加速康复外科护理措施在直肠癌微创手术围术期中的应用效果分析

目的 探讨加速康复外科(enhanced recorvery after surgery,ERAS)护理措施在直肠癌微创手术中的应用效果.方法 回顾性分析2015年3月至2016年3月在中山大学附属第一医院行直肠癌微创手术的157例患者临床资料,根据患者围术期护理措施的不同,分为ERAS组(87例)和传统组(70例).传统组患者接受传统围术期护理,ERAS组患者接受围术期的加速康复外科护理措施.比较两组患者术后康复情况和术后并发症的发生情况.结果 ERAS组在术后胃肠功能恢复时间、进食流质时间、进食半流时间及术后住院时间均明显短于传统组(均P<0.05).两组总体并发症发生率无明显差异[10.3%(9/87)vs 18.6%(13/70),P=0.168].ERAS组在围术期的护理满意度高于传统组[(93±5.6)分vs.(86±6.5)分,t=7.245,P<0.001].结论 围术期实施加速康复外科护理措施能促进直肠癌微创手术患者的术后康复.     

岭南结直肠外科手术麻醉的加速康复外科临床操作规范专家共识(2016版)

加速康复外科 (enhanced recovery after surgery,ERAS)又称快速康复外科或快通道外科,最早由丹麦Henrik Kehlet教授于1997年提出[1].ERAS是指采用有循证医学证据的围术期(术前、术中和术后)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[2-16].ERAS带来的益处包括[1-17]:减少手术创伤及应激,减少并发症,促进患者快速康复,缩短住院时间,降低住院费用,提升医疗服务质量,节约医疗资源,促进医患关系和谐.此外,ERAS对患者术后免疫功能的恢复有明显促进作用,可加快患者术后白细胞计数、免疫球蛋白及补体C3的恢复[11-14].ERAS组结直肠癌患者术后5年肿瘤复发风险为15.8％,传统治疗组为25％,ERAS组结直肠癌患者的术后5年肿瘤复发相对危险度较传统治疗组降低了37％[11].结直肠癌患者应用ERAS措施联合腹腔镜手术,可有效减少术后炎症反应,保护机体免疫功能,对患者术后康复起到积极的作用[11,12,14].     

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.     

加速康复外科理念在腹腔镜辅助结直肠癌手术围手术期中的应用价值

目的 探讨加速康复外科(Enhanced recovery after surgery,ERAS)理念在腹腔镜辅助结直肠癌手术围手术期的应用价值。方法 选取2015年11月—2016年7月我院结直肠外科收治的86例结直肠癌患者,分为ERAS组和常规治疗组,分别行腹腔镜辅助下结直肠癌根治术和和开腹结直肠癌根治术,比较两组患者一般资料、临床指标、术中和术后恢复情况及并发症情况。结果 ERAS组手术用时、术中出血量与常规治疗组无统计学差异(P＞0.05),ERAS组术后排气、排便时间早于后者,术后住院天数、术后疼痛评分均低于后者,术后并发症比率低于后者(P＜0.05)。结论 ERAS理念指导下的经腹腔镜结直肠癌手术有助于患者术后康复、缩短住院时间、减少住院费用,其进一步应用需多学科共同努力。     

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。     

加速康复外科理念在高龄患者腹腔镜胃癌手术中的应用研究

目的 探讨加速康复外科理念及措施在高龄患者腹腔镜胃癌根治手术中应用的安全性和有效性.方法 回顾性分析2015年9月至2017年3月间在深圳市龙岗中心医院收治的60例接受腹腔镜胃癌根治术的高龄患者临床资料,按围术期是否采用加速康复外科措施分为ERAS组(n=30)和对照组(n=30),ERAS组患者围术期应用加速康复外科理念和措施,对照组患者采用传统治疗措施.比较两组术前基本资料、术后首次排气时间、住院时间、住院费用、术后2周胃肠功能生存质量、手术并发症的情况.结果 ERAS组术后住院时间[(8.51±0.97)天vs.(9.43±1.55)天,P<0.05]、住院费用[(49482.07±4486.59)元vs.(51774.47±3464.14)元,P<0.05]均少于对照组,ERAS组患者肺部感染发生率明显低于对照组(6.67%vs.30.00%,P<0.01).结论 高龄患者行腹腔镜胃癌根治术围术期应用加速康复外科理念和措施是安全有效的.     

加速康复外科在我国结直肠外科临床实践中的挑战与对策

加速康复外科（enhanced recovery after surgery , ERAS）概念是丹麦的Henrik Kehlet 教授于1997年提出来的［1］。历经19年的临床应用,ERAS已在许多外科领域取得了显著的成绩。ERAS是采用有循证医学证据支持的一系列围术期处理措施,优化了术前、术中和术后的全过程,其核心是减少手术对患者生理及心理的创伤和应激,减少并发症,达到快速康复的目的［2－4］。 ERAS的优点包括［2－4］：减少手术创伤及应激,降低手术并发症,促进患者快速康复,缩短住院时间,降低住院费用,提升医疗服务质量,节约医疗资源,促进医患关系和谐。     

加速康复外科与传统围手术期管理模式在机器人辅助腹腔镜前列腺癌根治术的临床疗效对比分析

目的将加速康复外科(ERAS)围手术期管理模式应用于机器人辅助腹腔镜前列腺癌根治术(RARP),并对比传统围手术期管理模式与ERAS的临床实践效果差异。 方法回顾性分析2018年5月至2018年8月南京大学医学院附属鼓楼医院泌尿外科共110例行机器人辅助腹腔镜根治性前列腺切除术患者的临床资料,并按照筛选条件最终纳入共70例患者,采用RARP术,且均采用ERAS围手术期管理模式,为ERAS组。并按照纳入标准纳入既往于南京大学医学院附属鼓楼医院泌尿外科2017年5月至2018年4月行RARP但未行加速康复外科围手术期管理模式的70例患者为对照组。ERAS组与对照组患者在年龄、体质量指数、术前实验室检查如血清白蛋白及血红蛋白、前列腺体积、术前PSA、术前ECOG评分、EPIC评分、临床分期和Gleason评分的差异均无统计学意义(P>005)。 结果两组手术均顺利完成,围手术期未出现病死或严重并发症,患者均顺利出院。术中情况:ERAS组与对照组在手术时间、术中出血量、术中直肠损伤、闭孔神经损伤、大血管损伤、淋巴结清扫比率差异均无统计学意义(P>005)。术后情况:ERAS组与传统围手术管理组在回病房后至首次进食时间、首次活动时间、首次排气时间、术后6 h疼痛评分、住院天数差异均有统计学意义(P<005),术后Clavien Dindo并发症分级、切缘阳性情况、术后实验室指标差异及术后1周及术后1个月早期尿控恢复差异无统计学意义(P>005)。 结论将加速康复外科围手术期管理模式应用于机器人辅助腹腔镜前列腺癌根治术,较传统围手术期管理模式更能促进患者康复,缓解术后疼痛,缩短住院天数。     

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.     

肝胆胰外科术后加速康复专家共识(2015版)

1 前言 加速康复外科(enhanced recovery after surgery,ERAS)是基于循证医学依据的一系列围手术期优化处理措施,以达到快速康复为目的[1].ERAS通过减轻术后应激反应、合理管理疼痛、早期恢复饮食和早期活动等措施来减少术后并发症,缩短术后住院时间,减少医疗费用.自1997年丹麦外科医师Kehlet提出ERAS以来,ERAS已在骨科、乳腺外科、心胸外科、胃肠外科、妇产科等多个外科领域开展[2-4].目前,国际上已相继发布了择期结直肠手术、直肠和(或)盆腔手术、胰十二指肠手术和胃切除手术的ERAS指南或专家共识[5-8].肝胆胰手术较复杂、创伤大,术后并发症发生率高,近年提倡并应用的精准、微创、损伤控制的现代外科理念为ERAS的施行奠定了基础[9].目前,多家医疗中心开始在肝胆胰手术患者中施行ERAS,并取得了一定成效[10].但如今,国内外均无一致的针对肝胆胰手术的ERAS方案来指导临床实践.因此,《中华消化外科杂志》编辑委员会和中国研究型医院学会肝胆胰外科专业委员会组织业内专家,启动了《肝胆胰外科术后加速康复专家共识(2015版)》(以下简称本共识)讨论会,总结国内外研究进展及专家经验,按照循征医学原则通过深入论证,最终制订本共识,旨在为实现我国肝胆胰外科手术ERAS的规范化、标准化提供参考意见.     

促进术后恢复综合方案在结直肠手术中的应用

促进术后恢复综合方案(ERAS)创新性地整合了围手术期被证明有效的干预措施,以达到减少机体应激反应、支持正常功能恢复和减少术后并发症为目的.目前,已有多个临床研究采用了ERAS方案,均显示了良好的效果.     

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。     

Enhanced recovery after surgery (ERAS) versus standard recovery for elective gastric cancer surgery: A meta-analysis of randomized controlled trials

Enhanced recovery after surgery (ERAS) protocols have been effective in improving postoperative recovery after major abdominal surgeries including colorectal cancer surgery, however its impact after gastric cancer surgery is unclear. A systematic review and meta-analysis was conducted to evaluate the effect of ERAS after gastric cancer surgery. Medline, EMBASE, CENTRAL, and PubMed was searched from database inception to December 2018. Randomized controlled trials (RCTs) comparing ERAS versus standard care in gastric cancer surgery were included. Outcomes included the postoperative length of stay (LOS), hospital costs, time to first flatus, defecation, oral intake, and ambulation after surgery, and complications. Pooled estimates were calculated using random-effects meta-analysis. The GRADE approach assessed overall quality of evidence. 18 RCTs involving 1782 patients were included. ERAS significantly reduced the LOS (Mean Difference (MD) −1.78 days, 95%CI -2.17 to −1.40, P < 0.0001), reduced hospital costs (MD -650 U S. dollars, 95%CI -840 to −460, P < 0.0001), and reduced time to first flatus, defecation, ambulation, and oral intake. ERAS had significantly lower rates of pulmonary infections (Risk Ratio (RR) 0.48, 95%CI 0.28 to 0.82, P = 0.007), but not surgical site infections, anastomotic leaks, and postoperative complications. However, ERAS significantly increased readmissions (RR 2.43, 95%CI 1.09 to 5.43, P = 0.03). The quality of evidence was low to moderate for all outcomes. Implementation of an ERAS protocol may reduce LOS, costs, and time to return of function after gastric cancer surgery compared to conventional recovery. However, ERAS may increase the number of postoperative readmissions, albeit with no impact on the rate of postoperative complications.     

Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery

Enhanced Recovery After Surgery (ERAS) is an evidence-based paradigm shift in perioperative care, proven to lower both recovery time and postoperative complication rates. The role of ERAS in several surgical disciplines was reviewed. In colorectal surgery, ERAS protocol is currently well established as the best care. In gastric surgery, 2014 saw an establishment of ERAS protocol for gastrectomies with resulting meta-analysis showing ERAS effectiveness. ERAS has also been shown to be beneficial in liver surgery with many centers starting implementation. The advantages of ERAS in pancreatic surgery have been strongly established, but there is still a need for large-scale, multicenter randomized trials. Barriers to implementation were analyzed, with recent studies concluding that successful implementation requires a multidisciplinary team, a willingness to change and a clear understanding of the protocol. Additionally, the difficulty in accomplishing necessary compliance to all protocol items calls for new implementation strategies. ERAS success in different patient populations was analyzed, and it was found that in the elderly population, ERAS shortened the length of hospitalization and did not lead to a higher risk of postoperative complications or readmissions. ERAS utilization in the emergency setting is possible and effective; however, certain changes to the protocol may need to be adapted. Therefore, further research is needed. There remains insufficient evidence on whether ERAS actually improves patients’ course in the long term. However, since most centers started to implement ERAS protocol less than 5 years ago, more data are expected.     

Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery

Background  

Radical gastrectomy for gastric cancer is among the most invasive procedures in gastrointestinal surgery. Several studies have found that an enhanced recovery after surgery (ERAS) protocol is useful in patients who undergo colorectal surgery, but its value in gastric surgery remains uncertain. The aim of this study was to assess the usefulness of an ERAS protocol for gastric surgery.     

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。     

加速康复外科在妇科恶性肿瘤手术中的应用

加速康复外科是指在围手术期采用一系列经循证医学证实有效的优化措施,以减少围手术期应激并加快手术患者术后恢复的理念。由于妇科恶性肿瘤手术创面大、手术并发症多,住院治疗费用高,患者身心都会受到一定的影响。目前国内外有大量研究报道ERAS理念在妇科恶性肿瘤围手术期管理措施中的应用,结果显示加速康复理念的引入,能够在达到治疗效果的同时使患者更快地恢复,更快地进入后续的放化疗阶段,同时减少并发症,缩短住院时间从而减低医疗费用。因此,在术后恢复学会更新发布的妇产科/肿瘤科围术期管理指南基础上,本文结合文献就术前禁食水的时间、肠道准备、腹腔镜手术、术后镇痛及围术期营养对患者术后康复的影响进行综述。     

Enhanced recovery after surgery (ERAS) in gynecology oncology

The Enhanced Recovery After Surgery (ERAS) is a pathway designed to achieve early recovery for patients undergoing major surgery. The ERAS pathway included three important components preoperative, intraoperative, postoperative program. Pre-habilitation and re-habilitation are of paramount importance to improve patients’ care. The ERAS is based on evidence-based medicine. Accumulating evidence highlighted that adopting ERAS resulted in lower complication rate, and shorter length of hospital stay in comparison to standard protocols of care. The adoption of the ERAS resulted in a significant improvement of patients’ outcomes and a reduction of the overall cost of care. In the present review, we summarized current evidence on ERAS, focusing on the steps useful for its adoption into clinical practice.     

Enhanced recovery after surgery (ERAS) versus standard recovery for gastric cancer patients: The evidences and the issues

The significant advances that have been reached, in the last decades, in the treatment of gastric cancer, contributed to the concept of enhanced recovery after surgery (ERAS) with the aim to reduce the surgical stress, accelerate postoperative recovery, and reduce the length of hospital stay. The most important items included in the ERAS protocols are the pre-operative patient education, early mobilization and immediate oral intake from the first postoperative day. The aim of this narrative review is to focus the attention on the possible advantages of ERAS program on perioperative functional recovery outcomes after gastrectomy for gastric cancer.