Tovar E A
The Department of Cardiothoracic Surgery, St. Jude Medical Center, Fullerton, CA, USA.
Chest. 1998 Nov;114(5):1454-8. doi: 10.1378/chest.114.5.1454.
To establish the effects of the use of a clinical pathway that includes a minimally invasive access among patients undergoing pneumonectomy.
Prospective study from February to December of 1997.
A community hospital.
Five consecutive patients with a mean age of 60 years (range 43 to 74 years) with lung malignancies who required pneumonectomy.
Clinical pathway based on patient education, a meticulous minimally invasive operation (oblique muscle-sparing minithoracotomy), intercostal nerve cryoanalgesia, and a quick postoperative resumption of physical activity.
All five patients were extubated in the operating room. They all had unrestricted shoulder mobility in the recovery room, and none required intravenous narcotics after leaving this unit. All patients were out of bed the day of the operation, and one patient was able to ambulate freely only a few hours after the procedure. Four patients were discharged the day after surgery, and one patient was discharged the same day of the operation. None required readmission related to the procedure.
This initial experience seems to indicate that the application of this clinical pathway in patients undergoing pneumonectomy greatly accelerates their recovery and, for a select group of patients, converts it into an outpatient procedure.
确定在接受肺切除术的患者中采用包含微创入路的临床路径的效果。
1997年2月至12月的前瞻性研究。
一家社区医院。
连续5例平均年龄60岁（范围43至74岁）的肺恶性肿瘤患者，均需接受肺切除术。
基于患者教育的临床路径、细致的微创手术（斜肌保留小切口开胸术）、肋间神经冷冻镇痛以及术后快速恢复体力活动。
所有5例患者均在手术室拔管。他们在恢复室时肩部活动均不受限，离开该病房后均无需静脉注射麻醉剂。所有患者均在手术当天即可下床，1例患者在术后仅数小时就能自由行走。4例患者术后次日出院，1例患者在手术当天出院。无一例因该手术需要再次入院。
这一初步经验似乎表明，在接受肺切除术的患者中应用该临床路径可大大加速其康复，对于特定的一组患者而言，还可将其转变为门诊手术。
