手术后加速康复的历史启示与现实思考

Historical inspiration and practical thinking of enhanced recovery after surgery

近年来,手术后加速康复(ERAS)受到外科领域的关注。ERAS是患者围术期处理的新模式,其更加关注患者自身对医疗的感受,而不同于以往完全由医疗实施者主导的医疗模式。因此,ERAS更加人性化,更加合理。在保证医疗安全的前提下,ERAS通过一系列措施,特别是循证医学手段优化围术期管理,促进患者康复,并伴有一定的经济和社会效益。笔者系统回顾ERAS的发展历史,对ERAS的由来和历程有了更清楚的认识,并追溯20世纪60年代我国外科学界提出的"两减一保"和"革除两管一禁"的围术期处理模式变革。医学前辈们当年追求的目标和具体措施与现今ERAS惊人的相似,堪称"ERAS的启蒙者"。在ERAS广泛开展的今天,人们应该客观地评价ERAS这一新医疗模式,建立一个以患者为核心的医疗体系,从学术的角度推进ERAS的发展,实现"没有危险和疼痛手术"的最终目标。

In recent years,enhance recovery after surgery(ERAS)has attracted many attentions in the surgical field.ERAS is a new model of perioperative management,in which more attention is paid to patients′perception to the medical treatment.This new medical model is different from the past one which is completely led by medical practitioners,thus full of humanistic concerns and rationality.With the premise of medical safety guaranteed,a series of measures,especially evidence-based medical interventions,are implemented to optimize the perioperative management and promote the recovery of patients in ERAS.A certain level of economic and social benefit will be gained with this process.The development history of ERAS was systemically reviewed in current editorial to help the readers to get a better understanding of the origin and evolving process of ERAS.It tracked back to the 1960s when"two reductions and one guarantee"and"removal of two tubes and one prohibition"were proposed as a revolutional perioperative management mode by the surgical community in our country.The goals pursued and measures implemented by our surgical predecessors back in those days were astonishingly similar to those in today′s ERAS practice.They actually enlightened the initiation of ERAS in China.While ERAS is widely implemented nowadays,this new medical model should be objectively evaluated.A patient-centered medical system should be built,and ERAS should be promoted from an academic perspective,through which the ultimate goal of"surgery without danger and pain"could be finally achieved.