Kehlet Henrik, Wilmore Douglas W
Department of Surgical Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark.
Am J Surg. 2002 Jun;183(6):630-41. doi: 10.1016/s0002-9610(02)00866-8.
To evaluate the effect of modifying perioperative care in noncardiac surgical patients on morbidity, mortality, and other outcome measures.
New approaches in pain control, introduction of techniques that reduce the perioperative stress response, and the more frequent use of minimal invasive surgical access have been introduced over the past decade. The impact of these interventions, either alone or in combination, on perioperative outcome was evaluated.
We searched Medline for the period of 1980 to the present using the key terms fast track surgery, accelerated care programs, postoperative complications and preoperative patient preparation; and we examined and discussed the articles that were identified to include in this review. This information was supplemented with our own research on the mediators of the stress response in surgical patients, the use of epidural anesthesia in elective operations, and pilot studies of fast track surgical procedures using the multimodality approach.
The introduction of newer approaches to perioperative care has reduced both morbidity and mortality in surgical patients. In the future, most elective operations will become day surgical procedures or require only 1 to 2 days of postoperative hospitalization. Reorganization of the perioperative team (anesthesiologists, surgeons, nurses, and physical therapists) will be essential to achieve successful fast track surgical programs.
Understanding perioperative pathophysiology and implementation of care regimes to reduce the stress of an operation, will continue to accelerate rehabilitation associated with decreased hospitalization and increased satisfaction and safety after discharge. Developments and improvements of multimodal interventions within the context of "fast track" surgery programs represents the major challenge for the medical professionals working to achieve a "pain and risk free" perioperative course.
评估改变非心脏外科手术患者围手术期护理对发病率、死亡率及其他结局指标的影响。
在过去十年中，引入了疼痛控制的新方法、可减轻围手术期应激反应的技术以及更频繁地使用微创外科手术入路。评估了这些干预措施单独或联合使用对围手术期结局的影响。
我们使用关键词“快速康复外科”“加速护理计划”“术后并发症”和“术前患者准备”在1980年至今的Medline数据库中进行检索；并对检索到的纳入本综述的文章进行审查和讨论。这些信息还补充了我们自己关于外科手术患者应激反应介质、择期手术中硬膜外麻醉的使用以及多模式方法快速康复外科手术程序的试点研究。
引入新的围手术期护理方法降低了外科手术患者的发病率和死亡率。未来，大多数择期手术将成为日间手术或术后仅需住院1至2天。围手术期团队（麻醉医生、外科医生、护士和物理治疗师）的重组对于成功实施快速康复外科计划至关重要。
了解围手术期病理生理学并实施护理方案以减轻手术应激，将继续加速康复进程，减少住院时间，提高出院后的满意度和安全性。在“快速康复”外科手术计划背景下开展多模式干预措施的开发和改进，是致力于实现“无痛且无风险”围手术期过程的医学专业人员面临的主要挑战。
