乳房重建最佳围手术期护理的共识性综述：术后加速康复（ERAS）学会推荐意见
Consensus Review of Optimal Perioperative Care in Breast Reconstruction: Enhanced Recovery after Surgery (ERAS) Society Recommendations.
作者信息
Temple-Oberle Claire, Shea-Budgell Melissa A, Tan Mark, Semple John L, Schrag Christiaan, Barreto Marcio, Blondeel Phillip, Hamming Jeremy, Dayan Joseph, Ljungqvist Olle
机构信息
Calgary, Alberta, and Toronto, Ontario, Canada; Duarte, Calif.; Recife, Pernambuco, Brazil; Ghent, Belgium; New York, N.Y.; and Örebro, Sweden.
From the Departments of Surgery, Oncology, and Anesthesiology and Pain Medicine, University of Calgary; the Tom Baker Cancer Centre; the Cancer Strategic Clinical Network, Alberta Health Services; the City of Hope National Medical Center; the Department of Surgery, University of Toronto; the Department of Plastic and Reconstructive Surgery, University Hospital of Ghent; Memorial Sloan Kettering Cancer Center; Department of Surgery, Faculty of Medicine and Health, Örebro University; and private practice.
出版信息
Plast Reconstr Surg. 2017 May;139(5):1056e-1071e. doi: 10.1097/PRS.0000000000003242.
BACKGROUND
Enhanced recovery following surgery can be achieved through the introduction of evidence-based perioperative maneuvers. This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery and to provide evidence-based recommendations for an enhanced perioperative protocol.
METHODS
A systematic review of meta-analyses, randomized controlled trials, and large prospective cohorts was conducted for each protocol element. Smaller prospective cohorts and retrospective cohorts were considered only when higher level evidence was unavailable. The available literature was graded by an international panel of experts in breast reconstructive surgery and used to form consensus recommendations for each topic. Each recommendation was graded following a consensus discussion among the expert panel. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society.
RESULTS
High-quality randomized controlled trial data in patients undergoing breast reconstruction informed some of the recommendations; however, for most items, data from lower level studies in the population of interest were considered along with extrapolated data from high-quality studies in non-breast reconstruction populations. Recommendations were developed for a total of 18 unique enhanced recovery after surgery items and are discussed in the article. Key recommendations support use of opioid-sparing perioperative medications, minimal preoperative fasting and early feeding, use of anesthetic techniques that decrease postoperative nausea and vomiting and pain, use of measures to prevent intraoperative hypothermia, and support of early mobilization after surgery.
CONCLUSION
Based on the best available evidence for each topic, a consensus review of optimal perioperative care for patients undergoing breast reconstruction is presented.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
背景
通过引入循证围手术期策略可实现术后加速康复。本综述旨在就接受乳房重建手术患者的最佳围手术期管理达成共识，并为强化围手术期方案提供循证建议。
方法
针对每个方案要素，对荟萃分析、随机对照试验和大型前瞻性队列研究进行系统综述。仅在缺乏更高水平证据时才考虑较小的前瞻性队列研究和回顾性队列研究。现有文献由国际乳房重建外科学专家小组进行分级，并用于形成每个主题的共识性建议。在专家小组进行共识讨论后，对每项建议进行分级。这些建议的制定得到了术后加速康复协会的认可。
结果
接受乳房重建患者的高质量随机对照试验数据为部分建议提供了依据；然而，对于大多数项目，除了来自非乳房重建人群高质量研究的外推数据外，还考虑了目标人群中较低水平研究的数据。共针对18项独特的术后加速康复项目制定了建议，并在本文中进行了讨论。关键建议支持使用减少阿片类药物的围手术期药物、最短的术前禁食和早期进食、采用可减少术后恶心呕吐和疼痛的麻醉技术、采取措施预防术中低体温以及支持术后早期活动。
结论
基于每个主题的最佳现有证据，本文对接受乳房重建患者的最佳围手术期护理进行了共识性综述。
临床问题/证据水平：治疗性，V级
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