快速康复外科(ERAS)在不同外科中的研究进展与未来趋势

Research Progress and Future Trends of Enhanced Recovery after Surgery (ERAS) in Different Surgical Specialties

摘要: 快速康复外科(Enhanced Recovery after Surgery, ERAS)作为一种以减轻手术应激、促进术后快速恢复为核心的围手术期优化管理模式。近年来在胃肠外科、肝胆外科、泌尿外科、胸外科等多个外科专科得到广泛推广。大量研究表明，ERAS能有效缩短住院时间、降低术后并发症、减轻疼痛并提升患者生活质量，同时具有明显的经济效益。不同外科领域根据手术特点对ERAS路径进行相应调整，其关键措施包括术前宣教与优化、微创技术应用、术中精细化管理及术后早期营养和活动。然而，ERAS在多专科实施过程中仍面临路径依从性不足、高危患者管理缺乏标准、团队协作不完善以及资源受限地区推广困难等问题。未来发展方向包括个体化ERAS模式的构建、基于数字化技术和人工智能的过程监测与决策支持、路径执行质量的系统评估，以及跨中心协作项目的建立，以推动ERAS在更大范围内的标准化和可持续发展。综上，ERAS已成为提升外科围手术期管理质量的重要手段，其跨专科融合与创新模式将在未来临床实践中发挥更重要作用。

Abstract: Enhanced Recovery After Surgery (ERAS), a comprehensive perioperative care model designed to mitigate surgical stress and facilitate accelerated postoperative recovery. In recent years, ERAS has been widely implemented across multiple surgical specialties, including colorectal surgery, hepatobiliary surgery, urologic surgery, and thoracic surgery. A substantial body of evidence indicates that ERAS protocols can significantly reduce hospital length of stay, lower the incidence of postoperative complications, alleviate postoperative pain, and enhance patients’ quality of life, while also offering considerable economic benefits. To accommodate the unique physiological and procedural characteristics of different surgical fields, ERAS pathways are tailored accordingly, with core interventions encompassing preoperative education and optimization, the application of minimally invasive techniques, refined intraoperative management, and early postoperative nutritional support and mobilization. Despite its demonstrated benefits, the implementation of ERAS across specialties continues to encounter several challenges. These include suboptimal adherence to pathway components, the absence of standardized approaches for managing high-risk patient populations, insufficient multidisciplinary coordination, and practical barriers to ERAS adoption in resource-limited settings. Future priorities should focus on developing individualized ERAS models, integrating digital health technologies and artificial intelligence into perioperative monitoring and decision-making, establishing systematic mechanisms for evaluating pathway compliance, and fostering multi-center collaborative networks to support wider and more sustainable adoption. Overall, ERAS has emerged as a pivotal strategy for enhancing the quality of perioperative care, and its cross-specialty integration and innovative evolution are expected to exert an increasingly important influence on clinical practice.