冠狀動脈繞道手術整合性照護──以術後加速康復為例

Enhanced Recovery After Surgery: An Example of Integrated Care for Coronary Artery Bypass Graft Surgery

冠狀動脈繞道術後病人常有疼痛、身體多種併發症之生理不適，亦可能有疲憊、憂鬱等心理問題，進而導致家屬照護負荷，影響其生活品質，因此需要完整的多科整合照護計畫來加速術後復原並進而減少社會負擔。近年政府致力推動整合性醫療照護，術後加速康復之照護模式也開始導入於手術後照護。因此本文透過文獻回顧，將術後加速康復計畫應用於心臟術後整合性照護，提供跨學科且基於實證資料之組合式照護計畫，包括碳水化合物飲料、多模式止痛、輸液管理等，將病人的情緒和生理壓力降至最低，使其儘快恢復生理功能狀態，藉此提供臨床團隊未來照護冠狀動脈繞道手術後照護之參考。

After post-coronary artery bypass surgery, patients often experience physiological issues such as pain and complications as well as psychological issues such as fatigue and depression. These issues may burden family caregivers and impact patient quality of life. Therefore, a comprehensive, multidisciplinary integrated care plan is needed to expedite postoperative recovery and reduce the social burden on patients. In recent years, government promotion of integrated healthcare, including the implementation of postoperative accelerated recovery care models, has led to the introduction of the enhanced recovery after surgery program as part of post-cardiac surgery integrated care. This program, providing combined care that is multidisciplinary and evidence-based, incorporates elements such as the provision of carbohydrate drinks, multimodal pain management, and fluid management. Reducing to a minimum the emotional and physiological stresses on patients facilitates a faster return to normal functionality. In this paper, a literature review is conducted to provide a reference for future post-coronary artery bypass surgery care by clinical teams, with the aim of offering an integrated approach to patient care.