多团队协作的ERAS-幻灯片.ppt

* * 快速康复外科理念主张术后早期活动。术后长期卧床会降低肌肉强度，损害肺功能及组织氧化能力、加重静脉淤滞及血栓形成 Optimizing perioperative management of patients undergoing colorectal surgery: what is new? Environment should encourage independence Out of bed x 2h on day of surgery Out of bed x 6h every day after * A multimodal approach with epidural and near-zero fluid balance is recommended. Oral laxatives and chewing gum given postoperatively are safe, and may accelerate gastrointestinal transit. * Patients should be allowed a normal diet after surgery without restrictions. They should be cautioned to begin carefully and increase intake according to tolerance over 3-4 days. Enteral tube feeding should be given only on specific indications and parenteral nutrition should not be employed routinely. Patients should be screened for nutritional status and if at risk of under-nutrition given active nutritional support. Perioperative fasting should be minimised. Postoperatively patients should be encouraged to take normal food as soon as lucid after surgery. ONS may be used to supplement total intake. * ERAS的核心在于减少患者的创伤和应激损害，在多学科协助治疗下产生最佳结果。 ERAS注重一系列围术期措施多学科技术综合运用、有效协作，主要包括快麻醉、体液治疗、围术期疼痛管理，以及其他一些措施等。 麻醉方法的改进，包括_____________ 体液治疗，则包括____________ * The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: A meta-analysis of randomized controlled trials Enhanced recovery pathways optimize health outcomes and resource utilization controlled trials in colorectal surgery. Surgery 2011;149:830-840. * 临床营养 * Adherence to the Enhanced Recovery After Surgery Protocol and Outcomes After Colorectal Cancer Surgery * 已在许多择期手术中取得成功，其中以结肠切除手术最为成功 * ERAS对围手术期处理原则提出了革命性的改变，也可以说是与传统的围手术期医疗护理常规相去甚远，但这一理念已经得到循证医学的支持。 就目前而言，国外ERAS在多个领域得到广泛应用。ERAS已在许多择期手术中取得成功，其中以结肠切除手术最为成功。 * 由于ERAS的广泛应用，多个领域已制定了相应的ERAS指南共识。 NHS和ASGBI发布了介绍ERAS和推广ERAS的指南；（左侧两个）；而具体地，由NHS发布了骨关节术后ERAS（中一）和肾脏切除术后ERAS的指南（右上），国际ERAS学会及英国分会则发布了结直肠ERAS手册（右下）。 除此之外，还有不少指南、共识发布在相关的杂志上，这里就不一一列举了。 * * Enhanced recovery aft