采用 Delphi 方法的盆腔廓清术的围手术期管理和麻醉考虑因素：PelvEx 协作的结果。
Perioperative management and anaesthetic considerations in pelvic exenterations using Delphi methodology: results from the PelvEx Collaborative.
出版信息
BJS Open. 2021 Jan 8;5(1). doi: 10.1093/bjsopen/zraa055.
BACKGROUND
The multidisciplinary perioperative and anaesthetic management of patients undergoing pelvic exenteration is essential for good surgical outcomes. No clear guidelines have been established, and there is wide variation in clinical practice internationally. This consensus statement consolidates clinical experience and best practice collectively, and systematically addresses key domains in the perioperative and anaesthetic management.
METHODS
The modified Delphi methodology was used to achieve consensus from the PelvEx Collaborative. The process included one round of online questionnaire involving controlled feedback and structured participant response, two rounds of editing, and one round of web-based voting. It was held from December 2019 to February 2020. Consensus was defined as more than 80 per cent agreement, whereas less than 80 per cent agreement indicated low consensus.
RESULTS
The final consensus document contained 47 voted statements, across six key domains of perioperative and anaesthetic management in pelvic exenteration, comprising preoperative assessment and preparation, anaesthetic considerations, perioperative management, anticipating possible massive haemorrhage, stress response and postoperative critical care, and pain management. Consensus recommendations were developed, based on consensus agreement achieved on 34 statements.
CONCLUSION
The perioperative and anaesthetic management of patients undergoing pelvic exenteration is best accomplished by a dedicated multidisciplinary team with relevant domain expertise in the setting of a specialized tertiary unit. This consensus statement has addressed key domains within the framework of current perioperative and anaesthetic management among patients undergoing pelvic exenteration, with an international perspective, to guide clinical practice, and has outlined areas for future clinical research.
背景
对接受盆腔廓清术的患者进行多学科围手术期和麻醉管理对于获得良好的手术效果至关重要。目前尚未制定明确的指南，国际上的临床实践差异很大。本共识陈述综合了临床经验和最佳实践，并系统地解决了围手术期和麻醉管理中的关键领域。
方法
采用改良 Delphi 方法，由 PelvEx 协作组达成共识。该过程包括一轮在线问卷调查，涉及受控反馈和结构化参与者响应、两轮编辑以及一轮基于网络的投票。它于 2019 年 12 月至 2020 年 2 月举行。共识定义为超过 80%的同意，而低于 80%的同意则表示低共识。
结果
最终的共识文件包含 47 项投票声明，涉及盆腔廓清术围手术期和麻醉管理的六个关键领域，包括术前评估和准备、麻醉考虑因素、围手术期管理、预测可能发生的大量出血、应激反应和术后重症监护以及疼痛管理。根据在 34 项声明上达成的共识建议制定了共识推荐。
结论
在专门的三级单位中，具有相关领域专业知识的多学科团队最适合对接受盆腔廓清术的患者进行围手术期和麻醉管理。本共识陈述在国际视角下，针对接受盆腔廓清术患者的围手术期和麻醉管理的当前框架内解决了关键领域，为临床实践提供了指导，并概述了未来临床研究的领域。
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