中华骨与关节外科杂志

2016, 01, v.9 1-9

中国髋、膝关节置换术加速康复——围术期管理策略专家共识

周宗科⁴ 翁习生⁵ 曲铁兵⁶ 张先龙⁷ 严世贵⁸ 曹力⁹ 朱振安¹⁰ 廖威明¹¹ 钱齐荣¹² 杨柳¹³ 朱庆生¹⁴ 吴海山¹² 史占军¹⁵ 黄伟¹⁶ 赵建宁¹⁷ 钱文伟⁵ 廖刃¹⁸ 刘斌¹⁸ 孙学礼¹⁹ 王坤正²⁰ 邱贵兴⁵ 裴福兴⁴

1.国家卫生计生委公益性行业科研专项《关节置换术安全性与效果评价》项目组 2.中华医学会骨科学分会关节外科学组 3.中国医疗保健国际交流促进会骨科分会关节外科委员会 4.四川大学华西医院骨科 5.中国医学科学院北京协和医学院北京协和医院骨科 6.北京朝阳医院骨科 7.上海市第六人民医院骨科 8.浙江大学第二附属医院骨科 9.新疆医科大学第一附属医院骨科 10.上海交通大学医学院附属第九人民医院骨科 11.中山大学附属第一医院骨科 12.上海长征医院骨科 13.第三军医大学西南医院骨科 14.第四军医大学西京医院骨科 15.南方医科大学南方医院骨科 16.重庆医科大学第一附属医院骨科 17.南京军区总医院骨科 18.四川大学华西医院麻醉科 19.四川大学华西医院精神科 20.西安交通大学医学院第二附属医院骨科

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摘要：

加速康复外科(enhanced recovery after surgery,ERAS)是采用有循证医学证据证明有效的围术期处理措施,降低手术创伤的应激反应、减少并发症、提高手术安全性和患者满意度,从而达到加速康复的目的。ERAS在髋、膝关节置换术(total hip/knee arthroplasty,THA/TKA)中的重点在于提高手术操作技术和优化围术期管理,包括减少创伤和出血、优化疼痛与睡眠管理、预防感染、预防静脉血栓栓塞症(venous thromboembolism,VTE),以及优化引流管、尿管和止血带的应用等。通过查阅文献,基于国家卫生计生委公益性行业科研专项《关节置换术安全性与效果评价》项目组数据库大样本数据分析,遵循循证医学原则,经过全国专家组反复讨论,编辑整理完成本共识,供广大骨科医师在临床工作中参考应用。本共识主要内容包括:患者教育、营养支持、麻醉管理、微创操作理念、围术期血液管理、预防感染、预防VTE、优化镇痛方案、睡眠管理、优化止血带应用、伤口管理、优化尿管应用、预防术后恶心呕吐(postoperative nausea and vomiting,PONV)、功能锻炼、出院后管理和随访管理。

关键词： 加速康复; 全髋关节置换术; 全膝关节置换术; 围术期管理;

Abstract：

Enhanced recovery after surgery(ERAS) is defined that effective perioperative management therapies proved by evidence-based medicine is applied to reduce the stress reaction and complications caused by surgery and improve the operation safety and patients' satisfaction. Enhanced recovery after total hip/knee arthroplasty(THA/TKA) focus on the improvement of surgical techniques and optimization of perioperative management, including reducing surgical trauma and blood loss, managing pain, preventing infection and venous thromboembolism(VTE), optimizing the use of drainage tube, catheter and tourniquet. By means of reading literatures and expert group discussion, based on the database of the project group for the "National Health and Family Planning Commission's public-benefit project: the safety and effect assessment of joint arthroplasty" and evidence-based medicine, we compile this consensus which mainly contains patients' education, nutritional support, anesthetic management, concept of minimally invasive operation, perioperative blood management, prevetion of infection, VTE and postoperative nausea and vomiting(PONV), optimization of analgesia, sleep management, wound management, functional exercise and postoperative follow-up management. We hope that this consensus wound give some help to orthopedic surgeon.

KeyWords： Enhanced Recovery After Surgery(ERAS); Total Hip Arthroplasty(THA); Total Knee Arthroplasty(TKA); Perioperative Management;

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[1]周宗科,翁习生,曲铁兵,等.中国髋、膝关节置换术加速康复——围术期管理策略专家共识[J].中华骨与关节外科杂志,2016,9(01):1-9.

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