食管癌围手术期加速康复外科护理专家共识

Expert consensus on surgical nursing in enhanced recovery after surgery for esophageal cancer during perioperative period

目的对食管癌ERAS护理领域提出推荐意见,制定《食管癌围手术期加速康复外科护理专家共识》,本研究旨在为食管癌患者ERAS围手术期的护理策略提供标准化的指导,并对临床护理工作起到一定的指导作用,进一步加速患者的康复。方法本研究通过系统查阅国内外文献,结合专家经验,组织国内三级甲等医院食管癌相关专家开展2轮德尔菲会诊,对共识内容进行修订与完善。结果在加速康复手术围手术期食管癌预康复的研究、营养管理、术前肠道准备、管路管理等11个方面达成专家共识:在食管恶性肿瘤患者的预康复过程中,需要进行综合评估,个体化宣教,心肺评估,有氧运动训练,贫血评估与管理等措施,并在术前采取合适的管路管理措施,如不推荐常规使用鼻胃管/鼻空肠管,早期口服摄入,以及尽早拔除胃肠减压管等,以促进患者康复,降低并发症风险,提高手术成功率。结论基于已有证据,并结合临床专家意见,整合了加速康复食管癌手术围手术期护理规范,形成共识,为临床实践提供参考。

Objective To make recommendations for surgical nursing in enhanced recovery after surgery(ERAS)for esophageal cancer(EC),to formulate Expert Consensus on Surgical Nursing in Enhanced Recovery after Surgery for Esophageal Cancer during Perioperative Period,to provide standardized guidance for perioperative nursing strategies in ERAS for patients with EC,to play a certain guiding role in clinical nursing,and to further accelerate the recovery of patients.Methods After literature review,two rounds of Delphi consultation in EC-related experts from domestic tertiary grade-A hospitals were conducted.The consensus was revised and improved.Results An expert consensus was formulated in 11 aspects,including research on pre-rehabilitation of EC during perioperative period,nutrition management,preoperative intestinal preparation and pipeline management.In the pre-rehabilitation of patients with EC,comprehensive evaluation,individualized education,cardiopulmonary evaluation,aerobic exercise training,anemia evaluation and management should be carried out,and appropriate pipeline management measures should be taken before surgery,such as not recommending routine use of nasogastric tube/nasojejunal tube,early oral intake and early removal to enhance recovery and low the risk of complications.Conclusion According to existing evidence and clinical experts,perioperative nursing norms in EARS for EC esophageal cancer surgery are integrated,and a consensus was formed to provide reference for clinical practice.