骨科快速康复理念及应用(课件).pptVIP

****广义上，ERAS方案构成可大致分为术前、围手术期和术后干预。术前术前咨询和培训缩短禁食时间及术前碳水化合物负荷避免机械性肠道准备深静脉血栓形成预防预防性抗生素治疗围手术期高氧吸入低体温预防目标导向术中液体疗法手术径路和切口避免术后留置引流管和鼻胃管短期硬膜外止痛和局部神经阻滞术后避免使用阿片类药物，应与对乙酰氨基酚和NSAIDS应用术后早期进食术后早期活动限制静脉补液量审查*********Marianne就髋关节置换患者术中保温问题进行了研究，通过将术中体温提高0．5℃，结果发现术中失血量显著减少。**********Near-zerofluidbalanceaswellasavoidingoverloadofsaltandwaterresultsinimprovedoutcomes.Perioperativemonitoringofstrokevolumewithtrans-oesophagealDopplertooptimizecardiacoutputwithfluidbolusesimprovesoutcomes.Balancedcrystalloidsshouldbepreferredto0.9%saline*****广义上，ERAS方案构成可大致分为术前、围手术期和术后干预。术前术前咨询和培训缩短禁食时间及术前碳水化合物负荷避免机械性肠道准备深静脉血栓形成预防预防性抗生素治疗围手术期高氧吸入低体温预防目标导向术中液体疗法手术径路和切口避免术后留置引流管和鼻胃管短期硬膜外止痛和局部神经阻滞术后避免使用阿片类药物，应与对乙酰氨基酚和NSAIDS应用术后早期进食术后早期活动限制静脉补液量审查****Postoperativepainisstillinadequatelyrelieveddespitesubstantialimprovementsintheknowledgeofthemechanismsandtreatmentofpain[1].Evidencesuggeststhatinadequatereliefofpostoperativepainmayresultinharmfulphysiologicandpsychologicconsequencesthatleadtosignificantmorbidityandmortality[2],whichmaydelayrecoveryandthereturntodailyliving[3].Inaddition,thepresenceofpostoperativesymptoms,includingpain,significantlycontributestopatients’dissatisfactionwiththeiranesthesiaandsurgicalexperience[4].Mostimportantly,ithasbeenrecognizedthatinadequatelytreatedpostoperativepainmayleadtochronicpain,whichisoftenmisdiagnosedandneglected[5,6].Thisarticlereviewsthephysiologicandpsychologicconsequencesofinadequatepainrelief,withanemphasisonchronicpersistentpostoperativepain.*****2011年，Henrik等撰文《Whystillinhospitalafterfast-trackhipandkneearthroplasty?》，即《为何膝/髋关节置换术后依旧无法尽早出院？》，探讨分析了影响骨科大手术后影响患者出院的因素。他们的分析发现：疼痛、眩晕和全身乏力是影响患者出院的主要因素。而疼痛，是骨科手术后延迟患者出院的第一因素！******Subacutepainandfunctionafterfast-trackhipandkneearthroplasty.TKA患者在