CAJ | 학술논문

加速康复外科(ERAS)整合了一系列优化的围术期处理措施,其目标是通过减轻围术期的各种应激反应,减少能量损耗,改善器官功能紊乱,加快患者术后康复.它最先应用于结直肠外科领域,随后逐渐向其他外科领域拓展.对于胃癌手术,其总体的有效性和安全性已得到循证医学的初步证实,但是对于ERAS的各个详细措施,目前还存在一定的争议.2014年欧洲加速康复外科协会制订并发布《胃切除术加速康复外科指南》,为医疗单位实施ERAS提供了优化的围术期处理方案.但在临床实践中,应该注意将指南与共识中的普遍原则与患者个体的特殊性有机地结合.由于胃癌手术的复杂性和患者情况的多样性,因此需要发展个体化的ERAS.未来ERAS的发展方向,一方面需要开展更多针对ERAS中各个措施的随机对照临床试验,以得出更加明确和有力的结论;另一方面,需要重视提高患者对各项措施的依从性.
가속강복외과(ERAS)정합료일계렬우화적위술기처리조시,기목표시통과감경위술기적각충응격반응,감소능량손모,개선기관공능문란,가쾌환자술후강복.타최선응용우결직장외과영역,수후축점향기타외과영역탁전.대우위암수술,기총체적유효성화안전성이득도순증의학적초보증실,단시대우ERAS적각개상세조시,목전환존재일정적쟁의.2014년구주가속강복외과협회제정병발포《위절제술가속강복외과지남》,위의료단위실시ERAS제공료우화적위술기처리방안.단재림상실천중,응해주의장지남여공식중적보편원칙여환자개체적특수성유궤지결합.유우위암수술적복잡성화환자정황적다양성,인차수요발전개체화적ERAS.미래ERAS적발전방향,일방면수요개전경다침대ERAS중각개조시적수궤대조림상시험,이득출경가명학화유력적결론;령일방면,수요중시제고환자대각항조시적의종성.
Enhanced recovery after surgery (ERAS) combines various techniques used in the care of patients undergoing elective surgery,with an aim to attenuate the surgical stress response and energy loss,improve the organ function,reduce postoperative complications and the time required for full recovery.ERAS was first applied in the colorectal surgery,and gradually expanded to other surgical areas.As for ERAS in the gastric surgery,the safety and efficacy have been proved preliminarily by evidence-based medicine.However,there is still controversy about the individual items of the ERAS programs due to limited studies.Recent publications of the 2014 consensus guidelines for enhanced recovery after gastrectomy Enhanced Recovery After Surgery (ERAS@) Society recommendations that was composed by the ERAS Society indicated the developing direction of ERAS,and also updated perioperative practice to each medical unit implementing ERAS.Meanwhile,general principles (guideline or consensus) and patients' conditions should be combined closely into clinical practice.Since gastric cancer surgery is complex and patients' conditions are various,further research may focus on individualized ERAS.In the further study,more high-quality randomized clinical trials with single-component administration in fast recovery settings need to reach more definite conclusions and recommendations.Furthermore,attentions should be paid to enhance patients' compliance with the ERAS items.