術後加速康復療程（ERAS）不只是提早出院而已

Enhanced Recovery after Surgery (ERAS) is More than Just Shortening Length of Stay

王瑞琪(Juei-Chii Wang) ； 黃暐琇(Wei-Hsiu Huang) ； 郭書麟(Shu-Lin Guo)

《台灣醫學》 23卷2期 (2019/03) Pp. 184-191

https://doi.org/10.6320/FJM.201903_23(2).0005

摘要

近年來術後加速康復療程（ERAS）越多地應用於醫療常規中。主要目的是將實證醫學建議有效的手術全期醫療照護方案措施，結合跨領域合作協調，加上以標準化和優化手術與麻醉治療流程。除了可重整臨床醫療流程之外，ERAS具有較短的康復時間及降低相關併發症的發生率，進而減少額外的醫療支出。本文的目的乃介紹術中麻醉處置的具體概念及其優勢。這五項必要元素可改善照護品質，確保患者安全性，提高患者滿意度以及以患者為中心的治療方針。因此，麻醉醫師可以在手術室中熟稔這些操作，成為麻醉的標準照護的一部份：（1）合宜的麻醉深度；（2）多重模式疼痛控制；（3）穩定的體溫維持；（4）適當的體液調節；（5）術後噁心嘔吐的預防。ERAS這些術中的介入，大大影響患者照護，醫療團隊和整個專業社群的運作，這極需要團隊精神，同時也強化團隊內部的凝聚力。所以，台灣麻醉醫學會（TSA）的「ERAS推廣委員會」會一直以全國性的規模持續推動教育會員的活動，也通過媒體推廣相關概念給一般大眾。

關鍵字

術後加速康復療程 ； 手術全期照護 ； 麻醉深度 ； 多重模式疼痛控制 ； 目標導向血液動力學治療

並列摘要

Enhanced recovery after surgery (ERAS) is now being increasingly applied in daily practice. The main aims to combine and coordinate evidence-based perioperative care interventions that support standardizing and optimizing surgical care. In conjunction with its clinical benefits, it has been suggested that ERAS reduces costs through shorter convalescence and reduced morbidity. The purpose of this article is to introduce specific aspects and advantages of intraoperative phase of anesthetic practices. There are five necessary elements involved in improved care quality, enhanced patient safety, increased patient satisfaction, and focused patient-centered care. Hence, anesthesiologists can operate these items in operation room as the standard care of anesthesia: (1) suitable anesthetic depth; (2) multimodal analgesia; (3) controlled body temperature management; (4) precise fluid management; (5) prophylaxis of postoperative nausea and vomiting. ERAS includes issues and stakes that affect patient care, the care team and society in general. A spirit of teamwork is required and the program contributes substantially to cohesion within the team. Finally, ERAS committee of Taiwan Society of Anesthesiologists (TSA) keeps educating the members through activities and citizen through media on the national level.

並列關鍵字

enhanced recovery after surgery ； perioperative care ； anesthetic depth ； multimodal analgesia ； goal-directed hemodynamic therapy