《直肠肛门日间手术临床实践指南(2019版)》解读

Interpretation of clinical practice guideline for anorectal day surgery 2019 edition

随着微创外科技术、麻醉和围手术期加速康复外科(ERAS)理念的发展,日间手术模式在直肠肛门疾病领域的应用越来越受到关注。日间手术的优势在于提高医疗资源的利用效率,降低医疗成本,缩短患者工作以及家庭生活的中断时间,降低医院内感染概率。日间手术模式住院时间有限,需在24 h内完成入院、手术、复苏、出院等多项工作。因此,建立科学合理的日间手术流程,有利于顺利实施日间手术临床路径,保障患者医疗安全和满意度,高效利用医疗资源和控制医疗费用增长。国家老年疾病临床医学研究中心(湘雅)联合中国日间手术合作联盟,于2019年9月制订了《直肠肛门日间手术临床实践指南(2019)》(以下简称《指南》)并刊登于《中华胃肠外科杂志》2019年第11期上。本文基于直肠肛门日间手术流程,从适应证、术前检查、术前风险评估、健康宣教、日间手术麻醉和离开麻醉复苏室(PACU)评估、术后管理、出院评估及随访几个阶段,对《指南》涉及的细节进行补充解读,以便于各医疗机构参考并根据自身实际情况开展日间手术。

As the rapid development of minimally invasive techniques,anesthesia,and enhanced recovery after surgery(ERAS),anorectal day surgery receiving more and more attention by improving efficiency of medical care while reducing cost and hospitalized infection.However,day surgery also faces the challenge of completing the whole process from patient admission to discharge within 24 hours.Therefore,establishing a reasonable and detailed day surgery process is the cornerstone to guarantee safe medical practice and patients satisfaction.National Clinical Research Center for Geriatric Disorders(Xiangya),together with China Ambulatory Surgery Alliance formulates the clinical practice guideline for anorectal day surgery 2019 edition.Here we make some interpretations of the guidelines on the detailed process of anorectal day surgery,including indication,preoperative examination,preoperative risk evaluation,health education,assessment of day surgery anesthesia and before leaving postanesthesia care unit(PACU),postoperative management,assessment of discharge and follow-up,for the convenience of various medical centers.