摘要
加速康复外科(enhanced recovery after surgery,ERAS)是采用有循证医学证据证明有效的围术期处理措施,降低手术创伤的应激反应、减少并发症、提高手术安全性和患者满意度,从而达到加速康复的目的。ERAS在髋、膝关节置换术(total hip/knee arthroplasty,THA/TKA)中的重点在于提高手术操作技术和优化围术期管理,包括减少创伤和出血、优化疼痛与睡眠管理、预防感染、预防静脉血栓栓塞症(venous thromboembolism,VTE),以及优化引流管、尿管和止血带的应用等。通过查阅文献,基于国家卫生计生委公益性行业科研专项《关节置换术安全性与效果评价》项目组数据库大样本数据分析,遵循循证医学原则,经过全国专家组反复讨论,编辑整理完成本共识,供广大骨科医师在临床工作中参考应用。本共识主要内容包括:患者教育、营养支持、麻醉管理、微创操作理念、围术期血液管理、预防感染、预防VTE、优化镇痛方案、睡眠管理、优化止血带应用、伤口管理、优化尿管应用、预防术后恶心呕吐(postoperative nausea and vomiting,PONV)、功能锻炼、出院后管理和随访管理。
Enhanced recovery after surgery （ERAS） is defined that effective perioperative management therapies proved by evidence-based medicine is applied to reduce the stress reaction and complications caused by surgery and improve the opera-tion safety and patients＆#39; satisfaction. Enhanced recovery after total hip/knee arthroplasty （THA/TKA） focus on the improve-ment of surgical techniques and optimization of perioperative management, including reducing surgical trauma and blood loss, managing pain, preventing infection and venous thromboembolism （VTE）, optimizing the use of drainage tube, catheter and tourniquet. By means of reading literatures and expert group discussion, based on the database of the project group for the＂National Health and Family Planning Commission＆#39;s public-benefit project：the safety and effect assessment of joint arthro-plasty＂and evidence-based medicine, we compile this consensus which mainly contains patients＆#39; education, nutritional sup-port, anesthetic management, concept of minimally invasive operation, perioperative blood management, prevetion of infec-tion, VTE and postoperative nausea and vomiting （PONV）, optimization of analgesia, sleep management, wound manage-ment, functional exercise and postoperative follow-up management. We hope that this consensus wound give some help to or-thopedic surgeon.
出处
《中国骨与关节外科》
2016年第1期1-9,共9页
Chinese Journal of Bone and Joint Surgery
