骨科快速康复理念及应用讲解课件.ppt

骨科常见疼痛的处理专家建议 * 广义上，ERAS方案构成可大致分为术前、围手术期和术后干预。 术前 术前咨询和培训 缩短禁食时间及术前碳水化合物负荷 避免机械性肠道准备 深静脉血栓形成预防 预防性抗生素治疗 围手术期 高氧吸入 低体温预防 目标导向术中液体疗法 手术径路和切口 避免术后留置引流管和鼻胃管 短期硬膜外止痛和局部神经阻滞 术后 避免使用阿片类药物，应与对乙酰氨基酚和NSAIDS应用 术后早期进食 术后早期活动 限制静脉补液量 审查 * Marianne就髋关节置换患者术中保温问题进行了研究，通过将术中体温提高0．5℃，结果发现术中失血量显著减少。 * * Near-zero fluid balance as well as avoiding overload of salt and water results in improved outcomes. Perioperative monitoring of stroke volume with trans-oesophageal Doppler to optimize cardiac output with fluid boluses improves outcomes. Balanced crystalloids should be preferred to 0.9% saline * 广义上，ERAS方案构成可大致分为术前、围手术期和术后干预。 术前 术前咨询和培训 缩短禁食时间及术前碳水化合物负荷 避免机械性肠道准备 深静脉血栓形成预防 预防性抗生素治疗 围手术期 高氧吸入 低体温预防 目标导向术中液体疗法 手术径路和切口 避免术后留置引流管和鼻胃管 短期硬膜外止痛和局部神经阻滞 术后 避免使用阿片类药物，应与对乙酰氨基酚和NSAIDS应用 术后早期进食 术后早期活动 限制静脉补液量 审查 Postoperative pain is still inadequately relieved despite substantial improvements in the knowledge of the mechanisms and treatment of pain [1]. Evidence suggests that inadequate relief of postoperative pain may result in harmful physiologic and psychologic consequences that lead to significant morbidity and mortality [2], which may delay recovery and the return to daily living [3]. In addition, the presence of postoperative symptoms, including pain, significantly contributes to patients’ dissatisfaction with their anesthesia and surgical experience [4]. Most importantly, it has been recognized that inadequately treated postoperative pain may lead to chronic pain, which is often misdiagnosed and neglected [5,6]. This article reviews the physiologic and psychologic consequences of inadequate pain relief, with an emphasis on chronic persistent postoperative pain. * 2011年，Henrik 等撰文《Why still in hospital after fast-track hip and knee arthroplasty? 》，即《为何膝/髋关节置换术后依旧无法尽早出院？》，探讨分析了影响骨科大手术后影响患者出院的因素。 他们的分析发现：疼痛、眩晕和全身乏力是影响患者出院的主要因素。 而疼痛，是骨科手术后延迟患者出院的第一因素！ * * Subacute pain and function after fast-track hip and knee arthroplasty. TKA患者在术后1个月步行时，52%报告了中度疼痛(VAS评分 30-59 mm)；16% 重度疼痛(VAS ≥60 mm)