- 期刊
運用ERAS概念建立手術全期的營養照顧專案計畫
Establishment of a Standardized Process for Perioperative Nutritional Care Project Using Nutritional Aspects of the Enhanced Recovery After Surgery (ERAS) Concept
摘要
術後加速康復照顧（Enhanced Recovery After Surgery, ERAS），依據實證、多模式的治療準則，減少手術帶來的身體壓力，可以達到減少併發症的發生、縮短住院時間與花費以及加快康復的目的。本院於2019年啟動專案計畫，成立跨部門的專案小組，營養室參與展開營養照護計畫，凝聚共識、規劃營養照護流程、設計與供應營養處方，和教育訓練與執行。營養照護流程的規劃涵蓋手術前中後全面的營養照護，包括：一、術前營養篩檢與介入。二、手術前一天提供碳水化合物飲料，讓病人手術前可持續進食至術前2小時，而不須禁食8小時。三、儘早開始進食：大腸直腸癌患者術後當日進食，對ERAS術後餐耐受良好者，手術次日即可進食半流質飲食。食道癌患者於手術次日則開始灌食，耐受良好時，每日增加500卡。四、術後飲食指導。執行成果：與專案實施前相較之，提早術後進食時間，食道癌病人術後第一天開始灌食，可灌食至1000卡的時間平均可縮短約1.5天；大腸直腸癌病人術後當日即可進食，開始吃半流質飲食的時間平均可縮短約2天。參與者對「手術前—不用禁食8小時以上」、「手術後—可以早期進食」的滿意程度達80%以上。參與專案計畫病人住院天數下降約5天。本專案經由團隊合作帶動了醫療人員的學習與成長，也創新供膳領域，ERAS營養照護的導入，縮短病人禁食時間，加速病人回復至正常飲食，大幅改善病人的營養狀況與醫療照護品質。
並列摘要
Enhanced Recovery After Surgery (ERAS) protocol is a multimodal approach and evidence-based. Reducing the physical stress of surgery reduces complications, shortens hospital stay time, lowers medical cost, and speeds up recovery. Our hospital project plan started first in 2019, with an interdisciplinary team. Our Food and Nutrition department participated in the key development of the nutrition care plan, building consensus, planning the nutrition care process, designing and supplying nutrition prescriptions, education, training and implementation. The planning of nutritional care process covered comprehensive nutritional care before, during, and after surgery. That included three parts: (1) Preoperative nutritional screening and intervention; (2) Providing carbohydrate drinks the day before operation, so that patients were able to continue food intake until 2 hours before operation, without having to fast for 8 hours; (3) Early initiation of oral intake: For patients with colorectal cancer, they can start oral intake on the day of surgery, and when they tolerate the "ERAS postoperative diet" well, they can transition to a semi-liquid diet on the day after surgery. In the case of esophageal cancer patients, they can start tube feeding on the day after surgery, and when they tolerate it well, the caloric intake can be increased by 500 calories per day; and (4) Providing postoperative dietary guidance, and design and supply of ERAS diets both pre- and post- operatively. Results: after implementation of the project, the postoperative eating time was brought forward. Patients with esophageal cancer started feeding on the first day after operation. The average time for feeding up to 1000 calories was shortened by ~1.5 days. Patients with colorectal cancer were able to start eating on the same day of surgery. The average time to start eating a semi-liquid diet was shortened by ~2 days. Over 80% of patients were satisfied with: "before surgery-no need to fast for > 8 hours," and "after surgery-able to eat early." The average number of hospitalization days of patients who had participated in the project dropped by ~5 days. This project had promoted the learning and growth of medical staff through teamwork and also innovated in the field of catering. The implementation of ERAS nutritional care shortened the fasting time of patients, accelerated their resumption to normal diet, and greatly improved their nutritional status and the quality of medical care.