Department of Anesthesiology, LSU School of Medicine, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
Department of Anesthesiology, North Shore Hospital, 124 Shakespeare Rd., Takapuna, Auckland, 0620, New Zealand.
Curr Pain Headache Rep. 2019 Apr 11;23(5):33. doi: 10.1007/s11916-019-0770-4.
Enhanced recovery pathways are a multimodal, multidisciplinary approach to patient care that aims to reduce the surgical stress response and maintain organ function resulting in faster recovery and improved outcomes.
A PubMed literature search was performed for articles that included the terms of metabolic surgical stress response considerations to improve postoperative recovery. The surgical stress response occurs due to direct and indirect injuries during surgery. Direct surgical injury can result from the dissection, retraction, resection, and/or manipulation of tissues, while indirect injury is secondary to events including hypotension, blood loss, and microvascular changes. Greater degrees of tissue injury will lead to higher levels of inflammatory mediator and cytokine release, which ultimately drives immunologic, metabolic, and hormonal processes in the body resulting in the stress response. These processes lead to altered glucose metabolism, protein catabolism, and hormonal dysregulation among other things, all which can impede recovery and increase morbidity. Fluid therapy has a direct effect on intravascular volume and cardiac output with a resultant effect on oxygen and nutrient delivery, so a balance must be maintained without excessively loading the patient with water and salt. All in all, attenuation of the surgical stress response and maintaining organ and thus whole-body homeostasis through enhanced recovery protocols can speed recovery and reduce complications. The present investigation summarizes the clinical application of enhanced recovery pathways, and we will highlight the key elements that characterize the metabolic surgical stress response and improved postoperative recovery.
强化康复路径是一种多模式、多学科的患者护理方法，旨在减轻手术应激反应，维持器官功能，从而实现更快的康复和更好的结果。
对包括代谢性手术应激反应考虑因素以改善术后恢复的术语的 PubMed 文献进行了检索。手术应激反应是由于手术过程中的直接和间接损伤引起的。直接手术损伤可由组织的解剖、牵拉、切除和/或操作引起，而间接损伤是由于低血压、失血和微血管变化等事件引起的。更大程度的组织损伤将导致更高水平的炎症介质和细胞因子释放，最终导致体内免疫、代谢和激素过程，从而引发应激反应。这些过程导致葡萄糖代谢、蛋白质分解代谢和激素失调等改变，所有这些都会阻碍康复并增加发病率。液体疗法对血管内容量和心输出量有直接影响，从而对氧和营养物质的输送产生影响，因此必须在不使患者过度水合和盐负荷的情况下保持平衡。总之，通过强化康复方案减轻手术应激反应并维持器官和全身内环境稳定，可以加速康复并减少并发症。本研究总结了强化康复路径的临床应用，并将重点介绍描述代谢性手术应激反应和改善术后恢复的关键要素。
