Rapid postoperative recovery (ERAS) refers to the adoption of a series of optimized measures during the perioperative period to reduce stress and complications, shorten the hospital stay, and promote postoperative recovery. This concept was first proposed in 1997 by Professor Kehlet of the University of Copenhagen, Denmark. In recent years, domestic scholars have also actively introduced and used it in clinical practice. Let me briefly introduce its content.
Nutritional support is one of the important links
Accelerated rehabilitation surgery has overturned many traditional surgical concepts and is an innovative revolution in treatment models. It emphasizes patient-centered collaboration involving many disciplines such as anesthesiology, surgery, nutrition, nursing, pain medicine, rehabilitation medicine, etc., and truly realizes the cooperation and overall process optimization of the entire team before, during, and after surgery. Compared with traditional nursing care, ERAS can significantly accelerate the recovery of patients after surgery, help reduce the psychological and physical trauma and stress response of patients, reduce postoperative complications, promote early postoperative recovery, shorten the length of hospital stay, and reduce Medical expenses etc.
One of the important links in ERAS is nutritional support, which is divided into enteral nutrition (EN) and parenteral nutrition (PN). The former provides nutrients through the gastrointestinal tract, while the latter provides nutrients through the vein. Enteral nutrition is close to natural physiological metabolism. It not only provides energy for the body, but also activates the anti-inflammatory pathway of the vagus nerve, reduces inflammation, reduces intestinal bacteria from entering the blood system, and improves patient immunity. Short-term parenteral nutrition also does not damage the intestinal mucosal barrier and can reduce the risk of intestinal leakage. The two complement each other and accelerate the recovery of patients.
Ban solid diet 6 hours before surgery
Anyone in the family who has undergone surgery knows that previous operations, especially gastrointestinal surgery, emphasized fasting 12 hours before surgery and 6 hours before surgery to reduce the incidence of postoperative aspiration pneumonia. However, modern medical research has found that fasting for a long time will put patients in a metabolic stress state, triggering insulin resistance, which is not conducive to reducing the incidence of postoperative complications.
Therefore, ERAS recommends that as long as there is no gastrointestinal motility disorder, patients should fast for a solid diet 6 hours before surgery, and fast for clear liquids for 2 hours before surgery. This can alleviate the preoperative discomfort caused by hunger, thirst, anxiety and other emotions caused by long-term fasting, and reduce the incidence of postoperative insulin resistance and hyperglycemia. However, it should be noted that the above-mentioned preoperative diet plan is not suitable for patients with gastrointestinal disorders, such as gastric emptying disorder, digestive tract obstruction, gastroesophageal reflux or history of gastrointestinal surgery.
Early enteral nutrition helps postoperative gas
In the past, in order to prevent symptoms such as bloating and abdominal pain caused by premature eating after surgery, it was often allowed to enter water and eat after the intestinal tract returned to exhaust and peristalsis. ERAS recommends the concept of oral or enteral nutritional support in the early postoperative period (6-8 hours). Its role is not to provide nutrients to the body, but to believe that a small amount of nutrition can nourish the intestinal mucosa. Intestinal mucosal cells One characteristic is that the nutrients needed for its growth, proliferation and repair come directly from the chyme in contact with the mucous membrane. In addition to giving intestinal mucosal repair substances, early eating can also promote intestinal peristalsis and portal circulation, and restore intestinal movement early-to achieve exhaust; at the same time, it can also speed up the recovery time of intestinal flora balance.
It is generally recommended that patients can drink a small amount of water after waking up after the operation. On the first postoperative day, start taking 500-1000ml of liquid or a small amount of clear liquid food, and gradually increase it every day; if the oral liquid volume reaches the physiological requirement of 2000-2500ml per day At this time, consider stopping intravenous infusion. Once the patient resumes ventilation, the fluid diet can be switched to a semi-fluid diet. Food intake can be gradually increased according to gastrointestinal tolerance.
Of course, regarding the early eating time, different diseases are different: patients with rectal or pelvic surgery can start eating 4 hours after surgery; start eating and drinking water 1 day after colon and gastrectomy, and gradually increase their intake according to their own tolerance Intake; pancreatic surgery can gradually resume oral intake 3 to 4 days after the operation according to the patient’s tolerance.
However, it should be noted that patients with signs of fever or anastomotic leakage, intestinal obstruction, and gastroparesis are not recommended to eat early.