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减重手术中的术后加速康复

Enhanced Recovery after Surgery in Bariatric Surgery.

作者信息

Huh Yeon-Ju, Kim Dong Jin

机构信息

Department of Surgery, Bariatric and Metabolic Surgery Center, Seoul National University College of Medicine, Seoul, Korea.

Department of Surgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

出版信息

J Metab Bariatr Surg. 2021 Dec;10(2):47-54. doi: 10.17476/jmbs.2021.10.2.47. Epub 2021 Oct 21.

Abstract

The enhanced recovery after surgery (ERAS) program is now widely applied in bariatric surgeries and other surgical procedures. The ERAS program in bariatric surgery consists of various components similar to that in colorectal surgery or other procedures. The major concept of the ERAS protocol relies on a multidisciplinary and multimodal approach to resolve various problems after surgical treatment. The key principles of the ERAS program in bariatric surgery include patient education, opioid-sparing multimodal pain management, prophylaxis of postoperative nausea and vomiting, goal-directed fluid therapy, and minimizing insulin resistance and catabolism. Several guidelines and studies, including randomized clinical trials and systematic reviews, have advocated for the ERAS program in bariatric surgery, which has consistently shown advantages in shortening hospital stay without increasing morbidity. The systematic application of the ERAS program in bariatric patients results in less pain and early recovery and should be routinely recommended.

摘要

术后加速康复(ERAS)方案目前已广泛应用于减肥手术及其他外科手术中。减肥手术中的ERAS方案包含与结直肠手术或其他手术类似的多个组成部分。ERAS方案的主要理念依赖多学科、多模式方法来解决手术治疗后的各种问题。减肥手术中ERAS方案的关键原则包括患者教育、多模式镇痛以减少阿片类药物使用、预防术后恶心呕吐、目标导向性液体治疗以及尽量减少胰岛素抵抗和分解代谢。包括随机临床试验和系统评价在内的多项指南和研究都提倡在减肥手术中应用ERAS方案,该方案始终显示出在缩短住院时间且不增加发病率方面的优势。在肥胖症患者中系统应用ERAS方案可减轻疼痛并促进早期康复,应常规推荐使用。

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本文引用的文献

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Bariatric Surgery Survey 2018: Similarities and Disparities Among the 5 IFSO Chapters.
Obes Surg. 2021 May;31(5):1937-1948. doi: 10.1007/s11695-020-05207-7. Epub 2021 Jan 12.
2
Enhanced Recovery after Surgery (ERAS): a Systematic Review of Randomised Controlled Trials (RCTs) in Bariatric Surgery.
Obes Surg. 2020 Dec;30(12):5071-5085. doi: 10.1007/s11695-020-05000-6. Epub 2020 Sep 26.

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