加速康复外科多学科团队的建设与管理

The Building and Management of Multi-disciplinary Team in the Era of Enhanced Recovery After Surgery

经过20余年的发展,加速康复外科(enhanced recovery after surgery,ERAS)理念已从结直肠外科逐步拓展到肝胆外科、泌尿外科、妇产科、头颈外科等多个学科,给医患双方带来诸多益处,如降低术后并发症和医疗费用、促进患者身心康复,同时也一定程度上缓解了医患矛盾。然而在临床实践中,ERAS理念仍存在参与方依从性不够、效果评价标准不统一、全程管理不足等问题,以致难以实现临床效果的最大化。2010年欧洲ERAS协会成立,随后发布了一系列针对各学科的ERAS指南,不仅细化了具体措施,而且强调多学科团队(multidisciplinary team,MDT)协作在落实这些措施当中的重要作用。在强调个体化医疗的当代,怎样运用MDT来集束化实施ERAS临床方案,真正实现患者身心康复,值得我们思考。本文将就ERAS理念下多学科团队的建设与管理作简要论述。

In the last two decades, enhanced recovery after surgery(ERAS) has expanded from colorectal surgery to many other disciplines, such as hepatobiliary surgery, urology, obstetrics and gynecology,and head and neck surgery, which brings much benefit to medical workers and patients, such as reducing postoperative complication and medical expenses, promoting early recovery of patients, and to some extent,alleviating the contradiction between doctors and patients. However, the practice of ERAS still encounters many problems, for example, inadequate compliance, inconsistent evaluation criteria and insufficient full-course management. In 2010, ERAS~? Society of Europe was established, followed by several discipline-tailored guidelines, which not only refined ERAS measures, but also emphasized the key role of multidisciplinary team(MDT) in carrying out these measures. In this era of personalized medicine, it ’s urgent to build up MDT to truly achieve early recovery of patients. Key issues about team building and management were discussed in this article.