快速康复ERAS普外科幻灯整理版.ppt

* NSAIDS are also an important part of multimodal analgesia. There have been clinical case series linking voltarol (150 mg, p.o. once a day) and celecoxib (cyclo-oxygenase (COX)-2 inhibitor) to an increased incidence of anastomotic dehiscence.173e 176 However, until more thorough studies addressing this question have been carried out, there is not sufficient evidence to stop using NSAIDS as a component of multimodal analgesia in the postoperative period. Tramadol is an alternative to NSAIDs * thoracic epidural analgesia using low-dose local anaesthetic and opioids should be used in open surgery. For breakthrough pain, titration to minimise the dose of opioids may be used. In laparoscopic surgery, an alternative to TEA is a carefully administered spinal analgesia with a low-dose, longacting opioid. In connection with TEA withdrawal, NSAIDs and Paracetamol should be used. * * 快速康复外科理念主张术后早期活动。术后长期卧床会降低肌肉强度，损害肺功能及组织氧化能力、加重静脉淤滞及血栓形成 Optimizing perioperative management of patients undergoing colorectal surgery: what is new? Environment should encourage independence Out of bed x 2h on day of surgery Out of bed x 6h every day after * A multimodal approach with epidural and near-zero fluid balance is recommended. Oral laxatives and chewing gum given postoperatively are safe, and may accelerate gastrointestinal transit. * Insulin resistance and hyperglycaemia are strongly associated with postoperative morbidity and mortality. Treatment of hyperglycaemia with intravenous insulin in the intensive-care setting improves outcomes but hypoglycaemia remains a risk. Several ERAS protocol items attenuate insulin resistance and facilitate glycaemic control without the risk of hypoglycaemia. Hyperglycaemia should be avoided as far as possible without introducing the risk of hypoglycaemia. * Patients should be allowed a normal diet after surgery without restrictions. They should be cautioned to begin carefully and increase intake according to tolerance over 3-4 days. Enteral