Исследования и практика в медицине №03 2021
Основные компоненты протокола ускоренного выздоровления в хирургии опухолей легкого
Номера страниц в выпуске:70-83
В связи с высокой заболеваемостью раком легкого и необходимостью хирургического лечения данной категории пациентов, внедрение концепции стандартизированного протокола ускоренного выздоровления может позволить добиться снижения количества осложнений после операций и сокращения сроков госпитализации.
Целью данного обзора литературы явилось изучение основных компонентов протокола ускоренного выздоровления в торакальной онкохирургии при проведении видеоторакоскопических вмешательств. Показано, что использование целенаправленных мер в пред- (консультация пациента перед операцией, соблюдение режима приема жидкости и пищи, отказ от рутинного применения седативных препаратов, профилактика венозных тромбозов, использование внутривенных антибиотиков, а также спиртового раствора хлоргексидина для обработки кожи), интра- (профилактика гипотермии, использование торакоскопического доступа, одного дренажа при анатомических резекциях легкого, отказ от плеврального дренажа, установка уретрального катетера только при проведении эпидуральной анестезии не более, чем на 2 часа) и послеоперационном (ранняя мобилизация и прекращение инфузионной терапии, обезболивание с использованием комбинации ацетаминофена и НПВС, поддержание нормоволемии, использование сбалансированных кристаллоидных растворов и нефармакологических мер для коррекции тошноты и рвоты) периодах способствуют улучшению результатов лечения, снижению уровня после операционных осложнений и послеоперационной летальности.
Целью данного обзора литературы явилось изучение основных компонентов протокола ускоренного выздоровления в торакальной онкохирургии при проведении видеоторакоскопических вмешательств. Показано, что использование целенаправленных мер в пред- (консультация пациента перед операцией, соблюдение режима приема жидкости и пищи, отказ от рутинного применения седативных препаратов, профилактика венозных тромбозов, использование внутривенных антибиотиков, а также спиртового раствора хлоргексидина для обработки кожи), интра- (профилактика гипотермии, использование торакоскопического доступа, одного дренажа при анатомических резекциях легкого, отказ от плеврального дренажа, установка уретрального катетера только при проведении эпидуральной анестезии не более, чем на 2 часа) и послеоперационном (ранняя мобилизация и прекращение инфузионной терапии, обезболивание с использованием комбинации ацетаминофена и НПВС, поддержание нормоволемии, использование сбалансированных кристаллоидных растворов и нефармакологических мер для коррекции тошноты и рвоты) периодах способствуют улучшению результатов лечения, снижению уровня после операционных осложнений и послеоперационной летальности.
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