剖宫产术后加速康复：现状与新趋势
Enhanced Recovery After Cesarean: Current and Emerging Trends.
作者信息
Patel Kishan, Zakowski Mark
机构信息
Department of Anesthesiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd #8211, Los Angeles, CA 90048 USA.
出版信息
Curr Anesthesiol Rep. 2021;11(2):136-144. doi: 10.1007/s40140-021-00442-9. Epub 2021 Mar 2.
Abstract
PURPOSE OF REVIEW
What are the latest enhanced recovery elements for cesarean delivery?
RECENT FINDINGS
Enhanced recovery after cesarean delivery (ERAC) provides an evidenced-based system to improve maternal outcomes, functional recovery, maternal-infant bonding, and patient experience. Postsurgical recovery has evolved from a one-dimensional pain score to a holistic multidimensional approach emphasizing faster functional recovery. ERAC involves multidisciplinary efforts of the anesthesiologist, obstetrician, nursing, hospital, and patient. Components of ERAC include preoperative patient education, limited fasting, carbohydrate load, limiting opioids intra- and postoperatively, using scheduled non-opioid analgesics and supplementing with advanced therapies for women at higher risk for pain. ERAC protocols reduce opioid consumption, reduce length of stay, and improve maternal and neonatal outcomes.
SUMMARY
Implementing ERAC standardized care will likely be the most important change you can make in your practice to improve outcomes, improve quality care, help address racial disparities, and minimize opioid exposure and potential for addiction.
摘要
综述目的
剖宫产最新的加速康复要素有哪些？
最新发现
剖宫产术后加速康复（ERAC）提供了一个基于证据的系统，以改善产妇结局、功能恢复、母婴情感联结和患者体验。术后恢复已从单一维度的疼痛评分发展为强调更快功能恢复的整体多维度方法。ERAC涉及麻醉医生、产科医生、护理人员、医院和患者的多学科协作。ERAC的组成部分包括术前患者教育、缩短禁食时间、碳水化合物负荷、限制术中和术后阿片类药物的使用、使用定时非阿片类镇痛药以及为疼痛风险较高的女性补充先进疗法。ERAC方案可减少阿片类药物的使用、缩短住院时间，并改善母婴结局。
总结
实施ERAC标准化护理可能是你在实践中可以做出的最重要的改变，以改善结局、提高护理质量、帮助解决种族差异，并最大限度地减少阿片类药物暴露和成瘾可能性。
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本文引用的文献
1
Liposomal Bupivacaine.脂质体布比卡因
Anesthesiology. 2021 Feb 1;134(2):139-142. doi: 10.1097/ALN.0000000000003658.
2
Clinical Effectiveness of Liposomal Bupivacaine Administered by Infiltration or Peripheral Nerve Block to Treat Postoperative Pain.脂质体布比卡因经浸润或外周神经阻滞给药治疗术后疼痛的临床效果。
Anesthesiology. 2021 Feb 1;134(2):283-344. doi: 10.1097/ALN.0000000000003630.
3
Society for Obstetric Anesthesia and Perinatology: Consensus Statement and Recommendations for Enhanced Recovery After Cesarean.美国产科麻醉学会与围产学会：剖宫产术后加速康复的共识声明与建议
Anesth Analg. 2021 May 1;132(5):1362-1377. doi: 10.1213/ANE.0000000000005257.
4
Chronic Pain and High-impact Chronic Pain Among U.S. Adults, 2019.美国成年人慢性疼痛和高影响慢性疼痛，2019 年。
NCHS Data Brief. 2020 Nov(390):1-8.
5
The mornings after-periarticular liposomal bupivacaine infiltration does not improve analgesic outcomes beyond 24 hours following total knee arthroplasty: a systematic review and meta-analysis.关节周围包载布比卡因脂质体浸润在全膝关节置换术后 24 小时以上并不能改善镇痛效果：系统评价和荟萃分析。
Reg Anesth Pain Med. 2021 Jan;46(1):61-72. doi: 10.1136/rapm-2020-101995. Epub 2020 Oct 26.
6
Impact of labor and delivery unit policy modifications on maternal and neonatal outcomes during the coronavirus disease 2019 pandemic.在 2019 冠状病毒病大流行期间，分娩单位政策调整对母婴结局的影响。
Am J Obstet Gynecol MFM. 2020 Nov;2(4):100234. doi: 10.1016/j.ajogmf.2020.100234. Epub 2020 Sep 21.
7
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Anesth Analg. 2020 Dec;131(6):1830-1839. doi: 10.1213/ANE.0000000000005075.
8
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Anesthesiology. 2020 Aug;133(2):265-279. doi: 10.1097/ALN.0000000000003428.
9
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AJP Rep. 2020 Apr;10(2):e187-e197. doi: 10.1055/s-0040-1709681. Epub 2020 Jun 19.
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