has gradually shifted to perioperative medicine, and anesthesiologists play an important role in the ERAS process, including preoperative education and evaluation, perioperative monitoring, postoperative analgesia, and prevention of complications. With the advances of ERAS concept, further requirements and challenges are raised for anesthesia management.

Key words: Enhanced recovery after surgery, Anesthesia management, Perioperative medicine

中图分类号:

R614

宋西成,马加海. 加速康复外科理念下的麻醉管理[J]. 山东大学学报 (医学版), 2019, 57(9): 12-17.

SONG Xicheng, MA Jiahai. Anesthesia management under the guidance of enhanced recovery after surgevy concept[J]. Journal of Shandong University (Health Sciences), 2019, 57(9): 12-17.

参考文献

[1] Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review [J]. JAMA Surgery, 2017, 152(3): 292-298.
[2] Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation [J]. Br J Anaesth,1997, 78(5): 606-617.
[3] Vukovic N, Dinic L. Enhanced recovery after surgery protocols in major urologic surgery [J]. Front Med(Lausanne), 2018, 5: 93. doi: 10.3389/fmed.2018.00093.
[4] Elhassan A, Elhassan I, Elhassan A, et al. Essential elements for enhanced recovery after intra-abdominal surgery [J]. Curr Pain Headache Rep, 2019, 23(5): 35. doi: 10.1007/s11916-019-0772-2.
[5] Medbery RL, Fernandez FG, Khullar OV. ERAS and patient reported outcomes in thoracic surgery: a review of current data [J]. J Thorac Dis, 2019, 11(Suppl7): S976-S986.
[6] 王东升, 仲蓓, 刘学玲, 等. 加速康复外科理念在甲状腺肿瘤手术中的应用[J]. 中华普通外科学文献(电子版), 2010, 4(5): 40-43. WANG Dongsheng, ZHONG Pei, LIU Xueling, et al. Observation of fast track surgery in patients with thyroid neoplasm[J]. Chinese Archives of General Surgery(Electronic Edition),2010, 4(5): 40-43.
[7] Elhassan A, Ahmed A, Awad H, et al. Enhanced Recovery for Breast Reconstruction Surgery [J]. Curr Pain Headache Rep, 2019, 23(4): 27. doi: 10.1007/s11916-019-0761-5.
[8] Hwang DW, Kim HJ, Lee JH, et al. Effect of Enhanced Recovery After Surgery program on pancreaticoduodenectomy: a randomized controlled trial [J]. J Hepatobiliary Pancreatic Sci, 2019, 26(8):360-369.
[9] Schwartz AR, Lim S, Broadwater G, et al. Reduction in opioid use and postoperative pain scores after elective laparotomy with implementation of enhanced recovery after surgery protocol on a gynecologic oncology service [J]. Int J Gynecol Cancer, 2019, 29(5): 935-943.
[10] 王天龙, 黄宇光. 推动麻醉学向围手术期医学转变: 加速康复外科中国专家共识及路径管理指南(2018版)麻醉部分解读[J]. 协和医学杂志, 2018, 9(6): 481-484.
[11] Steenhagen E. Enhanced Recovery After Surgery: It's time to change practice! [J]. Nutr Clin Pract, 2016, 31(1):18-29.
[12] 朱斌, 黄建宏. 加速康复外科在我国发展现状、挑战与对策[J]. 中国实用外科杂志, 2017, 37(1): 26-29. ZHU Bin, HUANG Jianhong. The development, challenges and strategies of enhanced recovery after surgery in China [J]. Chinses Journal of Practical Surgery, 2017, 37(1): 26-29.
[13] Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery(ERAS)Society recommendations [J]. Clin Nutr, 2012, 31(6): 783-800.
[14] Horosz B, Nawrocka K, Malec-Milewska M. Anaesthetic perioperative management according to the ERAS protocol [J]. Anaesthesiol Intensive Ther, 2016, 48(1): 49-54.
[15] Singh BN, Dahiya D, Bagaria D, et al. Effects of preoperative carbohydrates drinks on immediate postoperative outcome after day care laparoscopic cholecystectomy [J]. Surg Endosc, 2015, 29(11): 3267-3272.
[16] 陈凛,陈亚进,董海龙,等.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.
[17] Tan M, Law LS, Gan TJ. Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways [J]. Can J Anaesth, 2015, 62(2): 203-218.
[18] Ong CK, Lirk P, Seymour RA, et al. The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis [J]. Anesth Analg, 2005, 100(3): 757-773.
[19] Radovanovic D, Radovanovic Z, Skoric-Jokic S, et al. Thoracic epidural versus intravenous patient-controlled analgesia after open colorectal cancer surgery [J]. Acta Clin Croat, 2017, 56(2): 244-254.
[20] 石学银, 邹最. 加速康复外科的麻醉管理[J]. 中华消化外科杂志, 2015, 14(1): 38-42. SHI Xueyin, ZOU Zui. Anesthetic management in enhanced recovery after surgery [J]. Chinese Journal of Digestive Surgery,2015, 14(1): 38-42.
[21] 刁玉刚, 张铁铮. 麻醉可以在ERAS中做些什么[J]. 医学与哲学, 2017, 38(6): 15-17. DIAO Yugang, ZHANG Tiezheng. What can Anesthesia do in ERAS? [J]. Medicine & Philosophy, 2017, 38(6): 15-17.
[22] Saadeh W, Khan F, Altaf MAB. Design and implementation of a machine learning based EEG processor for accurate estimation of depth of anesthesia [J]. IEEE Trans Biomed Circuits Syst, 2019,13(4):658-669.
[23] 吴凡. 精准麻醉理念在临床实践中的应用与展望[J]. 江西医药, 2018, 53(2): 185-187.
[24] Austin PN. Forced-air warmers and surgical site infections in patients undergoing knee or hip qrthroplasty [J]. Annu Rev Nurs Res, 2017, 35(1): 179-199.
[25] Bernard H. Patient warming in surgery and the enhanced recovery [J]. Br J Nurs, 2013, 22(6): 319-320, 322-325.
[26] Myles PS, Bellomo R, Corcoran T, et al. Restrictive versus liberal fluid therapy for major abdominal surgery [J]. N Engl J Med, 2018, 378(24): 2263-2274.
[27] Srinivasa S, Tailor MH, Singh PP, et al. Randomized clinical trial of goal-directed fluid therapy within an enhanced recovery protocol for elective colectomy [J]. Br J Surg, 2013, 100(1): 66-74.
[28] 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 Anesthesiol, 2018, 18(1): 113-126.
[29] Guay J, Nishimori M, Kopp S. Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery [J]. Cochrane Database Syst Rev, 2016, 7: CD001893. doi: 10.1002/14651858.CD001893.pub2.
[30] Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain [J]. Curr Opin Anaesthesiol, 2009, 22(5): 588-593.
[31] Lee JH, Park JH, Kil HK, et al. Efficacy of intrathecal morphine combined with intravenous analgesia versus thoracic epidural analgesia after gastrectomy [J]. Yonsei Med J, 2014, 55(4): 1106-1114.
[32] 夏涵, 邓硕曾. 精准镇静/镇痛提升日间麻醉[J]. 实用疼痛学杂志, 2017, 13(6): 405-406. XIA Han, DENG Shuozeng. Precise sedation and analgesia to promote ambulatory anesthesia [J]. Pain Clinic Journal, 2017, 13(6): 405-406.
[33] Ma J, Wang XY, Sun QX, et al. Transversus abdominis plane block reduces remifentanil and propofol consumption, evaluated by closed?loop titration guided by bispectral index [J]. Exp Ther Med, 2018, 16(5): 3897-3902.
[34] Chang JT, Wang XY, Xin DQ, et al. Intraoperative and postoperative infusion of dexmedetomidine combined with butorphanol for intravenous patient-controlled analgesia after radical mastectomy: a double-blind, randomized clinical trial[J]. Int J Clin Exp Med, 2018,10(2): 2505-2513.
[35] Moningi S, Patki A, Padhy N, et al. Enhanced recovery after surgery: an anesthesiologists perspective [J]. J Anaesthesiol Clin Pharmacol, 2019, 35(Suppl1): S5-S13.
[36] Huang J. Enhanced recovery after surgery [J]. AANA J, 2014, 82(4): 259-261.
[37] 宋西成. 加速康复外科理念在头颈肿瘤手术的应用价值[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 1-4. SONG Xicheng. Application value of enhanced recovery after surgery in head and neck cancer surgery[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(5): 1-4.
[38] Gómez-Izquierdo JC, Trainito A, Mirzakandov D, et al. Goal-directed fluid therapy does not reduce primary postoperative ileus after elective laparoscopic colorectal surgery: a randomized controlled trial [J]. Anesthesiology,2017, 127(1): 36-49.
[39] Kehiet H. Enhanced Recovery After Surgery(ERAS): good for now, but what about the future? [J]. Can J Anaesth, 2015, 62(2): 99-104.

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