ERAS在普外科的应用学习课件.ppt

精 * 精 精 * thoracic epidural analgesia using low-dose local anaesthetic and opioids should be used in open surgery. For breakthrough pain, titration to minimise the dose of opioids may be used. In laparoscopic surgery, an alternative to TEA is a carefully administered spinal analgesia with a low-dose, longacting opioid. In connection with TEA withdrawal, NSAIDs and Paracetamol should be used. 精 精 * 精 精 * 精 精 * 精 精 * 精 精 * 精 精 * 快速康复外科理念主张术后早期活动。术后长期卧床会降低肌肉强度，损害肺功能及组织氧化能力、加重静脉淤滞及血栓形成 Optimizing perioperative management of patients undergoing colorectal surgery: what is new? Environment should encourage independence Out of bed x 2h on day of surgery Out of bed x 6h every day after 精 精 * 精 精 * A multimodal approach with epidural and near-zero fluid balance is recommended. Oral laxatives and chewing gum given postoperatively are safe, and may accelerate gastrointestinal transit. 精 精 * 精 精 * 精 精 * Patients should be allowed a normal diet after surgery without restrictions. They should be cautioned to begin carefully and increase intake according to tolerance over 3-4 days. Enteral tube feeding should be given only on specific indications and parenteral nutrition should not be employed routinely. Patients should be screened for nutritional status and if at risk of under-nutrition given active nutritional support. Perioperative fasting should be minimised. Postoperatively patients should be encouraged to take normal food as soon as lucid after surgery. ONS may be used to supplement total intake. 精 精 * A multimodal approach with epidural and near-zero fluid balance is recommended. Oral laxatives and chewing gum given postoperatively are safe, and may accelerate gastrointestinal transit. 精 精 * 精 精 * 精 精 * Henrik Kehlet 教授在其提出ERAS 概念的文章《多模式方法控制术后病生和康复》中，认为ERAS包括如下要素： 术前宣教、减少应激、缓解疼痛、锻炼、肠内营养等。我们可以看到：缓解疼痛是ERAS的重要组成部分 精 精 * 精 精 * 精 精 * 精 精 * 精 精 * 精 精 * 精 精 * 精 精 * ERAS学会目前发布的普外科指南是四个分别是胰十二指肠切除术，直肠、盆腔择期手术，择期结肠手术和新出的胃切除术 精 精 * 精 精 * 所有患者在术前应接受专门的咨询服务 针对手术和麻醉过程的术前宣教可能会减少恐