加速康复外科在心脏大血管外科的应用及展望

加速康复外科(enhanced recovery after surgery, ERAS)旨在通过一系列多模式、跨学科围手术期治疗方案优化治疗模式,促进患者康复,已在多个外科领域取得显著成绩。鉴于心脏大血管外科的特殊性,ERAS在心脏大血管外科的研究仍处于起步阶段,但心脏大血管外科开展ERAS是一大发展趋势,这一前沿理念值得进一步推广和探索。     

加速康复外科在结直肠癌中的应用

加速康复外科（ERAS）是一种优化的围手术期的先进理念,包含一系列能够促进患者术后康复,减少手术应激及并发症,缩短住院时间,降低住院费用的措施。ERAS理念在外科领域得到了广泛应用和推广,但目前国内ERAS的普及率仍很低,这可能与外科医师和患者对这一概念的认识不足有关。本文对ERAS在结直肠癌中的应用及最新进展做一综述,并深入分析ERAS对结直肠癌患者长期生存率的影响,为ERAS在结直肠肿瘤外科中的推广应用提供参考,从而使更多结直肠癌患者从中受益。     

基于加速康复外科理念的围手术期麻醉管理在十二指肠梗阻新生儿腹腔镜手术中的应用

目的 探讨基于加速康复外科(ERAS)理念的多方位围手术期麻醉管理在十二脂肠梗阻新生儿腹腔镜手术中的应用效果.方法 收集42例行腹腔镜手术的十二指肠梗阻新生儿,随机分为对照组20例和ERAS组22例.对照组采取围手术期一般麻醉管理方案,ERAS组实施ERAS围手术期麻醉管理方案.比较两组手术情况,包括手术时间、麻醉时间...     

快速康复外科在颅脑手术中的应用现状

快速康复外科(enhanced recovery after surgery,ERAS)是指通过各种基于循证医学证据的围手术期处理措施以促进患者术后早期康复。经过20余年的发展,ERAS已经被广泛应用于胃肠道手术、肝胆外科手术、泌尿外科手术等领域,但其在颅脑手术领域尚未得到足够重视。为了促进ERAS在颅脑手术中的应用拓展,现就其在颅脑手术中的应用作一综述。     

加速康复外科对消化道肿瘤患者长期生存率影响的Meta分析

背景加速康复外科(enhanced recovery after surgery, ERAS)是指在围手术期通过多学科协作模式采取一系列基于循证医学证据的最优化措施,降低围手术期应激反应,加快患者术后各器官功能恢复. ERAS已在多个学科得到推广,并被证实可以提高患者近期预后,而针对患者远期预后的研究正在初步进行.目的评价围手术期应用ERAS对消化道肿瘤患者生存率的影响.方法应用计算机检索1995-01/2018-11万方、CNKI、维普、PubMed、Cochrane Library、EMBASE数据库有关消化道肿瘤患者围手术期应用ERAS的随机对照试验、病例对照研究,由两名研究者分别对符合纳入标准的研究进行质量评价和数据提取,采用Rev Man5.3.5软件进行Meta分析.结果共纳入10篇研究进行Meta分析,共计2477例患者,其中ERAS组751例,对照组(采取传统围手术期管理)1726例.与对照组相比, ERAS组术后3年生存率提高(OR=0.48, 95%CI:0.30-0.78, P0.05),术后5年生存率提高(OR=0.51, 95%CI:0.40-0.65, P0.05);两组术后1年生存率差异无统计学意义(OR=1.13, 95%CI:0.63-2.02, P0.05),术后2年生存率差异无统计学意义(OR=1.19, 95%CI:0.38-3.73, P0.05).结论消化道肿瘤手术围手术期实施ERAS可以改善预后,3年生存率, 5年生存率.     

加速康复外科在甲状腺手术围手术期护理中的应用体会

目的 探讨在甲状腺手术围手术期护理中加用加速康复外科(ERAS)理念的临床效果。方法 2019年7月至2021年6月在某院甲乳外科接受甲状腺手术的病人120例,根据随机化原则分为ERAS组68例(给予ERAS理念和方法进行围手术期护理)和常规护理组52例(给予常规外科理念和方法进行围手术期护理)。采用视觉模拟量表(VAS)评估术后疼痛,术后患者出现恶心、呕吐、头晕、头痛及颈、腰背部肌肉酸痛等症状界定其为术后体位综合征,并记录住院时间和住院总费用。结果 ERAS组和常规护理组两组间性别比例、平均年龄和良恶性肿瘤比例比较,差异无统计学意义(P>0.05)。在甲状腺手术围手术期护理中加用ERAS理念后,ERAS组术后疼痛程度明显轻于常规护理组(t=2.184,P=0.032),体位综合征发生率明显低于常规护理组(χ²=6.930,P=0.007),住院时间明显少于常规护理组(t=2.283,P=0.026),住院总费用明显少于常规护理组(t=2.052,P=0.037)。结论 在甲状腺手术围手术期护理中加用ERAS理念,安全可靠有效,可明显提升患者舒适度,促进早期...     

肝胆胰外科术后加速康复专家共识(2015版)

正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     

减重代谢手术实施加速康复外科的单中心经验与存在问题分析

目的对比实施加速康复外科（ERAS）措施与传统外科措施在减重代谢手术围手术期处理的差异,分析目前实施ERAS存在的问题。 方法回顾性分析2014年11月至2016年11月南方医科大学附属小榄医院减重中心收治的34例肥胖症或2型糖尿病患者的临床资料,按照推广ERAS前后分为加速康复外科组（ERAS组）和传统胃肠外科处理组（对照组）。其中,ERAS组注重术前宣教和呼吸功能训练,术后不留置胃管、尿管,腹腔引流管不留置或较短时间留置,术后合理镇痛,早期进食和活动。对照组按传统胃肠外科围手术期处理。对比两组患者在平均住院时间、术后疼痛评分、术后进食及活动时间的差异,分析讨论目前实施ERAS的优点和存在问题。 结果ERAS组术后平均住院时间短（3.6±0.7）d vs.（8.3±2.8）d,P<0.05;无严重并发症发生;术后疼痛NRS评分低于对照组（3.3±0.8）vs.（5.5±1.3）,P<0.05;无腹腔引流管或留置短时间;术后活动时间早,卧床时间短,（0.8±0.5）d vs.（2.6±0.7）d,P<0.05;肛门排气时间提前（0.4±0.4）d vs.（3.6±0.6）d,P<0.05。 结论在减重与代谢手术的围手术期措施中,实施ERAS优于传统护理模式,可显著缩短住院时间,患者恢复迅速,值得临床推广。     

快速康复外科技术在结直肠癌中应用的研究进展

快速康复外科(enhanced recovery after surgery,ERAS)也称为快通道外科(fast-track surgery,FTS),是指采用一系列有循证医学证据证实的围手术期多模式优化的措施,以减少患者创伤应激,达到快速康复的目的。ERAS技术已广泛应用于结直肠癌患者,该文就近年来ERAS技术对结直肠癌患者应激反应、免疫、胰岛素抵抗等作用的研究进展作一综述。     

加速康复外科理念在胰腺外科中的应用与思考

近年来,加速康复外科(ERAS)理念及路径在我国临床实践被广泛认同与开展,在胰腺外科领域中也逐步开展。由于胰腺外科手术具有疾病复杂、手术难度大、术后并发症发生率高等客观因素,导致ERAS理念在胰腺外科的临床应用在不同胰腺中心差异较大,其相关路径的开展与应用显著滞后于其他学科。目前,ERAS理念在胰腺外科中应用效果的的高级别循证医学证据仍较为缺乏,需要开展高质量临床研究证实其安全性和有效性。评述了目前胰腺外科开展ERAS的可行性及相关热点问题,供同道参考。     

Enhanced recovery for non-colorectal surgery

In recent years the advent of programs for enhanced recovery after major surgery (ERAS) has led to modifications of long-standing and well-established perioperative treatments. These programs are used to target factors that have been shown to delay postoperative recovery (pain, gut dysfunction, immobility) and combine a series of interventions to reduce perioperative stress and organ dysfunction. With due differences, the programs of enhanced recovery are generally based on the preoperative amelioration of the patient's clinical conditions with whom they present for the operation, on the intraoperative and postoperative avoidance of medications that could slow the resumption of physiological activities, and on the promotion of positive habits in the early postoperative period. Most of the studies were conducted on elective patients undergoing colorectal procedures (either laparotomic or laparoscopic surgery). Results showed that ERAS protocols significantly improved the lung function and reduced the time to resumption of oral diet, mobilization and passage of stool, hospital stay and return to normal activities. ERAS' acceptance is spreading quickly among major centers, as well as district hospitals. With this in mind, is there also a role for ERAS in non-colorectal operations?     

The enhanced recovery after surgery (ERAS) protocol in elderly patients with acute cholecystitis: A retrospective study

Enhanced recovery after surgery (ERAS) protocol is a perioperative management theory aimed at reducing the injury of surgical patients and accelerating postoperative recovery. It has been widely recognized and applied in elective surgery. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. We collected medical data from 126 elderly patients with acute cholecystitis from October 2018 to August 2021. Among the 126 patients, 70 were included in the ERAS group and 56 in the traditional group. We analyzed the clinical data and postoperative indicators of the 2 groups. No significant differences were observed regarding the general characteristics of the 2 groups (P > .05). The ERAS group had significantly earlier time to first flatus, time to first ambulation, and time to solid intake, compared with the traditional group (P < .001); additionally, the ERAS group had significantly shorter stay and gentler feeling of postoperative pain (P < .001). Furthermore, the ERAS group had significant incidences of lower postoperative lung (P = .029) and abdominal cavity infection (P = .025) compared to the traditional group. No significant difference was observed regarding the incidences of other postoperative complications between the 2 groups (P > .05). The ERAS protocol helps reduce elderly patients’ stress reactions and accelerate postoperative recovery. Thus, it is effective and beneficial to implement the ERAS protocol during the perioperative period of elderly patients with acute cholecystitis.     

Survey of provider perceptions of enhanced recovery after surgery and perioperative surgical home protocols at a tertiary care hospital

Enhanced recovery after surgery (ERAS) and perioperative surgical home (PSH) initiatives are widely utilized to improve quality of patient care. Despite their established benefits, implementation still has significant barriers. We developed a survey for perioperative clinicians to gather information on perception and knowledge of ERAS/PSH programs to guide future expansion of these programs at our institution. The survey included questions about familiarity with ERAS/PSH and perceived value, perceived barriers to protocol implementation, preferred learning methods and prioritization of various ERAS/PSH protocol elements into care delivery and provider education. Faculty surgeons and anesthesiologists, in addition to advanced practice nurses and postgraduate physician trainees in the Departments of Surgery and Anesthesiology were asked to complete the survey. Overall survey participation was 25% (223/888). About half of survey respondents had provided care to a patient on an ERAS/PSH protocol, and a majority felt at least somewhat knowledgeable about ERAS/PSH protocols. Perception of the value of ERAS/PSH was positive. Participants were enthusiastic about on-going learning, with multimodal pain management being the topic of most interest and learning by direct participation in care of protocol patients being the favored educational approach. A significant majority of participants felt that upcoming health providers should receive formal ERAS/PSH education as part of their training. Based on our survey results, we plan to explore teaching methods that successfully engage learners of all levels of clinical expertise and also overcome the major barriers to gaining knowledge about ERAS/PSH identified by study participants, most notably lack of time for busy clinicians.     

加速康复措施在减重代谢外科中的应用价值

目的通过在减重代谢外科围手术期实施各种加速康复外科（ERAS）措施，总结出加速康复外科措施在减重与代谢病外科中的应用价值。 方法回顾性分析2015年1月至2018年1月南方医科大学附属小榄医院减重与代谢病外科收治的91例肥胖症或2型糖尿病患者的临床病例资料，将患者在围手术期实施快速康复措施的纳入加速康复外科组（ERAS组）；而仅采用传统胃肠外科围手术期措施的患者纳入对照组。对比两组患者在术后疼痛评分、肛门排气时间、并发症、平均住院时间、住院总费用、减重效果、再住院率、再手术率等方面的差异，分析ERAS实施在减重代谢外科中的应用价值。 结果ERAS组术后疼痛NRS评分低于对照组(3.8±1.2) vs. (6.4±1.5)，P<0.05；术后肛门排气时间缩短(1.0±0.3)d vs.(1.9±0.7)d，P<0.05；无严重并发症；术后住院时间短(6.4±1.3)d vs.(13.7±1.5)d ，P<0.05，住院费用降低（46813±3070）元vs. (66973±4520)元，P<0.05；两组的平均术后1年多余体重减除率均>80%。 结论在减重与代谢手术中，实施围手术期快速康复措施，可明显缩短住院时间，减少术后并发症，快速康复，节省费用，具有突出的应用价值。     

The effect of the enhanced recovery after surgery program on lung cancer surgery: a systematic review and meta-analysis

BackgroundLung cancer is one of the most common causes of cancer-related death worldwide. The enhanced recovery after surgery (ERAS) program is an effective evidence-based multidisciplinary protocol of perioperative care. However, the roles of ERAS in lung cancer surgery remain unclear. This systematic review and meta-analysis aimed to investigate the short-term impact of the ERAS program on lung resection surgery, especially in relation to postoperative complications.MethodsA systematic literature search of PubMed, EMBASE, and the Cochrane Library databases until October 2020 was performed to identify the studies that implemented an ERAS program in lung cancer surgery. The studies were selected and subjected to data extraction by 2 reviewers independently, which was followed by quality assessment. A random effects model was used to calculate overall effect sizes. Risk ratio (RR), risk difference (RD), and standardized mean difference (SMD) with 95% confidence interval (CI) served as the summary statistics for meta-analysis. Subgroup analysis and sensitivity analysis were subsequently performed.ResultsA total of 21 studies with 6,480 patients were included. The meta-analysis indicated that patients in the ERAS group had a significantly reduced risk of postoperative complications (RR =0.64; 95% CI: 0.52 to 0.78) and shortened postoperative length of stay (SMD=−1.58; 95% CI: −2.38 to −0.79) with a significant heterogeneity. Subgroup analysis showed that the risks of pulmonary (RR =0.58; 95% CI: 0.45 to 0.75), cardiovascular (RR =0.73; 95% CI: 0.59 to 0.89), urinary (RR =0.53; 95% CI: 0.32 to 0.88), and surgical complications (RR =0.64; 95% CI: 0.42 to 0.97) were significantly lower in the ERAS group. No significant reduction was found in the in-hospital mortality (RD =0.00; 95% CI: −0.01 to 0.00) and readmission rate (RR =1.00; 95% CI: 0.76 to 1.32). In the qualitative review, most of the evidence reported significantly decreased hospitalization costs in the ERAS group.ConclusionsThe implementation of an ERAS program for surgery of lung cancer can effectively reduce risks of postoperative complications, length of stay, and costs of patients who have undergone lung cancer surgery without compromising their safety.     

结直肠手术应用加速康复外科中国专家共识(2015版)

这是由中华医学会肠外肠内营养学会加速康复外科协作组制订的第1个关于加速康复外科(ERAS)在结直肠手术应用的中国专家共识。ERAS的概念是指通过优化围术期的处理,减少患者心理和生理的创伤应激,达到减少并发症,减少医疗费用,缩短住院时间,使患者获得快速康复的作用。ERAS是21世纪一项重要的外科学进展及革命,目前在结直肠手术中的应用最为成功。根据国内外文献及专家经验,制订了《结直肠手术应用加速康复外科中国专家共识(2015版)》。     

ERAS理念在结直肠癌治疗中的应用

加速康复外科是近年来提出的一种崭新的围手术期管理模式,其具有术后恢复快、并发症少、住院时间短、住院费用低等特点,并已广泛应用于各个外科领域。本文主要概述了加速康复外科在手术治疗结直肠癌中的具体应用。     

Neurosurgical enhanced recovery after surgery ERAS for geriatric patients undergoing elective craniotomy: A review

Population aging is an unprecedented, multifactorial, and global process that poses significant challenges to healthcare systems. Enhanced recovery after surgery (ERAS) protocols aim to optimize perioperative care. The first neurosurgical ERAS protocol for elective craniotomy has contributed to a shortened postoperative hospital stay, accelerated functional recovery, improved patient satisfaction, and reduced medical care cost in adult patients aged 18 to 65 years compared with conventional perioperative care. However, ERAS protocols for geriatric patients over 65 years of age undergoing cranial surgery are lacking. In this paper, we propose a novel ERAS protocol for such patients by reviewing and summarizing the key elements of successful ERAS protocols/guidelines and optimal perioperative care for geriatric patients described in the literature, as well as our experience in applying the first neurosurgical ERAS protocol for a quality improvement initiative. This proposal aimed to establish an applicable protocol for geriatric patients undergoing elective craniotomy, with evidence addressing its feasibility, safety, and potential efficacy. This multimodal, multidisciplinary, and evidence-based ERAS protocol includes preoperative, intraoperative, and postoperative assessment and management as well as outcome measures. The implementation of the current protocol may hold promise in reducing perioperative morbidity, enhancing functional recovery, improving postoperative outcomes in geriatric patients scheduled for elective craniotomy, and serving as a stepping stone to promote further research into the advancement of geriatric patient care.