《2019版英国日间手术指南》解读

摘要/Abstract

摘要： 日间手术作为一种安全、高效、较好成本效果的围手术期管理模式，近年来已被广泛认可。随着医院管理、外科技术和麻醉技术的发展，日间手术的比例正在快速提高，目前已成为发达国家的默认外科模式。日间手术及其管理模式在我国也是大势所趋，国家层面也逐渐对日间手术提出了明确要求。参照国际医疗行业发展现状，我国大幅度提高日间手术比例、快速缩短与先进国家的差距已经刻不容缓，也是在卫生保障体系显示大国担当、改善民生的重要体现。英国麻醉师协会和日间手术协会发布的《2019版英国日间手术指南》，对于指导日间手术的临床应用和实践具有重要意义。本研究依据该指南的重要精神，对日间手术的定义、适应证、管理、术前准备和麻醉的相关问题，以及儿童和急诊日间手术开展的策略对指南进行了详细的解读，以期为我国日间手术工作者及管理模式提升提供借鉴和参考。

关键词: font-size:medium, ">日间手术；指南；英国；日间麻醉；围手术期管理

Abstract: As a safe， efficient and cost-effective perioperative management mode， day surgery has been widely recognized in recent years. With the development of management level， surgical technology and anesthesia technology， the proportion of day surgery is rapidly increasing， which has become the default surgical mode in developed countries. Day surgery and its management model are also the general trend in China， and the clear requirements for day surgery has gradually been put forward from the government. With reference to the development status of the international medical industry， it is urgent for China to greatly increase the proportion of day surgery and rapidly shorten the gap with advanced countries. The publication of “Guidelines for day-case surgery 2019” from the Association of Anaesthetists and the British Association of Day Surgery is of great significance in guiding the clinical application and practice of day surgery. According to the important spirit of the guidelines， this paper explains the definition， indications， management， preoperative preparation and anesthesia of day surgery， as well as the strategies for children and emergency day surgery in detail, so as to provide reference for day surgery in China.

Key words: font-size:medium, ">Day surgery； Guidelines； British；Day anesthesia； Perioperative management

中图分类号:

徐蕾, 刘小南, 宁鹏涛, 高博欣, 俞德梁. 《2019版英国日间手术指南》解读[J]. 中国医药导刊, 2021, 23(7): 481-485.

XU Lei, LIU Xiaonan, NING Pengtao, GAO Boxin, YU Deliang. Interpretation of Guidelines for Day-case Surgery 2019 from the Association of Anaesthetists and the British Association of Day Surgery[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2021, 23(7): 481-485.

参考文献

[1]原中华人民共和国国家卫生和计划生育委员会，国家中医药管理局. 关于印发进一步改善医疗服务行动计划的通知(国卫医发〔2015〕2号) [EB/OL]. (2015-01-28) [2021-05-12]. http：//www. nhc. gov. cn/yzygj/s3593g/201501/5584853cfa254d1aa4e38de 0700891fa. shtml.
     [2]嵇武，刘亚萍，戴玮. 我国日间手术开展现状与前景展望[J].中国实用外科杂志,2020,40(2):199-202.
     [3]Bailey CR， Ahuja M， Bartholomew K， et al. Guidelines for day-case surgery 2019： Guidelines from the Association of Anaesthetists and the British Association of Day Surgery[J]. Anaesthesia， 2019， 74(6)：778-792.
     [4]俞德梁，宁鹏涛，王娟，等. 关于日间手术定义与首批推荐适宜手术的思考[J]. 医学与哲学， 2015， 36(24)：5-7， 14.
     [5]Department of Health. The NHS Plan： a plan for investment， a plan for reform[EB/OL]. (2018-01-13) [2021-05-12]. http：//webarchive. nationalarchives. gov. uk/+/http：//www. dh. gov. uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002960.
     [6]杨玲，黄小龙，罗旭，等. 国内外日间手术发展现状与思考[J]. 中国卫生质量管理，2020，27(4)：33-37.
     [7]Recommendations for clinicions[EB/OL]. (2021-01-18) [2021-05-12]. http：//www. choosingwisely. co. uk/i-am-aclinician/recommendations.
     [8]Ansell GL， Montgomery JE. Outcome of ASA III patients undergoing day case surgery[J]. Br J Anaesth， 2004， 92(1)：71-74.
     [9]Rasmussen LS， Steinmetz J. Ambulatory anaesthesia and cognitive dysfunction[J]. Curr Opin Anaesthesiol， 2015， 28(6)：631-635.
     [10]Aldwinckle RJ， Montgomery JE. Unplanned admission rates and postdischarge complications in patients over the age of 70 following day case surgery[J]. Anaesthesia， 2004， 59(1)：57-59.
     [11]Nightingale CE， Margarson MP， Shearer E， et al. Peri-operative management of the obese surgical patient 2015： Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia[J]. Anaesthesia， 2015， 70(7)：859-876.
     [12]Joshi GP， Ankichetty SP， Gan TJ， et al. Society for Ambulatory Anesthesia consensus statement on preoperative selection of adult patients with obstructive sleep apnea scheduled for ambulatory surgery[J]. Anesth Analg， 2012， 115(5)：1060-1068.
     [13]Jackson I， McWhinnie D， Skues M. The pathway to success： management of the day surgical patient[R]. London， UK： British Association of Day Surgery， 2010.
     [14]Lewis S， Stocker M， Houghton K， et al. A patient survey to determine how day surgery patients would like preoperative assessment to be conducted[J]. J One Day Surgery， 2009， 19： 32-36.
     [15]Chung F， Yuan H， Yin L， et al. Elimination of preoperative testing in ambulatory surgery[J]. Anesth Analg， 2009， 108(2)：467-475.
     [16]Smith I， Kranke P， Murat I， et al. Perioperative fasting in adults and children： guidelines from the European Society of Anaesthesiology[J]. European Journal of Anaesthesiology， 2011， 28： 556-569.
     [17]Checketts MR， Alladi R， Ferguson K， et al. Recommendations for standards of monitoring during anaesthesia and recovery 2015： Association of Anaesthetists of Great Britain and Ireland[J]. Anaesthesia， 2016， 71(1)：85-93.
     [18]British Association of Day Surgery. Spinal anaesthesia for day surgery patients， 3rd edn[M]. London， UK： BADS， 2013.
     [19]Whitaker DK， Booth H， Clyburn P， et al. Immediate post anaesthesia recovery 2013[J]. Anaesthesia， 2013，68： 288-297.
     [20]Yogendran S， Asokumar B， Cheng DCH， et al. A prospective randomized double-blind study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery[J]. Anesthesia and Analgesia，1995，80： 682-686.
     [21]British Association of Day Surgery. Issues in paediatric day surgery[M]. London， UK： BADS， 2008.
     [22]British Association of Day Surgery. Ambulatory emergency care[M]. London， UK： BADS， 2016.

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