加速康复外科在中国大陆胸外科临床现状——基于胸外科医生及护士调查分析

Assessing the Current Status of Enhanced Recovery after Surgery in the Usage of Web-based Survey Questionnaires by Thoracic Surgeons and Nurses Attending the Meeting in China's Mainland

背景与目的虽然加速康复外科(enhanced recovery after surgery,ERAS)理念近年来已逐渐被外科医生所熟悉和应用于临床实践中,但目前关于我国大陆胸外科医师对ERAS理念的认知和应用现状如何仍不清楚。本研究基于对参会胸外科医生和护士进行ERAS相关问题的问卷调查结果,分析加速康复外科在胸外科的应用现状和面临的困难。方法对参与第一届胸科ERAS华西论坛代表回复的773份有效问卷进行分析,问卷内容主要包括两部分:一是被调查人单位情况及个人基本情况;二是加速康复外科相关的10个问题。结果①ERAS的临床应用现状为理念大于实践,69.6%的医生和58.7%的护士认同此观点;88.5%的医生和85.7%护士均认为ERAS理念适用于所有外科。②ERAS临床应用依从性差的主要原因是方案不成熟、无共识和规范(55.6%的医生和69.1%的护士)。③ERAS临床实施的最佳团队组合是外科为主的学科协作及医护一体(62.1%的医生和70.7%的护士)。④73.7%的医生和81.9%的护士认为ERAS的评价标准应为:平均住院日、患者感受和社会满意度进行综合评价。结论加速康复外科在胸外科应用现状仍然是理念大于实践,主要原因是缺乏临床可用的规范和方案。

Background and objective Though the concept of enhanced recovery after surgery（ERAS） has been progressively known by the surgeons and applied clinically,the current status of its cognition among thoracic surgeons and application in thoracic surgery is still unknown. Based on the analysis of a survey of thoracic surgeons and nurses on chest ERAS during a national conference,we aimed to analyze the status and difficulties of the application of ERAS in thoracic surgery. Methods A total of 773 questionnaires were collected during the first West China chest ERAS Forum and analyzed. The content of the questionnaire can be divided into two parts,including the respondents＇ institute and personal information,10 questions on ERAS. Results（1） Current status of clinical application of ERAS is the concept rather than the practice： 69.6% of the surgeons and 58.7% of the nurses agreed with this view; in addition,88.5% of the doctors and 85.7% of the nurses believed that the concept of ERAS may be applicable to every branches of surgery;（2） 55.6% of the doctors and 69.1% of the nurses believed that the reason of poor clinical application of ERAS included no mature procedure,lack of consensus and specifications;（3） The best team for the clinical practice of ERAS should be based on surgeon-centered multidisciplinary cooperation and integration of medical care： 62.1% of the surgeons and 70.7% of nurses agreed with this view;（4） 73.7% of the surgeons and 81.9% of the nurses agreed that mean hospital stay,patients＇ experience in hospital and social satisfaction should be the evaluation standard of ERAS practice. Conclusion The application of ERAS in thoracic surgery is still the concept rather than the practice. The reason included the lack of clinical applicable specifications and scheme.