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《胃肠外科加速康复实战笔记》编委语录集锦之共话ERAS过去、现在与未来

Published at: 2015年第1卷第S1期

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  • 1专家寄语(一)

“Fast-track surgery” or “enhanced postoperative recoveryprograms” were developed almost 20 years ago, initially in minor abdominal procedures, followed by colonic surgery. The clinical and economic benefits of these programs have been repeatedly confrmed by centres around the world, and later including programs from all other surgical specialties. However, despite much research on each of the many elements included in these programs, regional and national surveys have repeatedly shown a “knowing-doing” gap from clinical research data to actual clinical implementation. In this process, however, the ERAS organisation and sister organisations in US, the Middle-East and China are doing a great job to assist in the implementation process to provide guidelines, postgraduate teaching, etc.

The present booklet from the Chinese ERAS organisation on enhanced recovery programs provides an update on the diferent care elements to be considered for implementation of a successful program in several procedures, emphasising the required close collaboration between anaesthesiologists, surgeons and nurses for a successful program.

Although most scientific documentation has appeared from colorectal procedures, the future challenge is to develop evidence-based and beter protocols across surgical specialties and hopefully this booklet will stimulate this process. In this context, we should continue to ask the simple question “Why is the patient in hospital today”and analyse the diferent pathogenic mechanisms and to enhance the development of subsequent interventional strategies.

Henrik Kehlet

Professor of Surgery at Copenhagen University, Professor of Perioperative

Terapy at Rigshospitalet, Copenhagen University, Denmark.

Honorary Fellow of the Royal College of Anaesthetists, UK, the American

College of Surgeons, the American Surgical Association, the German Surgical

Society and German Anaesthesiological Society.

 

2专家寄语(二)

Enhanced recovery afer surgery, or ERS, protocols are perhaps more accurately called modern perioperative care. Originally ERAS was termed Fast-track and was conceived, designed and implemented in Copenhagen by Professor Henrik Kehlet and his team of surgeons, anaesthetists and nurses. The implementation of these protocols resulted in major decreases in day-stay, morbidity and cost for patients undergoing colorectal surgery. While it has undergone many

iterations the principles of teamwork, decreasing surgical stress, opiate sparing multimodal anaesthesia and analgesia, early feeding, early mobilization, audit and goal seting remain the core principles of an enhanced recovery programme. These programmes have now been extended to other types of surgery including in the emergency seting.

I congratulate the authors for putting together this resource for the use of clinicians in China. Chinese surgery in many ways has lead the world in recent times with the adoption of advanced surgical techniques and minimally invasive surgery. What has lagged behind in many centres has been matching advances in perioperative care. Tis publication will go someway to correcting that. Already there are significant scientific advances coming out of major Chinese centres on the efcacy of this approach to perioperative care. It is hoped that this publication will stimulate others to add to this literature and to contribute to the exciting future of the care of the patient undergoing major surgery.

Andrew G. Hill, MBChB, MD (Thesis), EdD, FACS, FRACS

Professor of Surgery, Head of the South Auckland Clinical Campus,

Assistant Dean, Faculty of Medical and Health Sciences,

University of Auckland, Clinical Lead Research and Evaluation, Ko Awatea,

Middlemore Hospital, Counties Manukau Health, New Zealand.

 

3专家寄语(三)

加速康复外科(ERAS)是以腹腔镜技术为代表的微创外科出现之后的又一外科新理念,这一理念的施行,可以显著减少手术创伤和应激、减少并发症、缩短住院时间。ERAS起源于胃肠外科,并广泛应用于外科各专业。广东省人民医院在Kehlet教授和黎介寿院士的启蒙和帮助下,结合国内外ERAS的理念和技术,经过4年的临床实践,探索出了一系列符合我国国情的ERAS实施措施,并总结成《胃肠外科加速康复实战笔记》。这是一本方便携带的口袋书,书中所提及的措施和方法简单易行,实践性强,为基层医院更快更安全地开展ERAS提供了直接的临床技术和经验。特推荐给外科医师、麻醉科医师以及护理人员以作临床参考所用。

李宁

中华医学会肠外肠内营养学分会主任委员;

中华医学会外科学分会常务委员、营养支持学组组长;

中国医师协会外科医师分会常委

 

4专家寄语(四)

黎介寿院士在2007年将ERAS理念引入中国,初衷就是想探索出一条符合中国实际情况的加速康复道路。这些年来,众多医院都在为ERAS在普通外科的普及而探索和努力,并不断总结和推广。ERAS是一个团队性工作,外科、麻醉科、手术室、病房护理每一个环节都缺一不可、举足轻重,从术前的宣教,术中的微创治疗、保温、切口止痛,术后的疼痛评分、早期进食等一系列措施,无不体现一个团队的坚持和合作。广东省人民医院胃肠外科团队将近年来在ERAS实践中所积累的经验撰写成书,希望将ERAS这种优秀、优越的观念传播到各级医院,规范ERAS流程,服务更多的病患,祝福这个有梦想的团队!

江志伟

教授,南京军区南京总医院全军

普通外科研究所副所长,博士生导师

 

5编委寄语

  • 如果开始行动,那么最困难的部分已经结束!许多时候需要激情与坚持!更重要的是再坚持!——李勇

  • 有梦想才有希望,有梦想才会飞翔,什么都不能阻挡!——王俊江

  • 踏实做事,老实做人!——郑佳彬

  • 做别人眼中优秀的自己,做自己眼中优秀的别人,ERAS,人性关怀,从此刻开始。——杨梓锋

  • 你的价值不会因为别人看不到而减少!——吕泽坚

  • 接纳和实施ERAS,是一名外科医生佛心仙手的最好写照,每一项加速康复措施都凝结了医生对病人的关怀和责任。——吴德庆

  • ERAS,期待成为营造美好医患环境的重要环节。——韦耿周

  • 更高!更快!更强!高质量强流程快康复!——冯兴宇

  • just do It!——罗志坚

  • 敢想,更要敢做。——胡伟贤

  • ERAS的加入,使外科治疗如虎添翼!——黎人杰

  • ERAS,给你术后最精心的呵护!——黎伟豪

  • ERAS,以人为本。——罗喻文

  • 举团队之力,尽医护之心,圆患者之梦,这是ERAS的“魅力”所在。——别逢桂

  • ERAS的顺利推行,离不开具有创新之头脑和勇敢之心的领航者,也离不开开拓型的领导支持平台,更离不开各司其职、积极落实措施的优秀团队,相信ERAS实战笔记能让更多的患者受益。——刘新莲

  • ERAS实现医患共赢。——常后婵

  • ERAS改变观念,突破固化思维,使整个治疗康复过程更精准、更安全、更无痛!——杨芬玲

  • 这几年我们用“ERAS理念”指导“医护一体化责任制护理”已初见成效,坚信“积微致著”,我们一定能促进更多外科患者更加舒适的早日康复!——熊代兰

  • 敞开怀抱,迎接新的观念和挑战。——李妹

  • 实施快速康复,机遇与挑战并存!——周萍

  • 人一生其实都处于理解与被理解之中,在工作、生活中,如果都能做到相互理解、支持、帮助,还会有什么问题不能克服、解决吗?——翟艳云

  • 以心为灯,愿作生命的守护天使!——何淑茵

  • 努力才会有收获!——彭婷

  • 快速康复,真心为病人减轻疼痛,促进康复!——吴小花

  • ERAS的信念:细节决定一切,坚持决定未来!——蔡平

  • ERAS:着重于整体,落实于细节!——孙怡

  • 细节的实质是认真的态度和科学的精神,ERAS正是把小事做细,把细事做透。——蔡宇晶

  • ERAS,践行围术期医学理念。——王晟

  • ERAS:有你,有我,也有他……——张登文

  • ERAS是一个不断挖掘患者痊愈潜力、挑战医疗技术的过程 ,同时也意味着医护人员更多的辛劳付出,如此技术与情怀紧密结合,才可助患者健康之完美。——蔡观福

doi: 

10.3978/kysj.2014.1.2157
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