张辉 卢麒丞

【摘要】 胃癌是我国最常见的消化道恶性肿瘤，其发病率和死亡率均位于我国癌症谱第2位，并逐年呈上升趋势，已经严重危及国人健康安全。目前胃癌的治疗方案包括手术、放化疗、分子靶向治疗等，而其中手术是目前胃癌的主要治疗手段，也是当下能完全治愈胃癌的唯一治疗方法，然而手术创伤不可避免地产生应激反应，可能导致器官功能不全及术后并发症的发生，这将明显地影响患者术后恢复速度。近年来，随着加速康复外科（ERAS）理念的深入发展及广泛运用，显著加速胃癌患者术后恢复的速度和明显地提高其术后生活质量。

【关键词】 加速康复外科； 胃癌； 围手术期

【Abstract】 Stomach cancer is the most common digestive tract malignant tumor in our country.Its morbidity and mortality are all at the second place of cancer spectrum in our country， and it is increasing year by year.So it has been seriously threatening the health and safety of the people in China.At present，the treatment of the gastric cancer include surgery，chemotherapy，molecular targeted therapy，but the surgery is the main method for the treatment of gastric cancer，the only treatment is now completely cure gastric cancer.However，surgical trauma will inevitably cause stress reaction，which may lead to the occurrence of complications and postoperative organ dysfunction.This will significantly affect the patients postoperative recovery rate.In recent years，with the rapid development and extensive application of the enhanced recovery after surgery（ERAS），it has significantly accelerated the postoperative recovery of patients with gastric cancer and significantly improved their postoperative quality of life.

【Key words】 Enhanced recovery after surgery； Gastric cancer； Perioperative period

First-authors address：The First Peoples Hospital of Changzhou，Changzhou 213003，China

doi：10.3969/j.issn.1674-4985.2018.04.040

加速康復外科（ERAS）概念是由“加速康复外科之父”Kehlet率先提出，现逐渐广泛应用于结直肠外科、肝胆外科、骨科等外科科室[1-6]。它是运用一系列拥有循证医学证据的围手术期优化治疗及护理方案，减轻创伤应激反应、保护免疫功能及降低术后并发症的发生，从而达到加速术后康复的目的[7]。目前，结直肠手术中应用ERAS技术效果最为显著，相关研究比较多[8]。但在死亡率更高的胃癌手术中的报道相对较少，现根据临床研究及经验将ERAS理念在胃癌患者围手术期应用的研究进展做一综述。

1 ERAS的具体内容

1.1 术前

1.1.1 术前宣传教育 医护人员应该在术前详细向患者介绍麻醉及手术过程，告知其ERAS理念及治疗措施，可能产生的问题及应对措施等，帮助其减轻术前恐惧、焦躁等不良情绪，以最佳的状态接受手术，从而降低创伤应激反应，保护免疫功能，减少如肺炎、腹腔感染等并发症的发生率，达到加速术后恢复的目的[9]。……