ERAS術中體液平衡輸液管理策略

ERAS Guideline for Fluid Management

強化術後恢復是一跨團隊跨領域整合照護模式，從術前評估與優化病患術前狀況，改善圍術期照護，促進術後恢復與減少功能受損，可以減少術後合併症，縮短住院天數與減少醫療支出。在維持適當體內血液容積的部分，以平衡體液輸液管理策略來進行。從術前避免延長空腹時間；術中在重大手術、高危險病患或術中有大量體液流失或出血時，使用微創血流動力學監測，以動態指標來進行目標導向輸液治療，避免過多的輸液與過度的限水，優化個別病患的體液狀態與血液循環；術後儘早恢復進食與停止輸液，可以減少合併症與加速恢復。 Enhanced recovery after surgery (ERAS) is an integrated, interdisciplinary and multi-modal care. From identification of the patient risks and optimization of pre-existing health condition, careful perioperative care and ensuring full recovery are important to reduce perioperative complications and shorten hospital stay decreased medical cost. To achieve maintenance of euvolemia, applying perioperative near zero fluid balance. Principles and meticulous perioperative hemodynamic management are helpful. It should prevent prolonged pre-operative fasting time. In major operations, high risk patients and the patients with large intravascular fluid loss, including blood loss and protein/fluid shift, goal-directed fluid therapy (GDFT) is recommended by using dynamic parameters with minimal invasive cardiac output monitor. It could optimize individual patient's perioperative volume status and improve tissue perfusion. In postoperative period, early oral intake is encouraged and routine intravenous fluids should be discontinued if oral intake is tolerated. We could reduce perioperative complications and enhance recovery.