摘要
加速康复外科(enhanced recovery after surgery,ERAS)理念已得到医护的认可,多学科协作是ERAS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,ERAS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,ELRAS)为例,分析ERAS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"。
The concept of enhanced recovery after surgery（ERAS） has already been accepted by almost all the clinicians and nurses, the practice of which is based on interdisciplinary cooperation. The reason is still unclear why the effect of ERAS varies a lot though the same ERAS scheme is used. The main cause may be the same ERAS scheme can not be suitable for different patients. In other words, does ERAS also need to conform to Precision Medicine Theory？ This study is focused on the necessity and clinical efficacy of ＂Precision ERAS＂ performed in lung cancer patients. The conclusions are the following： first of all, an accurate judgment of patients who need ERAS should be done properly before surgery, which means that the high risks assessment should be done accurately. Secondly, a specific ERAS scheme should be carried out in each independent patient who has obvious clinical symptoms in order to alleviate clinical symptoms and improve the ptients＇ quality of life（QOL）. Thirdly, for the asymptomatic patitents who also don＇t have severe concomitant diseases, process-optimized ERAS should be selected to make patients feel more comfortable and shorten the average length of stay（ALOS）. To summary, ＂subtraction＂ instead of ＂addition＂ should be considered when performing ERAS.
出处
《中国肺癌杂志》
CAS
CSCD
北大核心
2017年第8期549-554,共6页
Chinese Journal of Lung Cancer
基金
四川省科技厅基金项目(No.2015SZ0158)资助~~
关键词
加速康复外科
加速肺康复外科
精准医学
Enhanced recovery after surgery
Enhanced lung recovery after surgery
Precision medcine
