围手术期外科之家理念及其在炎症性肠病管理中应用

围手术期外科之家(PSH)是对围手术期处理进行重新设计的创新性管理模式,重点针对存在器官功能障碍及手术并发症风险因素的高危人群,强调从评估手术指征到术后处理直至出院后管理的长程管理模式,将病人评估、风险分层、术前预康复、手术方案、术后康复结合起来。即将术前、术中和术后三个围术期处理节段有效整合,进行全程管理。需要手术治疗的炎症性肠病(IBD)病人,多在术前接受激素、免疫抑制剂及生物制剂的治疗,常合并低蛋白血症和营养不良等风险因素,属于手术并发症高危人群,对这类病人进行术前评估、风险因素的优化以及术后的长程管理十分必要,从而使得PSH理念在IBD外科治疗中的应用和普及尤为重要。作为一种围手术期处理的管理模式,PSH可以为IBD这类具有一定风险因素的特殊病人群体提供一种全新的围手术期管理方式。

Construction of perioperative surgical home model for inflammatory bowel diseases

Construction of perioperative surgical home model for inflammatory bowel diseases LI Yi, GONG Jian-feng, ZHU Wei-ming. Department of General Surgery, General Hospital of Eastern Theater Command, PLA; Jinling Hospital, Medical School of Nanjing University, Nanjing 210002,China
Corresponding author:ZHU Wei-ming,E-mail: juwiming@126.com
Abstract As an innovative clinical model, perioperative surgical home (PSH) aimed to combine pre-operative, intra-operative, and post-operative management for patients undergoing surgical intervention, from the assessment of surgical indications to follow-up after discharge. PSH model provides patient-centered care while complies individualized strategy. PSH includes preoperative rehabilitation, surgical plan, enhanced recovery after surgery, postoperative rehabilitation, follow-up, data update, and continuous quality improvement. In addition to comorbidity such as hypoproteinemia and malnutrition, most patients with inflammatory bowel disease (IBD) requiring surgical treatment have received corticosteroid, immunosuppressive agents and biological agents before surgery. Therefore, preoperative risk factor screen and optimization prior to operation as well as postoperative long-term management are particularly important for these patients, which makes the PSH concept implicated in the surgical management of IBD. PSH model would shed light on the complicated status such as IBD which has an unmet needs in perioperative management.