加速康复外科在中国大陆各区域医院胸外科的应用现状分析

Status quo of enhanced recovery after surgery in different regional thoracic surgery in the mainland of China

目的分析目前加速康复外科(ERAS)在中国大陆各区域医院胸外科的应用现状和面临的困难。方法对注册参加第一届胸科ERAS华西论坛的医护代表回复的773份有效问卷按照地域分区进行分析,问卷内容主要包括两部分:(1)调查对象单位及个人基本情况;(2)ERAS相关的10个问题。结果 (1)各区域(四川省、直辖市、东部、西部、南部、北部)分别有83.57%、83.82%、89.58%、93.75%、94.74%、92.86%的医护人员认为ERAS应适用于所有外科;61.84%、60.29%、65.97%、81.25%、73.68%、75.00%认为目前ERAS是理念大于实践;77.99%、80.88%、74.31%、78.13%、83.33%、69.64%认为平均住院日、患者感受和社会满意度均为ERAS的评价标准;58.50%、63.24%、54.86%、62.50%、70.18%、58.93%认为方案不成熟、无共识与规范以及医患安全无保障是ERAS应用依从性差的主要因素。(2)63.23%、67.65%、59.72%、68.75%、72.81%、67.86%认为外科为主的联合、学科整合和医护一体是ERAS方案实施的最佳团队组合;43.73%、44.12%、43.75%、46.88%、59.65%、41.07%认为多学科协作、外科为主的多模式和外科制定方案均是ERAS方案实施的最佳模式;72.98%、69.12%、62.50%、65.63%、80.70%、55.36%认为ERAS规范与共识、现状与进展、项目与实施应为会议的主要内容。结论各区域胸外科医护人员对ERAS的临床应用有较为一致的观点,学科整合、医护一体和多学科、多模式协作是ERAS方案实施的最佳团队与最佳模式。

Objective To analyze the current status and difficulties of ERAS applicated in thoracic surgery in different regional hospitals. Methods A total of 773 valid questionnaires were collected during the First West China Forum on Chest ERAS and analyzed by geographical distribution. The content of the questionnaire was divided into two parts, including the respondents＇ institute and personal information, as well as 10 questions about ERAS.Results There were 83.57%, 83.82%, 89.58%, 93.75%, 94.74% and 92.86% of surgeons and nurses in Sichuan province, municipalities, the eastern, western, southern and northern respectively who believed that ERAS in all surgeries should be used. There were 61.84%, 60.29%, 65.97%, 81.25%, 73.68% and 75.00% of surgeons and nurses who thought that the concept of ERAS was more in the theory than in the practice; 77.99%, 80.88%, 74.31%, 78.13%, 83.33%and 69.64% of respondents agreed that average hospital stay, patients＇ experience and social satisfaction should be the evaluation standard of ERAS practice while 58.50%, 63.24%, 54.86%, 62.50%, 70.18% and 58.93% of respondents believed that immature procedure, lack of consensus and specifications and insecurity for doctors were the reasons for poor compliance of ERAS; 63.23%, 67.65%, 59.72%, 68.75%, 72.81% and 67.86% of respondents thought that the best t eam of ERAS should be based on the combination of subject integration, surgery orientation and surgeon-nurse teamwork; 43.73%, 44.12%, 43.75%, 46.88%, 59.65% and 41.07% of respondents thought that multidisciplinary cooperation, multi-modality conducted and surgical programming should be the best way for ERAS implementation;72.98%, 69.12%, 62.50%, 65.63%, 80.70% and 55.36% of responders agreed that the ERAS forum or conference should include the norms and consensus, analysis and implementation of projects and the status and progress of ERAS.Conclusion There are more consistent views on the clinical application of ERAS in all regions. The subject integration,surgeon-nurse teamwork and multidisciplinary, multi-modality cooperation are the best team and best way for ERAS program implementation.