“最小伤害”和“最佳照护”:加速康复外科的医学人文理念与实践  

“Minimal harm”and“optimal care”:t he concepts and practices of medical humanities in enhanced recovery after surgery

作　　者：符隆文 张常华[1,2] 许红璐[3] 程瑜[1,4] 何裕隆 FU Longwen;ZHANG Changhua;XU Hongu;CHENG Yu;HE Yuong(Clinical Medical Humanities Research Center,the Seventh Affiliated Hospital,Sun Yat-sen University,Shenzhen 518107,China;Digestive Medicine Center,the Seventh Affiliated Hospital,Sun Yat-sen University,Shenzhen 518107,China;Department of Nursing,the Seventh Affiliated Hospital,Sun Yat-sen University,Shenzhen 518107,China;School of Medicine,Sun Yat-sen University,Shenzhen 518107,China)

机构地区：[1]中山大学附属第七医院临床医学人文研究中心,广东深圳518107 [2]中山大学附属第七医院消化医学中心,广东深圳518107 [3]中山大学附属第七医院护理部,广东深圳518107 [4]中山大学医学院,广东深圳518107

出　　处：《中国医学伦理学》2024年第8期932-940,共9页Chinese Medical Ethics

基　　金：中山大学附属第七医院博士后启动基金“胃肠癌患者加速手术康复的叙事治疗与效果评估”(ZSQYRSFPD0027)。

摘　　要：近年来加速康复外科在临床上已经得到广泛应用,旨在通过循证医学优化围手术期处理措施,并以多学科协作减少手术患者的身心创伤、应激反应和并发症。从医学人文的角度考察加速康复外科的临床实践。回顾加速康复外科的发展与特点,首先指出“最小伤害”理念奠定了加速康复外科的医学人文基础。然而,“最小伤害”理念在实践中面临着有利与不伤害的差异化认知、普遍化与个性化之间的张力、康复延续性与家庭照料的落差等伦理现实难题。引入社会科学的照护视角,提出“最佳照护”作为加速康复外科的医学人文理念补充,并介绍了其内涵和实践。“最小伤害”与“最佳照护”的结合能够为加速康复外科中的医学人文关怀提供理论指导,创新医学人文走进临床的实践路径。In recent years,enhanced recovery after surgery(ERAS)has been widely used in clinical practice,aiming to optimize perioperative management measures through evidence-based medicine and reduce the physical and mental trauma,stress reactions,and complications of surgical patients through multidisciplinary collaboration.This paper examined the clinical practice of ERAS from the perspective of medical humanities,reviewed its development and characteristics,and first pointed out that the concept of“minimal harm”laid the medical humanities foundation for ERAS.However,the concept of“minimum harm”faced ethical and realistic challenges in practice,such as differentiated cognition between benefits and non-harm,the tension between generalization and personalization,and the gap between rehabilitation continuity and family care.This paper led into the caregiving perspective of social sciences,proposed“optimal care”as a supplement to the medical humanities concept of ERAS,and introduced its connotation and practice.The combination of“minimal harm”and“optimal care”can provide theoretical guidance for medical humanistic care in ERAS and innovate the practical path of medical humanities into clinical practice.

关 键 词：加速康复外科 医学人文 照护 社会科学 

分 类 号：R-05[医药卫生]