加速康复外科指南在我国25个省份三级甲等医院妇科的应用情况调查

Survey on implementation of Enhanced Recovery After Surgery Guidelines among gynecologic patients in tertiary hospitals in China

目的了解加速康复外科指南在中国三级甲等医院妇科围手术期的应用情况。方法根据"妇科及妇科肿瘤加速康复外科指南"设计调查问卷,对中国25个省、市、自治区的219所三级甲等医院"妇科及妇科肿瘤加速康复外科指南"应用情况进行调查。结果 "妇科及妇科肿瘤加速康复外科指南"中各项策略在中国三级甲等医院实施率低于30%的项目包括术前不常规剃毛、术前不常规机械性灌肠、禁食禁饮时间、改良术后咀嚼口香糖及术中使用保暖装置;实施率大于70%的项目包括术前预防性使用抗菌药物、术后应用弹力袜或压力泵、及术后24 h拔除导尿管和起床活动;实施率为30%～70%的项目包括设立术前教育与咨询部门、术前4周停止吸烟/酗酒、深静脉血栓形成高危患者术前使用抗血栓药物、术前/术中使用弹力袜或压力泵、及术后24 h停静脉输液和给予常规饮食策略。结论"妇科及妇科肿瘤加速康复外科指南"在中国三级甲等医院未完全落实,如何将以循证为基础的指南策略更好地应用于临床,是当前重要任务之一。

Objective To understand the implementation status of Enhanced Recovery After Surgery （ERAS） guidelines among gynecologic patients in tertiary hospitals in China. Methods Investigation questionnaire was de- signed according to ERAS guidelines,and 219 tertiary hospitals in 25 provinces,cities and autonomous regions in China were investigated. Results The ERAS items with implementation rates less than 30% were no routine pre- operative hair removal,no routine preoperative mechanical bowel preparation,duration of fasting,postoperative gum chewing and using intra-operative warming equipments;the items with implementation rates greater than 70% were preoperative preventative using antibiotic medication,routine use of compression stockings or intermittent pneumatic compression after surgery,urinary catheter removal and early mobilization within 24 hours after surgery;items with implementation rates between 30% and 70% were establishing preoperative patient education and counseling depart- ment,ceasing smoking/drinking four weeks before surgery,antithrombotic agents consumption for deep vein thrombo- sis high risk patients before surgery,use of compression stockings and intermittent pneumatic compression before surgery and during surgery,intravenous fluid treatment termination and regular diet initiation within the first 24 hours after surgery. Conclusion The implementation status of ERAS guidelines for gynecologic/oncology care was not optimistic in tertiary hospitals in China. One of the current key points is to better implement strategies from evidence-based guidelines into clinical practice.