麻醉会诊在加速术后康复中的作用探讨

An investigation of the role of anesthesia consultation in enhanced recovery after surgery

目的通过我院麻醉科104例会诊病例特点及相关解决方案实施,探讨麻醉科会诊治疗后如何提高医疗安全以及有效落实加速术后康复(ERAS)的执行理念。方法选取我院麻醉科2017-03-01/2018-03-01期间麻醉会诊患者104例为研究对象。其中男31例,女73例。年龄22~80岁,ASA分级Ⅰ~Ⅲ级,术前因手术风险较高需要会诊处理的患者为98例,术后因并发症需要麻醉会诊处理的患者为6例。通过ERAS管理原则进行针对性治疗,探讨麻醉会诊在ERAS中的作用。结果在104例申请围术期麻醉会诊的病例中,术前会诊共98例(其中心血管疾病36例占会诊总数34.61%,呼吸系统疾病11例占会诊总数10.57%,内分泌疾病32例占会诊总数30.76%,其他原因19例占会诊总数18.26%),术后会诊6例(腰麻后头痛5例占会诊总数4.80%,术后腰痛1例占会诊总数0.96%)。麻醉会诊处理后的病例中,我们引进PDCA循环模式用于落实ERAS。其中83例经过我科提供调整方案积极落实ERAS如期手术,其中7例根据我科提出的要求,经相关科室协助进一步检查、治疗后延期实施手术,其中8例因存在不能进行短期调整的安全隐患放弃手术治疗。结论经麻醉科会诊治疗后,对每例术前会诊患者的病例特点进行深入探讨,参考相关会诊科室的综合意见,根据ERAS理念,给予恰当地相应处理,从而使所有患者都可以在保障医疗安全的同时加快从手术创伤中更快地康复。

Objective To investigate how to improve medical safety and implement the idea of enhanced recovery after surgery(ERAS)through anesthesia consultation.Methods One hundred and four American Society of Anesthesiologists physical statusⅠ-Ⅲpatients,among whom 98 patients were at high surgical risks and 6 patients had postoperative complications,aged 22-80 years,receiving anesthesia consultation from March 2017 to March 2018 were selected to investigate the role of anesthesia consultation in the implementation of ERAS.Results Among the 104 cases who applied for perioperative anesthesia consultation,98 cases received preoperative consultation(36 cases of coexisting cardiovascular diseases accounting for 34.61%,11 cases of respiratory diseases accounting for 10.57%,32 cases of endocrine diseases accounting for 30.76%,19 cases of other reasons accounting for 18.26%),six cases received postoperative consultation(5 cases of headache after lumbar anesthesia accounting for 4.80%,1 case of lumbago accounting for 0.96%).PDCA circulation mode was introduced to implement ERAS after anesthesia consultation.Among them,83 cases underwent surgery on schedule considering adjustments provided by anesthetists,with the active implementation of ERAS.Besides,7 cases delayed surgery,and 8 cases cancelled surgery.Conclusion Through anesthesia consultation,the characteristics of each case are thoroughly investigated.After that,with the implementation of ERAS,medical safety can be ensured and patients recovery after surgeries can be enhanced.