一项针对接受电视辅助胸腔镜手术肺叶切除术患者的物理运动疗法及术后加速康复的综合方案。
A comprehensive protocol for physiokinesis therapy and enhanced recovery after surgery in patients undergoing video-assisted thoracoscopic surgery lobectomy.
作者信息
Bertani Alessandro, Ferrari Paolo, Terzo Danilo, Russo Emanuele, Burgio Gaetano, De Monte Lavinia, Raffaele Francesco, Droghetti Andrea, Crisci Roberto
机构信息
Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy.
Division of Thoracic Surgery, A. Businco Cancer Center, Ospedale Brotzu, Cagliari, Italy.
出版信息
J Thorac Dis. 2018 Mar;10(Suppl 4):S499-S511. doi: 10.21037/jtd.2018.02.55.
BACKGROUND
Video-assisted thoracoscopic surgery (VATS) lobectomy has recently been adopted as the gold standard surgical option for the treatment of early stage non-small cell lung cancer. Enhanced recovery after surgery (ERAS) is being progressively adopted in thoracic surgery to improve the postoperative outcomes. Even if the benefits of ERAS are universally accepted, to date a standardized and uniform approach has not been described in the medical literature. The Italian VATS group has recently proposed to include in the VATS lobectomy database a structured protocol for ERAS.
METHODS
The ERAS section of the Italian VATS group is proposing a comprehensive ERAS protocol within the VATS lobectomy database, allowing the prospective collection of a dedicated set of data. Separate sections of the protocol are dedicated to different topics of ERAS. This study is specifically dedicated to the section of physiokinesis therapy. The medical literature will be extensively reviewed and a physiotherapy (PT) protocol of ERAS will be presented and discussed. A seta of structured clinical pathways will also be suggested for adoption in the VATS Group database.
DISCUSSION
Pre- and post-operative adoption of an ERAS protocol in patients undergoing VATS lobectomy may promote an improved post-operative course, a shorter hospital stay and an overall more comfortable patients' experience. The mainstays of a physiokinesis therapy ERAS protocol are patients' education, constant physical and respiratory therapy sessions, and adoption of adequate devices. Although many studies have investigated the usefulness of physical and respiratory physiokinesis therapy, a comprehensive ERAS protocol for VATS lobectomy patients has not yet been described. The proposed ERAS platform, adopted by the VATS Group database, will contribute to a prospective data collection and allow a scientific analysis of the results.
背景
电视辅助胸腔镜手术（VATS）肺叶切除术最近已被用作治疗早期非小细胞肺癌的金标准手术选择。胸外科手术中逐渐采用加速康复外科（ERAS）以改善术后结果。即使ERAS的益处已被普遍接受，但迄今为止，医学文献中尚未描述标准化和统一的方法。意大利VATS小组最近提议在VATS肺叶切除术数据库中纳入一个ERAS结构化方案。
方法
意大利VATS小组的ERAS部门正在VATS肺叶切除术数据库中提出一个全面的ERAS方案，允许前瞻性收集一组专门的数据。该方案的不同部分专门针对ERAS的不同主题。本研究专门针对物理运动疗法部分。将广泛回顾医学文献，并提出和讨论ERAS的物理治疗（PT）方案。还将建议一套结构化临床路径以供VATS小组数据库采用。
讨论
在接受VATS肺叶切除术的患者中术前和术后采用ERAS方案可能会促进术后过程改善、缩短住院时间并使患者总体体验更舒适。物理运动疗法ERAS方案的主要内容包括患者教育、持续的物理和呼吸治疗课程以及采用适当的设备。尽管许多研究调查了物理和呼吸物理运动疗法的有用性，但尚未描述针对VATS肺叶切除术患者的全面ERAS方案。VATS小组数据库采用的拟议ERAS平台将有助于前瞻性数据收集并允许对结果进行科学分析。
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