中国骨肿瘤大手术加速康复围手术期管理专家共识
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摘要
加速康复外科(enhanced recovery after surgery, ERAS)是基于循证医学证据的一系列围手术期优化措施,降低手术患者围手术期的生理及心理创伤应激,减少并发症及缩短住院时间,达到促进患者术后康复的目的。通过查阅文献,遵循循证医学原则,经过全国骨肿瘤专家组反复讨论,针对骨肿瘤外科大手术患者的围手术期管理达成了共识,供广大骨肿瘤外科医师在临床工作中参考应用。本共识主要内容包括:心理教育和干预、营养状况评估和管理、预防性抗菌药物使用、麻醉、围术期血液管理、疼痛管理、血栓预防、切口及引流管管理和术后康复锻炼等。
Enhanced recovery after surgery(ERAS) is a series of perioperative optimization measures based on evidence based medicine, in order to reduce perioperative physiological and psychological trauma stress and complications, and achieve accelerated rehabilitation. By means of reading literatures and discussion of Chinese expert group in bone tumor, we compile this consensus which mainly contains patients' education, nutritional assessment and support, anesthetic management, perioperative blood management, pain releasing, VTE preventing, optimization of analgesia, wound management, functional exercise and postoperative follow-up management.
Enhanced recovery after surgery(ERAS) is a series of perioperative optimization measures based on evidence based medicine, in order to reduce perioperative physiological and psychological trauma stress and complications, and achieve accelerated rehabilitation. By means of reading literatures and discussion of Chinese expert group in bone tumor, we compile this consensus which mainly contains patients' education, nutritional assessment and support, anesthetic management, perioperative blood management, pain releasing, VTE preventing, optimization of analgesia, wound management, functional exercise and postoperative follow-up management.
引文
[1] Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5):606-617.
[2] Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6):630-641.
[3] Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg, 2008, 248(2):189-198.
[4]周宗科,翁习生,裴福兴,等.中国髋、膝关节置换术加速康复——围术期管理策略专家共识.中华骨与关节外科杂志,2016,9(1):1-9.
[5] Donovan RJ, Carter OB, Byrne MJ. People's perceptions of cancer survivability:implications for oncologists. Lancet Oncol, 2006,7(8):668-675.
[6] Fauske L,Bruland OS, Grov EK,et al. Cured of primary bone cancer, but at what cost:a qualitative study of functional impairment and lost opportunities. Sarcoma, 2015,2015:484196.
[7]唐丽丽.《中国肿瘤心理治疗指南》解读.医学与哲学,2016, 37(22):21-23.
[8] Siracuse BL, Gorgy G, Ruskin J, et al. What is the Incidence of Suicide in Patients with Bone and Soft Tissue Cancer?:Suicide and Sarcoma. Clin Orthop Relat Res, 2017, 475(5):1439-1445.
[9] Alfargieny R, Bodalal Z, Bendardaf R, et al. Nutritional status as a predictive marker for surgical site infection in total joint arthroplasty. Avicenna J Med, 2015, 5:117-122.
[10] Cross MB, Yi PH, Thomas CF, et al. Evaluation of malnutrition in orthopaedic surgery. J Am Acad Orthop Surg, 2014,22(3):193-199.
[11] Weimann A, Braga M, Carli F, et al. ESPEN guideline:Clinical nutrition in surgery. Clin Nutr, 2017, 36(3):623-650.
[12]《抗菌药物临床应用指导原则》修订工作组.抗菌药物临床应用指导原则(2015年版).国卫办医发[2015]43号附件.
[13] Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm, 2013, 70(3):195-283.
[14] Bryson DJ, Morris DL, Shivji FS, et al. Antibiotic prophylaxis in orthopaedic surgery:difficult decisions in an era of evolving antibiotic resistance. Bone Joint J, 2016, 98-B(8):1014-1019.
[15] Severyns M, Briand S, Waast D, et al. Postoperative infections after limb-sparing surgery for primary bone tumors of the pelvis:Incidence, characterization and functional impact. Surg Oncol, 2017, 26(2):171-177.
[16] Racano A, Pazionis T, Farrokhyar F, et al. High infection rate outcomes in long-bone tumor surgery with endoprosthetic reconstruction in adults:a systematic review. Clin Orthop Relat Res, 2013, 471(6):2017-2027.
[17]中国医师协会麻醉学医师分会.促进术后康复的麻醉管理专家共识.中华麻醉学杂志,2015, 35(2):141-148.
[18] Beverly A, Kaye AD, Ljungqvist 0, et al. Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery(ERAS)Guidelines. Anesthesiol Clin, 2017, 35(2):e115-e143.
[19] Smith MD, McCall J, Plank L, et al. Preoperative carbohydrate treatment for enhancing recovery after elective surgery.Cochrane Database Syst Rev, 2014,(8):CD009161.
[20] Miller TE, Roche AM, Mythen M. Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery(ERAS). Can J Anaesth, 2015, 62(2):158-168.
[21] Gupta R, Gan TJ. Peri-operative fluid management to enhance recovery. Anaesthesia, 2016,71 Suppl 1:40-45.
[22] Kawai A, Kadota H, Yamaguchi U, et al. Blood loss and transfusion associated with musculoskeletal tumor surgery. J Surg Oncol, 2005,92(1):52-58.
[23]周宗科,翁习生,孙天胜,等.中国骨科手术加速康复-围术期血液管理专家共识.中华骨与关节外科杂志,2017,10(1):1-7.
[24] Nieder C, Haukland E, Pawinski A, et al. Anaemia and thrombocytopenia in patients with prostate cancer and bone metastases. BMC Cancer, 2010, 10:284.
[25]马军,王杰军,张力,等.肿瘤相关性贫血临床实践指南(2015-2016版).中国实用内科杂志,2015, 35(11):921-930.
[26] Catalano L, Campolongo A, Caponera M, et al. Indications and organisational methods for autologous blood transfusion procedures in Italy:results of a national survey. Blood Transfus, 2014,12(4):497-508.
[27] Wirbel RJ, Roth R, Schulte M, et al. Preoperative embolization in spinal and pelvic metastases. J Orthop Sci, 2005, 10(3):253-257.
[28] Pikis S, Itshayek E, Barzilay Y, et al. Preoperative embolization of hypervascular spinal tumors:current practice and center experience. Neurol Res, 2014, 36(6):502-509.
[29] Luksanapruksa P, Buchowski JM, Tongsai S, et al. Systematic review and meta-analysis of effectiveness of preoperative embolization in surgery for metastatic spine disease. J Neurointerv Surg, 2018, 10(6):596-601.
[30] Zhang Y, Guo W, Tang X, et al. Can Aortic Balloon Occlusion Reduce Blood Loss During Resection of Sacral Tumors That Extend Into the Lower Lumber Spine? Clin Orthop Relat Res, 2018, 476(3):490-498.
[31] Tang X, Guo W, Yang R, et al. Use of aortic balloon occlusion to decrease blood loss during sacral tumor resection. J Bone Joint Surg Am, 2010, 92(8):1747-1753.
[32] Luo Y, Duan H, Liu W, et al. Clinical evaluation for lower abdominal aorta balloon occluding in the pelvic and sacral tumor resection. J Surg Oncol, 2013,108(3):148-151.
[33] Yang L, Chong-Qi T, Hai-Bo S, et al. Appling the abdominal aortic-balloon occluding combine with blood pressure sensor of dorsal artery of foot to control bleeding during the pelvic and sacrum tumors surgery. J Surg Oncol, 2008, 97(7):626-628.
[34] Yun SH, Kim JH, Kim HJ. Comparison of the hemodynamic effects of nitroprusside and remifentanil for controlled hypotension during endoscopic sinus surgery. J Anesth, 2015, 29(1):35-39.
[35] Elwatidy S, Jamjoom Z, Elgamal E, et al. Efficacy and safety of prophylactic large dose of tranexamic acid in spine surgery:a prospective, randomized, double-blind, placebo-controlled study. Spine(Phila Pa 1976), 2008, 33(24):2577-2580.
[36] Gill JB, Chin Y, Levin A, et al. The use of antifibrinolytic agents in spine surgery. A meta-analysis. J Bone Joint Surg Am, 2008, 90(11):2399-2407.
[37] Colomina MJ, Koo M, Basora M, et al. Intraoperative tranexamic acid use in major spine surgery in adults:a multicentre, randomized, placebo-controlled trialdagger. Br J Anaesth, 2017,118(3):380-390.
[38]岳辰,周宗科,裴福兴,等.中国髋、膝关节置换术围术期抗纤溶药序贯抗凝血药应用方案的专家共识.中华骨与关节外科杂志,2015, 8(4):281-285.
[39] Kutty S, McElwain JP. Padding under tourniquets in tourniquet controlled surgery:Bruner's ten rules revisited. Injury,2002, 33(1):75.
[40] Kumar K, Railton C, Tawfic Q. Tourniquet application during anesthesia:“What we need to know?”. J Anaesthesiol Clin Pharmacol, 2016, 32(4):424-430.
[41] Kumar N, Chen Y, Zaw AS, et al. Use of intraoperative cellsalvage for autologous blood transfusions in metastatic spine tumour surgery:a systematic review. Lancet Oncol, 2014, 15(1):e33-e41.
[42]中华医学会麻醉学分会.围术期输血的专家共识.临床麻醉学杂志,2009,25(3):189-191.
[43] Padhi S, Kemmis-Betty S, Rajesh S, et al. Blood transfusion:summary of NICE guidance. BMJ, 2015, 351:5832.
[44] National Clinical Guideline Centre(UK). Blood Transfusion.London:National Institute for Health and Care Excellence(UK); 2015 Nov. PMID:26632625
[45] Tan M, Law LS, Gan TJ. Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways. Can J Anaesth, 2015, 62(2):203-218.
[46] Dunkman WJ, Manning MW. Enhanced Recovery After Surgery and Multimodal Strategies for Analgesia. Surg Clin North Am, 2018, 98(6):1171-1184.
[47]沈彬,翁习生,廖刃,等.中国髋、膝关节置换术加速康复一围术期疼痛与睡眠管理专家共识.中华骨与关节外科杂志,2016,9(2):91-97.
[48] Mendez GM, Patel YM, Ricketti DA, et al. Aspirin for Prophylaxis Against Venous Thromboembolism After Orthopaedic Oncologic Surgery. J Bone Joint Surg Am, 2017, 99(23):2004-2010.
[49] Kaiser CL, Freehan MK, Driscoll DA, et al. Predictors of venous thromboembolism in patients with primary sarcoma of bone. Surg Oncol, 2017, 26(4):506-510.
[50] Ratasvuori M, Lassila R, Laitinen M. Venous thromboembolism after surgical treatment of non-spinal skeletal metastases-An underdiagnosed complication. Thromb Res, 2016,141:124-128.
[51] Yamaguchi T, Matsumine A, Niimi R, et al. Deep-vein thrombosis after resection of musculoskeletal tumours of the lower limb. Bone Joint J, 2013, 95-B(9):1280-1284.
[52] Damron TA, Wardak Z, Glodny B, et al. Risk of venous thromboembolism in bone and soft-tissue sarcoma patients undergoing surgical intervention:a report from prior to the initiation of SCIP measures. J Surg Oncol, 2011, 103(7):643-647.
[53] Mitchell SY, Lingard EA, Kesteven P, et al. Venous thromboembolism in patients with primary bone or soft-tissue sarcomas. J Bone Joint Surg Am, 2007, 89(11):2433-2439.
[54]中华医学会骨科学分会.中国骨科大手术静脉血栓栓塞症预防指南.中华骨科杂志,2016, 36(2):65-71.
[55]孙天胜,沈建雄,刘忠军,等.中国脊柱手术加速康复一围术期管理策略专家共识.中华骨与关节外科杂志,2017,10(4):271-279.
[56] Patel AR, Crist MK, Nemitz J, et al. Aspirin and compression devices versus low-molecular-weight heparin and PCD for VTE prophylaxis in orthopedic oncology patients. J Surg Oncol, 2010,102(3):276-281.
[57]中国健康促进基金会骨病专项基金骨科康复专家委员会.骨科康复中国专家共识.中华医学杂志,2018, 98(3):164-170.
[58]马拉沃,休格贝克.骨与软组织肿瘤外科学.上海:上海科学技术出版社,2010:690-699.
[59] Morri M, Forni C, Ruisi R, et al. Postoperative function recovery in patients with endoprosthetic knee replacement for bone tumour:an observational study. BMC Musculoskelet Disord, 2018,19(1):353.
[60] Morri M, Raffa D, Barbieri M, et al. Compliance and satisfaction with intensive physiotherapy treatment during chemotherapy in patients with bone tumours and evaluation of related prognostic factors:An observational study. Eur J Cancer Care(Engl), 2018, 27(6):e12916.
[2] Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6):630-641.
[3] Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg, 2008, 248(2):189-198.
[4]周宗科,翁习生,裴福兴,等.中国髋、膝关节置换术加速康复——围术期管理策略专家共识.中华骨与关节外科杂志,2016,9(1):1-9.
[5] Donovan RJ, Carter OB, Byrne MJ. People's perceptions of cancer survivability:implications for oncologists. Lancet Oncol, 2006,7(8):668-675.
[6] Fauske L,Bruland OS, Grov EK,et al. Cured of primary bone cancer, but at what cost:a qualitative study of functional impairment and lost opportunities. Sarcoma, 2015,2015:484196.
[7]唐丽丽.《中国肿瘤心理治疗指南》解读.医学与哲学,2016, 37(22):21-23.
[8] Siracuse BL, Gorgy G, Ruskin J, et al. What is the Incidence of Suicide in Patients with Bone and Soft Tissue Cancer?:Suicide and Sarcoma. Clin Orthop Relat Res, 2017, 475(5):1439-1445.
[9] Alfargieny R, Bodalal Z, Bendardaf R, et al. Nutritional status as a predictive marker for surgical site infection in total joint arthroplasty. Avicenna J Med, 2015, 5:117-122.
[10] Cross MB, Yi PH, Thomas CF, et al. Evaluation of malnutrition in orthopaedic surgery. J Am Acad Orthop Surg, 2014,22(3):193-199.
[11] Weimann A, Braga M, Carli F, et al. ESPEN guideline:Clinical nutrition in surgery. Clin Nutr, 2017, 36(3):623-650.
[12]《抗菌药物临床应用指导原则》修订工作组.抗菌药物临床应用指导原则(2015年版).国卫办医发[2015]43号附件.
[13] Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm, 2013, 70(3):195-283.
[14] Bryson DJ, Morris DL, Shivji FS, et al. Antibiotic prophylaxis in orthopaedic surgery:difficult decisions in an era of evolving antibiotic resistance. Bone Joint J, 2016, 98-B(8):1014-1019.
[15] Severyns M, Briand S, Waast D, et al. Postoperative infections after limb-sparing surgery for primary bone tumors of the pelvis:Incidence, characterization and functional impact. Surg Oncol, 2017, 26(2):171-177.
[16] Racano A, Pazionis T, Farrokhyar F, et al. High infection rate outcomes in long-bone tumor surgery with endoprosthetic reconstruction in adults:a systematic review. Clin Orthop Relat Res, 2013, 471(6):2017-2027.
[17]中国医师协会麻醉学医师分会.促进术后康复的麻醉管理专家共识.中华麻醉学杂志,2015, 35(2):141-148.
[18] Beverly A, Kaye AD, Ljungqvist 0, et al. Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery(ERAS)Guidelines. Anesthesiol Clin, 2017, 35(2):e115-e143.
[19] Smith MD, McCall J, Plank L, et al. Preoperative carbohydrate treatment for enhancing recovery after elective surgery.Cochrane Database Syst Rev, 2014,(8):CD009161.
[20] Miller TE, Roche AM, Mythen M. Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery(ERAS). Can J Anaesth, 2015, 62(2):158-168.
[21] Gupta R, Gan TJ. Peri-operative fluid management to enhance recovery. Anaesthesia, 2016,71 Suppl 1:40-45.
[22] Kawai A, Kadota H, Yamaguchi U, et al. Blood loss and transfusion associated with musculoskeletal tumor surgery. J Surg Oncol, 2005,92(1):52-58.
[23]周宗科,翁习生,孙天胜,等.中国骨科手术加速康复-围术期血液管理专家共识.中华骨与关节外科杂志,2017,10(1):1-7.
[24] Nieder C, Haukland E, Pawinski A, et al. Anaemia and thrombocytopenia in patients with prostate cancer and bone metastases. BMC Cancer, 2010, 10:284.
[25]马军,王杰军,张力,等.肿瘤相关性贫血临床实践指南(2015-2016版).中国实用内科杂志,2015, 35(11):921-930.
[26] Catalano L, Campolongo A, Caponera M, et al. Indications and organisational methods for autologous blood transfusion procedures in Italy:results of a national survey. Blood Transfus, 2014,12(4):497-508.
[27] Wirbel RJ, Roth R, Schulte M, et al. Preoperative embolization in spinal and pelvic metastases. J Orthop Sci, 2005, 10(3):253-257.
[28] Pikis S, Itshayek E, Barzilay Y, et al. Preoperative embolization of hypervascular spinal tumors:current practice and center experience. Neurol Res, 2014, 36(6):502-509.
[29] Luksanapruksa P, Buchowski JM, Tongsai S, et al. Systematic review and meta-analysis of effectiveness of preoperative embolization in surgery for metastatic spine disease. J Neurointerv Surg, 2018, 10(6):596-601.
[30] Zhang Y, Guo W, Tang X, et al. Can Aortic Balloon Occlusion Reduce Blood Loss During Resection of Sacral Tumors That Extend Into the Lower Lumber Spine? Clin Orthop Relat Res, 2018, 476(3):490-498.
[31] Tang X, Guo W, Yang R, et al. Use of aortic balloon occlusion to decrease blood loss during sacral tumor resection. J Bone Joint Surg Am, 2010, 92(8):1747-1753.
[32] Luo Y, Duan H, Liu W, et al. Clinical evaluation for lower abdominal aorta balloon occluding in the pelvic and sacral tumor resection. J Surg Oncol, 2013,108(3):148-151.
[33] Yang L, Chong-Qi T, Hai-Bo S, et al. Appling the abdominal aortic-balloon occluding combine with blood pressure sensor of dorsal artery of foot to control bleeding during the pelvic and sacrum tumors surgery. J Surg Oncol, 2008, 97(7):626-628.
[34] Yun SH, Kim JH, Kim HJ. Comparison of the hemodynamic effects of nitroprusside and remifentanil for controlled hypotension during endoscopic sinus surgery. J Anesth, 2015, 29(1):35-39.
[35] Elwatidy S, Jamjoom Z, Elgamal E, et al. Efficacy and safety of prophylactic large dose of tranexamic acid in spine surgery:a prospective, randomized, double-blind, placebo-controlled study. Spine(Phila Pa 1976), 2008, 33(24):2577-2580.
[36] Gill JB, Chin Y, Levin A, et al. The use of antifibrinolytic agents in spine surgery. A meta-analysis. J Bone Joint Surg Am, 2008, 90(11):2399-2407.
[37] Colomina MJ, Koo M, Basora M, et al. Intraoperative tranexamic acid use in major spine surgery in adults:a multicentre, randomized, placebo-controlled trialdagger. Br J Anaesth, 2017,118(3):380-390.
[38]岳辰,周宗科,裴福兴,等.中国髋、膝关节置换术围术期抗纤溶药序贯抗凝血药应用方案的专家共识.中华骨与关节外科杂志,2015, 8(4):281-285.
[39] Kutty S, McElwain JP. Padding under tourniquets in tourniquet controlled surgery:Bruner's ten rules revisited. Injury,2002, 33(1):75.
[40] Kumar K, Railton C, Tawfic Q. Tourniquet application during anesthesia:“What we need to know?”. J Anaesthesiol Clin Pharmacol, 2016, 32(4):424-430.
[41] Kumar N, Chen Y, Zaw AS, et al. Use of intraoperative cellsalvage for autologous blood transfusions in metastatic spine tumour surgery:a systematic review. Lancet Oncol, 2014, 15(1):e33-e41.
[42]中华医学会麻醉学分会.围术期输血的专家共识.临床麻醉学杂志,2009,25(3):189-191.
[43] Padhi S, Kemmis-Betty S, Rajesh S, et al. Blood transfusion:summary of NICE guidance. BMJ, 2015, 351:5832.
[44] National Clinical Guideline Centre(UK). Blood Transfusion.London:National Institute for Health and Care Excellence(UK); 2015 Nov. PMID:26632625
[45] Tan M, Law LS, Gan TJ. Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways. Can J Anaesth, 2015, 62(2):203-218.
[46] Dunkman WJ, Manning MW. Enhanced Recovery After Surgery and Multimodal Strategies for Analgesia. Surg Clin North Am, 2018, 98(6):1171-1184.
[47]沈彬,翁习生,廖刃,等.中国髋、膝关节置换术加速康复一围术期疼痛与睡眠管理专家共识.中华骨与关节外科杂志,2016,9(2):91-97.
[48] Mendez GM, Patel YM, Ricketti DA, et al. Aspirin for Prophylaxis Against Venous Thromboembolism After Orthopaedic Oncologic Surgery. J Bone Joint Surg Am, 2017, 99(23):2004-2010.
[49] Kaiser CL, Freehan MK, Driscoll DA, et al. Predictors of venous thromboembolism in patients with primary sarcoma of bone. Surg Oncol, 2017, 26(4):506-510.
[50] Ratasvuori M, Lassila R, Laitinen M. Venous thromboembolism after surgical treatment of non-spinal skeletal metastases-An underdiagnosed complication. Thromb Res, 2016,141:124-128.
[51] Yamaguchi T, Matsumine A, Niimi R, et al. Deep-vein thrombosis after resection of musculoskeletal tumours of the lower limb. Bone Joint J, 2013, 95-B(9):1280-1284.
[52] Damron TA, Wardak Z, Glodny B, et al. Risk of venous thromboembolism in bone and soft-tissue sarcoma patients undergoing surgical intervention:a report from prior to the initiation of SCIP measures. J Surg Oncol, 2011, 103(7):643-647.
[53] Mitchell SY, Lingard EA, Kesteven P, et al. Venous thromboembolism in patients with primary bone or soft-tissue sarcomas. J Bone Joint Surg Am, 2007, 89(11):2433-2439.
[54]中华医学会骨科学分会.中国骨科大手术静脉血栓栓塞症预防指南.中华骨科杂志,2016, 36(2):65-71.
[55]孙天胜,沈建雄,刘忠军,等.中国脊柱手术加速康复一围术期管理策略专家共识.中华骨与关节外科杂志,2017,10(4):271-279.
[56] Patel AR, Crist MK, Nemitz J, et al. Aspirin and compression devices versus low-molecular-weight heparin and PCD for VTE prophylaxis in orthopedic oncology patients. J Surg Oncol, 2010,102(3):276-281.
[57]中国健康促进基金会骨病专项基金骨科康复专家委员会.骨科康复中国专家共识.中华医学杂志,2018, 98(3):164-170.
[58]马拉沃,休格贝克.骨与软组织肿瘤外科学.上海:上海科学技术出版社,2010:690-699.
[59] Morri M, Forni C, Ruisi R, et al. Postoperative function recovery in patients with endoprosthetic knee replacement for bone tumour:an observational study. BMC Musculoskelet Disord, 2018,19(1):353.
[60] Morri M, Raffa D, Barbieri M, et al. Compliance and satisfaction with intensive physiotherapy treatment during chemotherapy in patients with bone tumours and evaluation of related prognostic factors:An observational study. Eur J Cancer Care(Engl), 2018, 27(6):e12916.