骨科择期手术加速康复围手术期并存呼吸系统疾病华西医院多学科评估与处理专家共识  

Expert consensus on multidisciplinary evaluation and management of coexisting respiratory diseases in orthopedics elective surgery patients of West China Hospital under ERAS scenario

作　　者：马俊[1] 廖刃[2] 倪忠[3] 车国卫[4] 周宗科[1] 徐宏伟[2] 申永春[3] 屠重棋[1] 刘浩[1] 李箭[1] 王光林[1] 陈磊[3] 文富强[3] 梁宗安[3] 刘伦旭[4] 朱涛[2] 刘斌[2] 裴福兴[1] MA Jun;LIAO Ren;NI Zhong;CHE Guowei;ZHOU Zongke;XU Hongwei;SHEN Yongchun;TU Chongqi;LIU Hao;LI Jian;WANG Guanglin;CHEN Lei;WEN Fuqiang;LIANG Zongan;LIU Lunxu;ZHU Tao;LIU Bin;PEI Fuxing(Department of Orthopaedics,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Respiratory and Critical Care Medicine,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Thoracic Surgery,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院骨科,成都610041 [2]四川大学华西医院麻醉科,成都610041 [3]四川大学华西医院呼吸与危重症医学科,成都610041 [4]四川大学华西医院胸外科,成都610041

出　　处：《中华骨与关节外科杂志》2020年第12期969-975,共7页Chinese Journal of Bone and Joint Surgery

摘　　要：年龄大于75岁或患有慢性呼吸道疾病(如慢性阻塞性肺疾病、哮喘、慢性支气管炎和支气管扩张症等)或患有影响胸廓运动疾病(如强直性脊柱炎、类风湿关节炎、胸廓严重畸形、肥胖等)等因素会影响气道、肺通气及血气交换,这些因素导致患者围手术期肺部并发症发生率高,死亡率高,常影响骨科手术的治疗效果,更影响骨科手术加速康复进程。华西医院骨科从2012年开始,逐渐开展骨科加速康复的各项工作,同时在国家卫生与健康委员会公益性行业科研专项"关节置换术安全性与效果评价"的支持下,遵循循证医学原则并结合项目组数据库大样本数据分析,逐步总结经验,最终与华西医院呼吸与重症医学科、麻醉科及胸外科就骨科手术围手术期并存呼吸系统疾病形成了华西医院多学科评估和处理专家共识。该共识包括:老年骨科手术围手术期呼吸系统并存疾病术前控制总体目标,呼吸系统高危因素,术前、术中呼吸系统并存基础疾病评估与处理,以及术后呼吸相关并发症防治等内容,供广大骨科医师在临床工作中参考使用。Patients over 75 years old,or suffering from chronic respiratory diseases,such as chronicobstructive pulmonary disease,asthma,chronic bronchitis and bronchiectasis,or suffering from diseases that affect thoracic movement,such as ankylosing spondylitis,rheumatoid arthritis,severe thoracic disease and obesity,are prone to pulmonary complications and high mortality during the perioperative period,which often affects the therapeutic effect as well as the process of enhanced recovery after surgeries(ERAS).The department of orthopaedics of West China Hospital of Sichuan University has gradually carried out various tasks of ERAS since 2012.At the same time,with the support of public-benefit special scientific research fund of National Health Commission of the Peopled Republic of China:the safety and effect assessment of joint arthroplasty,following the principles of evidence-based medicine,combined with large sample database of the project and gradually summing up our experience and research results,we finally reached an agreement with the department of respiratory medicine,anesthesiology and thoracic surgery on the evaluation and management for patients coexisting respiratory diseases during the perioperative priod of orthopedic surgery,and formed the multidisciplinary strategy of West China Hospital.The main contents of this strategy include:the overall preoperative controlling goal of respiratory system coexisting diseases,high risk factors of respiratory system complication,the evaluation and management of pre-and intra-operative respiratory diseases,the prevention and treatment of postoperative respiratory related complications,etc.We hope this strategy would give some help to orthopedists all around the country in daily routine clinical works.

关 键 词：骨科手术 加速康复 围手术期管理 呼吸系统 并存疾病 

分 类 号：R687.3[医药卫生—骨科学]