手术后改善康复:关于患者血液管理建议的叙述性综述
Esther Mendez1, Guillermo Puig2, Marta Barquero2
1Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain - mendezarias.esther@gmail.com.
Minerva anestesiologica
|June 12, 2023
概括
患者血液管理 (PBM) 建议在手术后增强恢复 (ERAS) 准则中最小存在. 虽然PBM整合在2019年后在某些领域有所改善,但仍然存在重大差距,特别是在高风险手术方面.
科学领域:
- 在外科手术期间的医学.
- 外科手术的结果
- 基于证据的实践.
背景情况:
- 手术后增强恢复 (ERAS) 计划旨在优化患者的康复和减少手术压力.
- 患者血液管理 (PBM) 专注于通过保护和增强患者自己的血液来改善结果.
- 早期的ERAS指导方针缺乏对外科手术期间血液管理的三个支柱的关注.
研究的目的:
- 分析患者血液管理 (PBM) 建议在手术后增强恢复 (ERAS) 指南中的整合.
- 确定ERAS指南在多大程度上解决了PBM的三个支柱:贫血管理,血静优化和输血避免.
主要方法:
- 2018年至2022年间发表的15个成人ERAS协会临床指南的系统审查.
- 分析了与PBM三大支柱相关的具体建议的选定指南.
主要成果:
- 在2019年之前,ERAS指南没有包含PBM建议.
- 自2019年以来,PBM建议已被引入结直肠,妇科/瘤和肺切除手术的指南.
- 高危出血手术的指导方针,如心脏手术,往往缺乏明确的手术前贫血管理指导方针.
结论:
- 目前的ERAS指南提供了有限的PBM建议.
- 有必要将有效的PBM策略整合到ERAS指南中.
- 改善外科手术期间的血液管理与更好的患者结果有关.
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