加速康复外科理念下多学科团队协作术前准备对患者术后恢复的影响  

Effects of multidisciplinary preoperative preparation mode on postoperative recovery under the concept of enhanced recovery after surgery

作　　者：邹文军[1] 刘飞[2] 赵泽宇 何富强[1] 郭波 陈祖权 ZOU Wenjun;LIU Fei;ZHAO Zeyu;HE Fuqiang;GUO Bo;CHEN Zuquan(Department of Anesthesiology,Fourth People’s Hospital of Sichuan Province,Chengdu 610016,Sichuan,China;不详)

机构地区：[1]四川省第四人民医院麻醉科,四川成都610016 [2]四川大学华西医院麻醉科 [3]成都中医药大学附属四川省康复医院麻醉科

出　　处：《上海医学》2021年第11期836-840,共5页Shanghai Medical Journal

摘　　要：目的探讨加速康复外科(ERAS)理念下MDT术前准备模式对患者术后恢复的影响。方法选取2015年1月-2019年12月在四川省第四人民医院实施ERAS理念下MDT术前准备后行手术的4773例有并存疾病的患者(试验组),另从医院信息系统中选取2010年1月-2014年12月行手术的4649例有并存疾病的患者(对照组)。记录所有患者的一般资料、并存疾病、来源科室,以及经麻醉科会诊、麻醉科早期介入术前准备、术前讨论、疑难病例讨论、建议放弃手术、非计划再次手术的患者比例,以麻醉科医师参与度为主要观察指标。记录围手术期患者不良事件发生情况,分析其诱因构成及转归。记录试验组中有无麻醉科医师参与患者的相关信息,包括NYHA心功能分级≥Ⅲ级、ASA分级≥Ⅲ级、麻醉开始后手术取消、术后24 h再次手术、术后24 h死亡的患者比例。结果两组间患者的一般资料、合并各种疾病患者所占比例、各来源科室分布的差异均无统计学意义(P值均>0.05)。试验组经麻醉科会诊的患者比例[相对危险度(RR)=6.198,95%CI为5.639~6.812]、麻醉早期介入术前准备的患者比例(RR=12.662,95%CI为1.657~96.754)、术前讨论的患者比例(RR=9.253,95%CI为3.305~25.905)、疑难病例讨论的患者比例(RR=4.782,95%CI为2.503~9.133)、建议放弃手术的患者比例(RR=11.688,95%CI为1.520~89.853)均显著高于对照组(P值均<0.01),非计划再次手术的患者比例(RR=6.673,95%CI为1.507~29.556)、麻醉开始后手术取消的患者比例(RR=3.764,95%CI为1.051~13.485)均显著低于对照组(P值分别<0.05,0.01)。试验组中有麻醉科医师参与组NYHA心功能分级≥Ⅲ级、ASA分级≥Ⅲ级的患者比例均显著高于无麻醉科医师参与组(P值均<0.01),麻醉开始后手术取消的患者比例显著低于无麻醉科医师参与组(P<0.05);两组间术后24 h再次手术、术后24 h死亡患者比例的差异均无统计学意义(P值均>0.05)。试验组Objective To investigate the effect of multidisciplinary team(MDT)preoperative preparation on postoperative recovery under the concept of enhanced recovery after surgery(ERAS).Methods A totalof 4773 patients with comorbidity,who underwent surgical treatment in the Fourth People’s Hospital of Sichuan Province from January 2015 to December 2019 after MDT preoperative preparation under the concept of ERAS,were selected as experiment group,and 4649 patients with comorbidity who underwent surgical treatment from January 2010 to December 2014 were assigned to control group.Patients’general information,basic diseases,source departments,and the proportion of patients consulted by the anesthesiologists,preoperative preparation for early anesthesia intervention,preoperative discussion,difficult case discussion,recommended abandonment of surgery and unplanned reoperation were recorded.The participation of anesthesiologists was the main observation index.The occurrence of adverse events in perioperative period was recorded,and its causes and outcome were analyzed.The relevant information with or without the participation of anesthesiologists in the experiment group,including the proportion of patients with New York Heart Association(NYHA)cardiac function grade≥Ⅲ,American Society of Anesthesiologists(ASA)grade≥Ⅲ,cancellation of operation after anesthesia,reoperation 24 h after operation,and death 24 h after operation were recorded.Results There were no significant differences in the general data,the proportion of patients with complications,or the distribution of departments between the two groups(P>0.05).The proportion of patients with anesthesia consultation(risk ratio(RR)=6.198,95%confidence interval(CI):5.639-6.812),the proportion of patients prepared for early anesthesia intervention(RR=12.662,95%CI:1.657-96.754),the proportion of patients discussed before operation(RR=9.253,95%CI:3.305-25.905),the proportion of patients with difficult case discussion(RR=4.782,95%CI:2.503-9.133),and the proportion of patients

关 键 词：加速康复外科 多学科团队协作 合并症 手术前期间 手术后不良事件 

分 类 号：R614[医药卫生—麻醉学]