Che Guowei, Liu Lunxu
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
Zhongguo Fei Ai Za Zhi. 2017 Aug 20;20(8):549-554. doi: 10.3779/j.issn.1009-3419.2017.08.09.
The concept of enhanced recovery after surgery (ERAS) has already been accepted by almost all the clinicians and nurses, the practice of which is based on interdisciplinary cooperation. The reason is still unclear why the effect of ERAS varies a lot though the same ERAS scheme is used. The main cause may be the same ERAS scheme can not be suitable for different patients. In other words, does ERAS also need to conform to Precision Medicine Theory? This study is focused on the necessity and clinical efficacy of "Precision ERAS" performed in lung cancer patients. The conclusions are the following: first of all, an accurate judgment of patients who need ERAS should be done properly before surgery, which means that the high risks assessment should be done accurately. Secondly, a specific ERAS scheme should be carried out in each independent patient who has obvious clinical symptoms in order to alleviate clinical symptoms and improve the ptients' quality of life (QOL). Thirdly, for the asymptomatic patitents who also don't have severe concomitant diseases, process-optimized ERAS should be selected to make patients feel more comfortable and shorten the average length of stay (ALOS). To summary, "subtraction" instead of "addition" should be considered when performing ERAS.
手术加速康复(ERAS)的理念已被几乎所有临床医生和护士所接受,其实施基于多学科合作。尽管采用了相同的ERAS方案,但ERAS的效果为何差异很大,原因仍不清楚。主要原因可能是相同的ERAS方案并不适用于所有患者。换句话说,ERAS是否也需要遵循精准医学理论?本研究聚焦于对肺癌患者实施“精准ERAS”的必要性及临床疗效。结论如下:首先,术前应准确判断哪些患者需要ERAS,即要准确进行高风险评估。其次,对于有明显临床症状的每位独立患者,应实施特定的ERAS方案,以缓解临床症状并提高患者生活质量(QOL)。第三,对于无症状且无严重合并症的患者,应选择流程优化的ERAS,以使患者感觉更舒适并缩短平均住院日(ALOS)。总之,实施ERAS时应考虑“减法”而非“加法”。