脊柱结核手术加速康复外科实施流程专家共识

Expert consensus on implementation procedures for accelerated rehabilitation of spinal tuberculosis surgery

手术是脊柱结核的有效治疗方式之一。基于加速康复外科(ERAS)理念的脊柱结核手术可最大程度降低围手术期患者的生理与心理应激,减少不良反应和手术并发症的发生。目前,针对脊柱结核手术尚无完整ERAS体系协助患者从术前、术中到术后加速康复。通过查阅文献,遵循循证医学原则,经过专家组反复讨论,针对脊柱结核手术患者围手术期管理达成共识,供广大医务工作者在临床工作中参考。本共识主要内容包括:脊柱结核手术的目的及围手术期ERAS进程的主要问题,术前宣教,术前评估,抗生素使用及皮肤准备,麻醉管理,手术时机及要点,围手术期血液管理,输液管理,疼痛管理,耐药脊柱结核的检测与管理,并发症的预防和处理,医用管路管理,术后康复训练及出院后管理。

Surgical treatment is one of the effective treatments for spinal tuberculosis.Spinal tuberculosis surgery based on the concept of enhanced recovery after surgery(ERAS)can minimize perioperative physical and psychological stress of patients,and reduce the occurrence of adverse reactions and surgical complications.At present,there is no complete ERAS system for spinal tuberculosis surgery to help patients recover quickly before,during and after operation.Through consulting the literature,following the principle of evidence-based medicine and repeated discussions by the expert group,we reached a consensus on the perioperative management of patients with spinal tuberculosis surgery,which can be used as a reference for medical staff in clinical work.The main contents of this consensus included the purpose of spinal tuberculosis surgery and the main issues of perioperative ERAS process,preoperative education,preoperative comprehensive evaluation,antibiotic use and skin preparation,anesthesia management,operation timing and key points,perioperative blood management,infusion management,pain management,detection and management of drugresistant spinal tuberculosis,prevention and management of complications,medical pipeline management,rehabilitation exercise and post-discharge management.