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西班牙麻醉、复苏和疼痛治疗学会胸外科和心血管外科分会关于纳入强化康复方案的肺手术患者的建议。

Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program.

机构信息

Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.

Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, Spain.

出版信息

Rev Esp Anestesiol Reanim (Engl Ed). 2022 Apr;69(4):208-241. doi: 10.1016/j.redare.2021.02.011. Epub 2022 May 15.

Abstract

In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyzes, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.

摘要

近年来,已经实施了多学科方案,包括在术前、术中和术后期间采取不同的行动,旨在减轻围手术期应激,从而改善接受手术干预的患者的结果。最初,这些方案是为结直肠手术制定的,从那时起,它们已经扩展到其他手术。胸外科被认为是高度复杂的,与其他术后发病率和死亡率高的手术一样,可能是最受益于实施这些方案的专业之一。这篇综述介绍了需要切除肺肿瘤的患者围手术期护理涉及的不同专业提出的建议。在准备本指南中提出的建议时,已经考虑了对接受这种干预的患者进行的荟萃分析、系统评价、随机和非随机对照研究以及回顾性研究。已经使用 GRADE 量表对建议进行了分类,一方面评估了针对每个具体方面发布的证据水平,另一方面评估了作者提出应用的建议的强度。对于这种类型的手术,最重要的建议是那些涉及术前适应、最大限度减少手术侵袭、围手术期疼痛管理卓越以及旨在提供快速术后康复的术后护理。

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