Engelman R M, Rousou J A, Flack J E, Deaton D W, Humphrey C B, Ellison L H, Allmendinger P D, Owen S G, Pekow P S
Department of Surgery, Baystate Medical Center, Springfield, Massachusetts 01199.
Ann Thorac Surg. 1994 Dec;58(6):1742-6. doi: 10.1016/0003-4975(94)91674-8.
A new approach termed "fast-track recovery" ws undertaken at both the Baystate Medical Center and Hartford Hospital. The fast-track protocol involves the following principles: (1) preoperative education; (2) early extubation; (3) methylprednisolone sodium succinate before bypass followed by dexamethasone for 24 hours postoperatively; (4) prophylactic digitalization, metoclopramide HCl, docusate sodium, and ranitidine HCl; (5) accelerated rehabilitation; (6) early discharge; (7) a dedicated fast-track coordinator to perform both daily telephone contact and a 1-week postoperative examination; and (8) a routine 1-month postoperative visit with a PA or MD. To evaluate the effects of this approach on patient care, a retrospective 1-year analysis was undertaken in both institutions with all coronary artery bypass grafting patients compared in a consecutive manner before the origin of the fast-track protocol and subsequent to its beginning. There were 280 patients in the fast-track and 282 in the non-fast-track group. The two groups were not significantly different except inexplicably there was a lower ejection fraction in the fast-track group and a longer cross-clamp time. Postoperatively, the mean time to extubation decreased from 22.1 to 15.4 hours, and peak weight gain decreased from 2.8 to 1.6 kg from the non-fast-track to the fast-track group (p < 0.01). This was accompanied by significant (p < 0.001) decreases in intensive care unit duration from 2.4 to 1.9 days and in postoperative length of stay from 8.3 to 6.8 days from the non-fast-track to the fast-track group. There was no increase in morbidity or mortality associated with the fast-track protocol either early or late. Thirty-day hospital readmission was not significantly different between the two groups. Fast-track methodology is effective, and we routinely employ this approach for all patients undergoing cardiopulmonary bypass.
贝斯州医疗中心和哈特福德医院都采用了一种名为“快速康复”的新方法。快速康复方案包括以下原则：（1）术前教育；（2）早期拔管；（3）体外循环前使用琥珀酸钠甲泼尼龙，术后24小时使用地塞米松；（4）预防性洋地黄化、盐酸甲氧氯普胺、多库酯钠和盐酸雷尼替丁；（5）加速康复；（6）早期出院；（7）由一名专门的快速康复协调员进行每日电话联系和术后1周检查；（8）术后1个月由医师助理或医生进行常规复诊。为了评估这种方法对患者护理的影响，两家机构对所有冠状动脉搭桥手术患者进行了回顾性1年分析，将快速康复方案实施前和开始后的患者进行连续比较。快速康复组有280例患者，非快速康复组有282例患者。两组之间没有显著差异，但令人费解的是，快速康复组的射血分数较低，体外循环时间较长。术后，快速康复组的平均拔管时间从22.1小时降至15.4小时，非快速康复组到快速康复组的体重峰值增加量从2.8千克降至1.6千克（p<0.01）。同时，快速康复组的重症监护病房住院时间从2.4天显著缩短至1.9天（p<0.001），术后住院时间从8.3天显著缩短至6.8天。快速康复方案在早期或晚期均未增加发病率或死亡率。两组之间的30天再入院率没有显著差异。快速康复方法是有效的，我们常规对所有接受体外循环的患者采用这种方法。
