现代麻醉与快速康复外科课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2017-1-31,#,现代麻醉与快速康复外科,BMJ 2001;322:4736,丹麦,H Kehlet,教授,于,1997,年提出,ERAS,概念,丹麦哥本哈根大学,Henrik Kehlet,教授与,1997,年提出,ERAS,概念，,其本人被誉为“快速康复外科”之父。,Henrik Kehlet,教授,Br J Anaesth,1997;78:606-17.,ERAS,一个崭新的理念,ERAS,stands for,E,nhanced,R,ecovery,A,fter,S,urgery,功能状态,禁食、卧床休息,营养,镇痛,运动,减少创伤及应激,ERAS,理念的核心,病理生理学的核心原则：减少创伤及应激,Br J Anaesth 1997;78:606-17.,更全面地重视,微创理念,激素,创伤,炎症反应,减轻,应激反应,的干预措施,ERAS,在多个领域得到广泛应用,BMJ 2001;322:4736,多个领域已制定了相应的,ERAS,指南共识,NHS-ERAS,指南,ASGBI-ERAS,指南,普外科,ERAS,应用,最早、,最为,成功的领域,早在,2005,年，,已发布欧洲,版,ERAS,专家共识指导临床工作,2009,年,，,ASGBI,（英国外科协会）发布快速康复方案实施指南,2012,年，,ERAS,学会发布,普外科三大,ERAS,指南，规范临床工作,Clinical Nutrition 31(2012)783,-,800,Clinical Nutrition 31(2012)801,-,816,Clinical Nutrition 31(2012)817,-,830,ERAS,的实施离不开麻醉的配合,ERAS,的实施离不开麻醉的配合,ASA,指南对禁食时间的推荐,美国麻醉学会,ASA,对禁食时间的推荐,Anesthesiology 2002;96:100417,体温,36,NICE clinical guideline 65 Inadvertent perioperative hypothermia,平衡晶体液,优于,0.9,的生理盐水,监测,FTc,和,SV,FTc,350 ms,FTc,350 ms,或,SV,下降,10%,是,胶体刺激,7 ml/kg,，首次大剂量推注（如,FTc,较低）,3 ml/kg,，后续推注（或首次改善,SV,治疗）,FTc,350 ms,监测,FTc,和,SV,自上次大剂量推注或测定后，,SV,升高,10%,FTc,400 ms,监测,FTc,和,SV,否,否,是,是,Guidelines for implementation of enhanced recovery protocols-December 2009,否,否,FTc,：降主动脉血流速度（,Velocity of biood fiow in the descending aorta,）,SV,：每搏输出量（,stroke volume,）,Br J Anaesth 1997;78:606-17.,Anesth Analg 2003;97:53440.,疼痛控制不足危害严重,Anesthesiology Clin N Am 23(2005)21 36,致死、致残,恢复缓慢,降低镇痛满意度,导致慢性痛,McDonnell JG,ODonnell BD,Tuite D,et al.,The regional abdominal field Infiltration(R.A.F.I.)technique:,Computerised tomographic and anatomical identification of a novel approach to the transversus,abdominis neuro-vascular fascial plane.Anesthesiology,2004,101:A899,McDonnell JG,ODonnell B,Curley G,et al.,The analgesic efficacy of transversus abdominis plane block,after abdominal surgery:a prospective randomized controlled trial.Anesth Analg,2007,104(1):193-7,腹横肌平面阻滞,Anesth Analg 2003;97:6271,Clinical Nutrition 31(2012)783-800,Thank You,