围手术期外科之家进展

Progress in perioperative surgical home

以减轻应激为核心的加速康复外科(ERAS)已经为当前标准的围手术期临床实践。然而,ERAS也存在一些不足,如老年、有合并症的病人的依从性差,服务涉及范围未能覆盖整个"围手术期"以及分块化的医疗服务,使病人在围手术期接受到不连贯、碎片化的就医过程等。近年来,临床医生认识到,外科择期治疗效果的提高需要主动性的(proactive)、目标导向的术前准备,并联合早期计划性出院,以及治疗后康复过程来实现。覆盖围手术期整个阶段、以病人为中心的连续性医疗服务的围手术外科之家(PSH)成为围手术期处理的关注点。

The enhanced recovery after surgery(ERAS)strategy,which focuses on alleviating surgical stress,has become the standard perioperative clinical practice currently.However,there are also deficits during implementation of ERAS,such as poor compliance in elderly patients and patients with comorbidities,failure of the range of care to cover the whole perioperative period,and segmented medical care that makes patients receive incoherent and fragmented medical treatment during perioperative period.In recent years,clinicians have realized that improvement of effect of surgical treatment requires proactive and target-oriented preparation before surgery,combining with early planned discharge and post-treatment rehabilitation.The perioperative surgical home,which covers the entire perioperative period with patient-centered continuous care,has become a focus of perioperative management.