加速肺康复外科,需要精准治疗吗?

加速康复外科(enhanced recovery after surgery,EARS)理念已得到医护的认可,多学科协作是EARS实践的前提.但现有临床方案实施效果却差异很大,原因何在呢?分析主要原因是统一方案不一定适应于所有手术患者,是否存在"过度医疗"呢?换言之,EARS是否也需要精准治疗呢?本文主要以肺手术后的加速肺康复(enhanced lung recovery after surgery,ELARS)为例,分析EARS精准治疗的必要性及达到的临床效果.一是术前需要肺康复训练的患者人群界定要准确(高危因素的评估标准要精准),肺康复训练为核心,以降低术后并发症为目的;二是术前有明确症状的患者,术前肺康复训练方案也应精准,以控制症状和改善患者生活质量为目的;三是术前无症状及严重相关伴随疾病患者,以优化围手术期流程(精准去掉不必要的操作)为主,以提高患者住院舒适度和缩短平均住院日为目的.总之,加速肺康复外科不是做"加法"而是做"减法".     

加速康复外科对胃肠手术后胃肠功能的影响

加速康复外科(enhanced recovery after surgery,ERAS)的核心是减少围术期创伤应激,促进各脏器功能快速恢复.围术期创伤应激反应对胃肠功能影响最早,但持续时间最长.围术期各项处理措施对术后胃肠功能恢复均有不同程度的影响,处理不当将导致术后胃肠功能恢复延迟,直接影响到ERAS的实施.本文针对ERAS的各项措施对术后胃肠功能影响进行论述.     

加速康复外科联合单孔胸腔镜在肺癌手术中的应用价值

加速康复外科(enhanced recovery after surgery，ERAS)是指在围术期采用一系列具有循证医学证据的优化处理措施，以减轻患者心理和生理的创伤和应激反应，减少术后并发症，缩短住院时间，降低医疗费用，促进患者快速康复。随着胸外科微创技术的不断发展，单孔胸腔镜应运而生，大量临床实践证明在保证肺癌根治性及安全、可行的前提下，单孔胸腔镜肺癌手术在疼痛、创伤等方面具有显著优势。为进一步探讨加速康复外科联合单孔胸腔镜在肺癌手术中的应用价值，现综述如下。     

加速康复外科在肝脏外科围手术期的应用现状与争论

近年来,随着现代外科学的蓬勃发展和医学治疗模式的转变,外科医生利用各种先进的外科器械及精湛的手术技巧以达到更精准手术切除的同时,越来越重视患者围手术期的治疗,以达到术后快速康复。加速康复外科（enhanced recovery after surgery,ERAS）在临床外科领域得到广泛应用,现就ERAS在肝脏外科围手术期的应用现状及争论作一综述。     

加速康复外科在腹部肿瘤外科的应用

加速康复外科(enhanced recovery after surgery,ERAS)是围手术期治疗基于循证医学的模式转变,目标是缩短患者的术后康复时间,降低术后并发症,同时节约医疗成本。临床实践证明,ERAS方案是有益且可行,其效果在结直肠手术中尤为显著。本研究对ERAS的发展、核心内容及其在不同腹部肿瘤外科和特定患者群中的应用情况进行综述。     

加速康复外科在经口腔前庭入路内镜甲状腺手术中的应用

近年来加速康复外科(enhanced recovery after surgery, ERAS)理念被逐步深入地应用到甲状腺外科领域,极大地加速了患者术后康复过程。而经口腔前庭入路内镜甲状腺手术(transoral endoscopic thyroidectomy vestibular approach, TOETVA)因其独特的优势在国内也得到广泛开展,此类患者术后康复也越来越受到重视。临床实践中应本着规范化应用ERAS的普适性理念和措施外,也要结合具体术式特点处理的原则,将ERAS理念应用到TOETVA人群中,更好地为患者服务。     

从长期生存角度看快速康复外科在结直肠癌患者中的临床应用

快速康复外科(enhanced recovery after surgery,ERAS;fast track surgery,FTS;enhanced recovery program,ERP;multimodal rehabilitation after surgery,MRAS)是多种围手术期干预措施的综合临床应用,可加快患者的术后康复[1],其在结直肠外科中的临床应用始于1995年Kehlet团队的探索性研究[2]。     

加速康复外科在胃肠手术中的应用经验浅析

加速康复外科(enhanced recovery after surgery,ERAS)是指围术期采取一系列有循证医学证据的措施,优化围术期的全过程,核心是降低患者生理和心理创伤应激,减少术后并发症,促进患者术后快速康复.目前虽然ERAS在各个外科专业中得到迅速发展与推广,但各级医院在临床实施ERAS过程中仍存在较多困难,其原因较复杂,各种实施方案也尚未规范化.针对上述情况.本文结合笔者所在中心在胃肠手术中实施ERAS的经验以及最新循证医学证据进行述评.     

应重视加速康复外科围术期的全程管理

加速康复外科(enhanced recovery after surgery,ERAS)是指采用有循证医学证据的围术期处理的一系列优化措施,其核心是减少手术和麻醉对患者生理和心理的创伤应激,减少并发症,达到术后快速康复.目前虽然ERAS已在许多外科专业、麻醉、护理等领域得到广泛应用并取得令人满意的效果,但ERAS在临床实践中仍然面临着诸多困难和挑战.临床上要贯彻落实好ERAS的相关措施并形成规范化流程,就应高度重视ERAS围术期的全程管理,本文就现阶段此热点问题进行系统阐述.     

乳房再造加速康复外科中国专家共识（2022版）

<正>加速康复外科(enhanced recovery after surgery,ERAS)指在外科治疗的多个环节中采取新方法，以减少患者生理与心理的创伤应激^[1]，提高围术期的安全性与满意度，缩短术后住院时间。乳房再造是乳腺癌综合治疗的重要组成部分，可最大限度恢复患者的自然外形，提高患者生存质量，已成为乳腺外科发展的趋势。     

加速康复外科病房建设探讨

随着加速康复外科(enhanced recovery after surgery,ERAS)理念在外科临床实践的推广和普及,外科、麻醉科医师及护士等ERAS相关领域的医务人员逐渐接受和认可ERAS理念。ERAS理念是继微创外科之后另外一个学术热点和临床关注点。无痛病房建设、ERAS病房建设等也在尝试当中,这些都极大地推动着ERAS理念的发展和手术学科的进步,但尚欠缺相应的标准或参考模式。本文将就ERAS病房建设需要具备的标准或管理制度进行探讨,包括需要建立一支ERAS多学科协作团队,建立多层次、多种手段的ERAS宣教及心理辅导制度,建立围术期ERAS全程管理制度,制定严格的ERAS出院标准,完善的ERAS随访制度以及建立完善的ERAS稽查制度。     

Impact of Enhanced Recovery Program on Colorectal Cancer Surgery

Surgical outcomes of colorectal cancer treatment depend not only on good surgery and tumor biology but alsoon an optimal perioperative care. The enhanced recovery program (ERP) – a multidisciplinary and multimodalapproach, or so called ‘fast-track surgery’ – has been designed to minimize perioperative and intraoperativestress responses, and to support the recovery of organ function aiming to help patients getting better sooner aftersurgery. Compared with conventional postoperative care, the enhanced recovery program results in quickerpatient recovery, shorter length of hospital stay, faster recovery of gastrointestinal function, and a lower incidenceof postoperative complications. Although not firmly established as yet, the enhanced recovery program aftersurgery could be of oncological benefit in colorectal cancer patients because it can enhance recovery, maintainintegrity of the postoperative immune system, increase feasibility of postoperative chemotherapy, and shorten thetime interval from surgery to chemotherapy. This commentary summarizes short-term outcomes and potentiallong-term benefits of enhanced recovery programs in the treatment of colorectal cancer.     

加速康复外科在中国大陆胸外科临床现状——基于胸外科医生及护士调查分析

背景与目的 虽然加速康复外科(enhanced recovery after surgery,ERAS)理念近年来已逐渐被外科医生所熟悉和应用于临床实践中,但目前关于我国大陆胸外科医师对ERAS理念的认知和应用现状如何仍不清楚.本研究基于对参会胸外科医生和护士进行ERAS相关问题的问卷调查结果,分析加速康复外科在胸外科的应用现状和面临的困难.方法对参与第一届胸科ERAS华西论坛代表回复的773份有效问卷进行分析,问卷内容主要包括两部分:一是被调查人单位情况及个人基本情况;二是加速康复外科相关的10个问题.结果①ERAS的临床应用现状为理念大于实践,69.6%的医生和58.7%的护士认同此观点;88.5%的医生和85.7%护士均认为ERAS理念适用于所有外科.②ERAS临床应用依从性差的主要原因是方案不成熟、无共识和规范(55.6%的医生和69.1%的护士).③ERAS临床实施的最佳团队组合是外科为主的学科协作及医护一体(62.1%的医生和70.7%的护士).④73.7%的医生和81.9%的护士认为ERAS的评价标准应为:平均住院日、患者感受和社会满意度进行综合评价.结论加速康复外科在胸外科应用现状仍然是理念大于实践,主要原因是缺乏临床可用的规范和方案.     

基于QoR-15评分系统的加速康复外科模式在肝门部胆管癌术后患者中的应用

目的 探讨基于15项恢复质量(QoR-15)量表的加速康复外科模式应用于肝门部胆管癌术后的临床价值.方法 分析2016年1月至2020年1月于南京医科大学附属淮安第一医院进行肝门部胆管根治术的102例患者临床资料,按患者入院先后顺序分为观察组49例和对照组53例,其中观察组采用基于QoR-15评分系统的加速康复外科模式...     

加速康复外科护理在腹腔镜下子宫肌瘤切除术中的应用效果

目的 探讨加速康复外科的手术室护理在腹腔镜下子宫肌瘤切除术中的应用效果.方法 选取2018年8月至2020年8月间西北妇女儿童医院收治的100例腹腔镜下子宫肌瘤切除术患者,随机分为观察组和对照组,每组50例.对照组患者采用传统康复护理措施,观察组患者在围术期采用加速康复外科手术室护理措施,比较两组患者的护理满意度、并发...     

快速康复外科理念下针药联合对腹腔镜结直肠癌术后患者胃肠功能的影响

目的 探讨基于快速康复外科理念下电针联合吴茱萸热熨治疗对腹腔镜结直肠癌术后患者胃肠功能恢复的影响及其安全性.方法 选取2019年10月—2020年12月在贵州省人民医院普外科住院治疗的60例结直肠癌患者为研究对象,随机分为观察组和对照组,每组30例.对照组围术期采用快速康复外科理念治疗,观察组在对照组的基础上予以电针双...     

Perioperative nutrition and enhanced recovery after surgery in gastrointestinal cancer patients. A position paper by the ESSO task force in collaboration with the ERAS society (ERAS coalition)

Malnutrition in cancer patients – in both prevalence and degree – depends primarily on tumor stage and site. Preoperative malnutrition in surgical patients is a frequent problem and is associated with prolonged hospital stay, a higher rate of postoperative complications, higher re-admission rates, and a higher incidence of postoperative death. Given the focus on the cancer and its cure, nutrition is often neglected or under-evaluated, and this despite the availability of international guidelines for nutritional care in cancer patients and the evidence that nutritional deterioration negatively affects survival. Inadequate nutritional support for cancer patients should be considered ethically unacceptable; prompt nutritional support must be guaranteed to all cancer patients, as it can have many clinical and economic advantages. Patients undergoing multimodal oncological care are at particular risk of progressive nutritional decline, and it is essential to minimize the nutritional/metabolic impact of oncological treatments and to manage each surgical episode within the context of an enhanced recovery pathway. In Europe, enhanced recovery after surgery (ERAS) and routine nutritional assessment are only partially implemented because of insufficient awareness among health professionals of nutritional problems, a lack of structured collaboration between surgeons and clinical nutrition specialists, old dogmas, and the absence of dedicated resources. Collaboration between opinion leaders dedicated to ERAS from both the European Society of Surgical Oncology (ESSO) and the ERAS Society was born with the aim of promoting nutritional assessment and perioperative nutrition with and without an enhanced recovery program. The goal will be to improve awareness in the surgical oncology community and at institutional level to modify current clinical practice and identify optimal treatment options.     

Cost analysis of the enhanced recovery after surgery protocol applied in advanced ovarian cancer: A secondary outcome of the PROFAST trial

IntroductionA randomised trial implementing Enhanced Recovery After Surgery (ERAS) for high complexity advanced ovarian cancer (AOC) surgery (PROFAST) demonstrated a reduction of median length of stay and hospital readmissions when compared to patients managed conventionally. One secondary objective was to determine if an ERAS pathway in the perioperative management of advanced ovarian cancer patients led to cost savings.Material and methodsSecondary objective of a prospective randomised trial of patients with suspected or diagnosed advanced ovarian cancer allocated to conventional or ERAS perioperative management, carried out at a referral centre from June 2014 to March 2018. Treatment was determined by a computer-generated random allocation system.MethodsGross counting was employed to estimate the cost of hospitalisation in wards, intensive care unit (ICU) and surgical care, while micro-costing was used to obtain image and laboratory test costs. Mean costs between trial arms were considered. Sensitivity analyses were performed.ResultsNinety-nine patients (n = 50 ERAS group, n = 49 Conventional group) were included. Mean costs per patient were 10,719€ in the ERAS group and 11,028€ in the conventional group, leading to an average saving of 309€ per patient. These results were based on 96 patients, excluding 3 extreme outliers mainly related with very high ICU costs. Savings, which were significant for hospital ward costs (?33% total; 759€ per patient in first hospitalisation, and 914€ per partient/day of readmission) were found as robust in the sensitivity analysis.ConclusionsImplementation of an ERAS pathway leads to cost savings when compared to conventional management after AOC surgery.     

Minimizing the impact of colorectal surgery in the older patient: The role of enhanced recovery programs in older patients

Enhanced recovery after surgery (ERAS) programs are multimodal treatment bundles designed with the aim to decrease the perioperative stress response to surgical trauma and reduce complication rates with elective surgery. They include different items in the preoperative, intra-operative, and postoperative phases that are based on prospective randomized trials with different grades of evidence. Their use is widespread in colorectal surgery and they have been proven to improve outcomes.Older patients are a specific group of patients with particular needs, due to age-related decline in physiological reserve and functional capacity, and frequent co-morbidity. There has been some hesitation to apply ERAS pathways in the older population, because of a lower compliance with the ERAS measures and a higher postoperative morbidity in these patients. However, recent studies have shown that most elements of the ERAS programs can be applied safely in older patients with the same benefits in reducing general complications and perioperative mortality as in younger patients.