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2017年5月，美国整形外科医师协会《整形重建外科》将正式发表加拿大卡尔加里大学、汤姆贝克癌症中心、艾伯塔省卫生署癌症策略临床网络、多伦多大学、美国希望之城国家医学中心、纪念斯隆凯特琳癌症中心、比利时根特大学、瑞典厄勒布鲁大学起草的术后加速康复学会（ERAS）推荐意见：乳房重建最佳围手术期处理共识评估。 由于术后加速康复可以通过引进循证措施实现，故该评估旨在对乳房重建手术患者最佳围手术期管理达成共识，并为围手术期加速康复方案提供循证推荐意见。 本文对各个方案项目进行大样本前瞻队列研究、随机对照研究、荟萃分析的系统评估。仅当缺乏较高级别证据时，才考虑小样本前瞻队列和回顾队列研究。可用文献由乳房重建手术国际专家组进行分级，并用于每个主题形成共识推荐意见。专家组进行共识讨论后，再对各个推荐意见进行分级。这些推荐意见的制定获得ERAS批准。 虽然某些推荐意见来自高质量的乳房重建患者随机对照研究数据，但是大多数推荐意见参考了相关人群的低水平研究、非乳房重建人群的高质量研究外推数据。 本文针对18个独特的术后加速康复问题，制定了推荐意见并进行了讨论。 关键推荐意见包括：围手术期避免使用阿片类药物、避免术前禁食、鼓励早期进食、使用减轻术后恶心呕吐和疼痛的麻醉技术、采取措施预防术中低温、鼓励术后早期活动。 根据各个主题的最佳可用证据，本文提出乳房重建患者最佳围手术期处理共识评估推荐意见如下：
对此，哈佛医学院、贝斯以色列女执事医疗中心整形外科专家 Samuel J. Lin 发表同期述评。 Plast Reconstr Surg. 2017 May;139(5):1056e-1071e. Consensus Review of Optimal Perioperative Care in Breast Reconstruction: Enhanced Recovery after Surgery (ERAS) Society Recommendations. Temple-Oberle C, Shea-Budgell MA, Tan M, Semple JL, Schrag C, Barreto M, Blondeel P, Hamming J, Dayan J, Ljungqvist O; ERAS Society. University of Calgary; Tom Baker Cancer Centre; Cancer Strategic Clinical Network, Alberta Health Services; City of Hope National Medical Center; University of Toronto; University Hospital of Ghent; Memorial Sloan Kettering Cancer Center; Faculty of Medicine and Health, Orebro University. BACKGROUND: Enhanced recovery following surgery can be achieved through the introduction of evidence-based perioperative maneuvers. This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery and to provide evidence-based recommendations for an enhanced perioperative protocol. METHODS: A systematic review of meta-analyses, randomized controlled trials, and large prospective cohorts was conducted for each protocol element. Smaller prospective cohorts and retrospective cohorts were considered only when higher level evidence was unavailable. The available literature was graded by an international panel of experts in breast reconstructive surgery and used to form consensus recommendations for each topic. Each recommendation was graded following a consensus discussion among the expert panel. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society. RESULTS: High-quality randomized controlled trial data in patients undergoing breast reconstruction informed some of the recommendations; however, for most items, data from lower level studies in the population of interest were considered along with extrapolated data from high-quality studies in non-breast reconstruction populations. Recommendations were developed for a total of 18 unique enhanced recovery after surgery items and are discussed in the article. Key recommendations support use of opioid-sparing perioperative medications, minimal preoperative fasting and early feeding, use of anesthetic techniques that decrease postoperative nausea and vomiting and pain, use of measures to prevent intraoperative hypothermia, and support of early mobilization after surgery. CONCLUSION: Based on the best available evidence for each topic, a consensus review of optimal perioperative care for patients undergoing breast reconstruction is presented. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V. PMID: 28445352 DOI: 10.1097/PRS.0000000000003242 Plast Reconstr Surg. 2017 May;139(5):1072e-1073e. Discussion: Consensus Review of Optimal Perioperative Care in Breast Reconstruction: Enhanced Recovery after Surgery (ERAS) Society Recommendations. Lin SJ. Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School. PMID: 28445353 DOI: 10.1097/PRS.0000000000003292
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