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胸壁切除和重建后的增强恢复:临床实践审查
Céline Forster1, Valentin Jacques1, Etienne Abdelnour-Berchtold1
1Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Journal of thoracic disease
|May 13, 2024
概括
手术后增强恢复 (ERAS) 途径可以适应高风险的胸壁切除 (CWR). 实施ERAS协议可以显著减少CWR患者的术后并发症.
科学领域:
- 胸部外科手术 胸部外科手术
- 手术瘤学手术瘤学
- 关键护理医学 关键护理医学
背景情况:
- 许多手术程序建立了手术后增强恢复 (ERAS) 途径,旨在减少术后发病率.
- 胸壁切除 (CWRs) 是具有显著发病率的高风险手术,但缺乏特定的ERAS协议.
- 本次审查解决了针对CWR患者量身定制的ERAS协议的需求.
研究的目的:
- 审查目前适用于胸部外科手术的ERAS指南.
- 为胸壁切除提出ERAS途径的关键元素.
- 突出ERAS实施对CWR患者的潜在好处.
主要方法:
- 对胸部外科手术现有的ERAS指导方针进行审查.
- 确定适用于CWR的手术前,手术周和手术后的要素.
- 针对CWR特定的ERAS协议的综合建议.
主要成果:
- 建议的ERAS要素包括术前优化 (教育,营养,戒烟),术后管理 (预防,流体管理,PONV最小化) 和术后护理 (早期动员,养和胸腔管切除).
- 优化疼痛管理对于尽量减少呼吸道并发症至关重要.
- 建议的元素是可实现的,适合于CWR患者.
结论:
- 对胸壁切除进行量身定制的ERAS途径的实施是可行的.
- 这种途径有可能显著降低CWR患者的术后发病率.
- ERAS协议可以标准化和改善高风险胸壁切除手术的护理.
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