快速康复外科在骨科的应用新进展

Application New Progress of Enhanced Recovery after Surgery in Orthopedics

摘要: 近些年，外科理念和新技术取得了突飞猛进的发展，患者的预后显著改善。有学者提出，外科手术术后并发症很大程度与围手术期应激有关，有效地控制手术相关的应激有助于改善预后。快速康复外科理念基于机体应激反应原理而提出，在循证医学证据的基础上对一系列围手术期管理措施进行优化和整合，以降低机体应激反应和减少手术并发症，其内容涵盖了外科学、麻醉学、营养学、康复医学、护理学以及心理学等多学科。自ERAS理念发展以来，许多机构利用该理念对骨科疾病进行了围手术期优化处置，可有效减轻应激水平，改善生理状态，有利于尽早功能锻炼，从而缩短恢复所需时间，获得更好的预后效果。加速康复外科代表了围手术期模式、理念的转变，依赖于多学科团队合作、科学的循证医学证据和护理方案，其在骨科的应用前景广阔，有望革新现有治疗模式，提高骨科手术整体医疗服务质量。

Abstract: In recent years, the patient’s prognosis has been significantly improved due to the rapid development of surgical concepts and new technologies. Some claim that postoperative complications are largely related to perioperative stress and controlling surgery-related stress helps improve prognosis. The concept of enhanced recovery after surgery (ERAS) is proposed on basis of the principle of stress response. It optimizes and integrates a series of perioperative management measures based on medical evidence to reduce stress response and surgical complications, and covers many disciplines, such as surgery, anesthesiology, nutrition, rehabilitation medicine, nursing and psychology. With the development of ERAS, many institutions try to perform optimal perioperative management of orthopedic diseases. It can effectively reduce the stress level, improve the physiological state and promote early functional exercise, thereby shorten the recovery period and obtain a better prognostic effect. Enhanced recovery after surgery represents a change in perioperative models and concepts and relies on multidisciplinary teamwork, medical evidence and nursing programs. In orthopedics, it has broad application prospects and is expected to reform the existing treatment model and improve the overall medical service quality of orthopedic surgery.