骨科快速康复理念及应用培训.ppt

20190109 优秀幻灯片与大家分享 优秀幻灯片与大家分享 * Patients should be encouraged to commence an oral diet at will after surgery (grade A). Oral nutritional supplements should be prescribed (approximately 200 mL, energy dense, 2-3 times daily) from the day of surgery until normal food intake is achieved. Continuation of oral nutritional supplements at home for several weeks is recommended for nutritionally depleted patients (grade A). * Eneroth等研究表明对于老年髋关节骨折的患者加强静脉营养可降低骨折的并发症。 * 麻醉与镇痛 Consensus Guidelines for Managing Postoperative Nausea and Vomiting 据国内外统计,PONV在住院手术患者中的发生率约20％～37％，大手术发生率达35％～50％，高危PONV患者发生率达70％～80％，日间手术患者则为20％～80％。近年来虽采取了许多预防措施，全身麻醉后发生率仍高达20％～30％ PONV主要发生在手术后24～48小时内，但也可能持续达5天之久 * NSAID类药物贯穿围手术期全程：从术前预防镇痛到术中麻醉再到术后镇痛 * 2010年，FT的学会（ERAS学会）在瑞典的厄勒布鲁省成立， * 1st ERAS congress * Reduced length of stay following hip and knee arthroplasty in Denmark 2000-2009: from research to implementation. Husted H,?Jensen CM,?Solgaard S,?Kehlet H. Source Department of Orthopedic Surgery, Hvidovre University Hospital, Copenhagen, Denmark, henrikhusted@dadlnet.dk. Abstract INTRODUCTION: Fast-track surgery is the combination of optimized clinical and organizational factors aiming at reducing convalescence and perioperative morbidity including the functional recovery resulting in reduced hospitalization. As the previous nationwide studies have demonstrated substantial variations in length of stay (LOS) following standardized operations such as total hip and knee arthroplasty (THA and TKA), this nationwide study was undertaken to evaluate the implementation process of fast-track THA and TKA in Denmark. MATERIALS AND METHODS: All hospitals in Denmark report to the National Patient Registry, linking the type of surgery and LOS with a unique individual social security number. This study is based on primary THA and TKA from a 5.5 million population from 2000 to the end of 2009. RESULTS: The number of performed primary unilateral THA and TKA has increased from around 7,200 in 2000 to 13,800 in