中国早期促进术后快速康复的探索与实践

Early exploration and practice of enhanced recovery after surgery in China

加速康复外科(enhanced recovery after surgery,ERAS)旨在通过一系列处理,加速患者术后康复,该理念经过20多年的发展,至今已趋于完善。事实上在该理念尚未提出的20世纪六七十年代,我国对促进术后快速康复已经有相关探索研究,如在围手术期减少胃肠减压管和静脉输液管的放置,缩短禁食、禁饮时间即革除两管一禁,以及在保证医疗质量的前提下尽量减少患者和国家的负担即两减一保,并创新性地加入中医药措施以提高疗效及安全性。本文首先介绍我国早期在腹部外科围手术期促进术后快速康复的探索与研究,及取得的有效成果,而后从术前、术中、术后3个方面总结归纳具体举措,最终得出结论,我国在早期就意识到探索新的加快患者术后康复技术的重要性,并为此开展了大量工作,包括中西医结合举措的实施,其中部分理念沿用至今,为现在的中西医结合ERAS建设打下基础、提供新思路。

Enhanced recovery after surgery(ERAS)is a concept to accelerate the recovery for surgery patients through a series of perioperative treatment,it has been perfected after more than 20 years of development.In fact,China has already conducted extensive exploration and research into the promotion of early recovery after surgery in the 1960s and 1970s,and innovatively added traditional Chinese medicine measures to improve efficacy and safety.For instance,the concept of abolition of two tubes and one prohibition entails minimizing the use of gastrointestinal decompression tubes and intravenous infusion tubes in the perioperative period,as well as reducing the duration of fasting and water deprivation.At the same time,two reductions and one protection aims to reduce the financial strain on patients and the healthcare system while maintaining high standards of medical care.This paper firstly introduces the exploration and research on promoting early rehabilitation after surgery in the perioperative period of abdominal surgery in China,which has achieved effective results.Then,it provides a comprehensive overview of specific measures in three aspects of pre,during,and post surgery.In brief,China has recognized the significance of exploring novel techniques to expedite postoperative rehabilitation in patients at an early stage and has undertaken extensive efforts towards this goal.Some of these concepts continue to be utilized in contemporary practices,laying a solid foundation for the current ERAS integrating traditional Chinese and western medicine.