新聞新知~手術前吃東西幫助復原？？
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在手術前吃東西可以幫助手術復原！！？？
By Jo Waters
Last updated at 11:42 PM on 27th September 2010
中文翻譯：
即使是從未動過手術的人都知道：手術前不能吃東西。
在手術前12小時禁止吃東西，這樣的規定已經施行了100多年。假如你動過腹部手術，你可能手術完一個星期不能進食，並且會被要求躺在床上一個星期。
不意外的，年長和身體虛弱的病患，會在術後體重急速下降，以至於傷口容易被感染、需花更多的時間復原。
在英國被腸癌外科醫師首創的一個激進新方法將改變這項慣例。這個方法不採用傳統的建議，不鼓勵禁食，在手術前6小時給病患吃富含碳水化合物的食物，例如：麵食、馬鈴薯。在手術前2小時給病患飲用高能量飲料。手術後鼓勵病患盡可能多吃ㄧ點，並且會督促他們下床活動，而非僅在床上休息。相關研究確認了這個方法的可行性，病人因此能降低併發症機率。且他們的恢復速度也明顯提升，住院時間減少1半，術後約少於3-4天即可回家休息。而不會像一般的腹部手術，需幾星期的康復時間。
Michael Attard，一位因腸癌住院在倫敦St Mark’s Hospital的病患表示：這種作法無形間省了NHS一筆費用，但關鍵點在於，病人能更早恢復。這家醫院是第一個採用此種方法的醫院，已經從此種Enhanced Recovery (ER)的模式中獲益。這位來自倫敦西北部78歲退休的工程師表示：我的醫師告訴我，由於癌症息肉的關係，我的腸子需被切開6英吋(約=15公分)，再以結腸合回去。這手術聽起來很激烈…我才在兩個月前被診斷出有前列腺癌，隨即擴散至腸子，是個嚴重的警訊。我已經設想好我將會深陷於病房床上數個星期無行為能力，且需要好幾個月才能復原。但在術後第二天早上，他的76歲太太Jean目瞪口呆看著他坐起來喝茶，並且幾小時後，他可以起身去走廊上廁所。隔天，他可以自己穿衣服，並且在醫院餐廳吃烤牛排，術後第四天就出院了。
我太太Jean原本以為會看到我躺在床上被施打嗎啡，但結果卻發現我坐在椅子上，並看起來不錯。她不敢相信我能這麼快的從手術中復原，其實我也同樣對於自己的復原感到驚訝。
Enhanced Recovery (ER)是個革命性的術前術後照護方法。其中心想法為-術前飲食可儲存病患的能量。術後好的營養可幫助增強病患免疫力與恢復力。
這個方法最早在1990年代後期由丹麥外科醫師Henrik Kehlet發明，他認為當病患需要體力康復時，禁食不太合理。雖然飲食是重要的部份，但讓病患起來動一動也同樣重要。Kehlet教授認為，長時間固定病患在床上，會增加傳染的風險、以及延長疾病康復時間。他質疑所有的標準程序，並且不經證實直接淘汰那些程序。
術前不吃東西最主要的理由為：手術時有將食物從胃吸入肺部的風險，但這風險被發現其實很小。先前，一般認為腸道在經過全身麻醉後，需要七天的時間才會關閉，但現在被發現大多數的病患術後幾小時，其腸道就有足夠的功能去推進食物。鼻管-穿過咽喉進入胃裡，在過去需要安裝一個星期才能將膽汁從胃裡排出，以防止嘔吐。但是，這個風險目前發現是很小的，鼻管只在病患嘔吐時才插入。鼻管不但不舒服，且增加感染風險。同樣的理由，傷口的引流管，以往會常態性的安裝，目前僅在一些程序進行。並且，病人使用硬膜外止痛或是自我管理移動式嗎啡滴管，使他們能儘快起來活動，導管也盡可能拔除，以減少傳染風險，有助於他們起床活動。Kehlet的方法自2002年以來，率先被耶奧維爾區醫院和聖馬可醫院直腸外科醫生沿用。
Michael的手術在聖馬可醫院進行，他解釋這種新方法所產生不同於傳統作法的地方。在過去，Michael在手術前會有12小時禁食，並會被給予高濃度的瀉藥，以清空他的腸道，相當不舒服。他不得不在手術前服用鎮定劑，並且在腹部被切上一刀。在醒來時，他必須被注射嗎啡，以及被插一隻導管在腹部，一根鼻管插進鼻子裡，一個導管長時間插在膀胱，不能吃喝，直到我們聽到他的腸子出現潺潺的聲音，才可進食，這可能需要一個禮拜的時間。
不意外的，經歷這樣過程的病患，相當不舒服，並且至少須留在醫院三個月，花上好幾個月復原，外加上容易受感染、和產生血塊。現在的手術經驗已經與以往不同，引用Enhanced Recovery似乎比較明智，但同時，這也似乎對它太有信心。太早將病患推出醫院，會不會有更大風險？Mr Jenkins解釋不會：我們不會隨便把人弄出院，除非我們已經證實他們的身體機能已經再次正常運作。事實上，自從Enhanced Recovery被引入聖馬可醫院後，儘管住院天數減少，但再住院率不變。
其餘表現成果相當亮眼：胸部感染率從4%降至不到2%，傷口感染率從11.5%降至3.8%。平均住院天數從2至3週降至僅3-5天。
根據聖馬可醫院研究，對某些人而言，手術後馬上活動似乎有點難，但有超過8成的病患能接受Enhanced Recovery計畫。
這項技術也被運用在其他專科上。
皇家伯恩茅斯醫院整形外科醫師Rob Middleton說，在使用Enhanced Recovery計畫之前，髖、膝關節手術只有5%的病人會寫感謝函給同仁，但使用次計劃後，比例提高至30%。
在急診室的故事明顯是個成功的案例。目前只有72間英國醫院將該技術使用至一定的程度上。而這個由英國衛生署(Department of Health)所主導的計畫，正慢慢平息下來了。
英國衛生署發言人表示，這項計畫只會運行兩年，而2011年三月後，將由NHS進行。
有人擔心這項計畫不會全面施行，只會交由立意良好、有時間壓力的外科醫師自行施行。
Michael Attard目前已經擺脫腸癌之苦，享受到這令人信服的好處。我的身體不用受癌症手術之苦。
英文原文：
Even people who have never had surgery know the drill - don’t eat anything before an op.
For more than 100 years medical protocol has been to starve patients up to 12 hours before surgery.
And if you’ve had abdominal surgery, you could end up having to fast for up to a week after the op, too. You would also be left immobilised in bed for weeks on end.
For more than 100 years medical protocol has been to starve patients up to 12 hours before surgery, but a radical new approach could change all that
Not surprisingly, patients - particularly the frail and elderly - often suffer dramatic weight loss; they are left weak and vulnerable to infection and take longer to recover.
But a radical new approach pioneered by bowel cancer surgeons in the UK could change all that. It goes against conventional advice - instead of fasting, patients are given carbohydrate-laden meals such as potatoes and pasta up to six hours before surgery, and high-energy drinks up to two hours before.
After surgery they are encouraged to eat as soon as possible. They are also urged to get up and about the next day, rather than just resting in bed.
Research confirms this approach works; patients have fewer complications, their recovery time is dramatically speeded up, and hospital stays can be cut in half -patients can be home in as little as three or four days, instead of the usual several weeks for abdominal surgery, for instance.
This potentially saves the NHS a fortune - and, crucially, patients feel better sooner.
Michael Attard, a bowel cancer patient at St Mark’s Hospital, London - one of the first hospitals to use the new approach - has recently benefited from this ‘enhanced recovery’ programme.
‘My surgeon told me I’d need 6 in of my bowel cut out, because of a cancerous polyp, and then have my colon joined back together. It sounded fairly drastic,’ says Michael, 78, a retired engineer, from north west London.
Fighting fit: Michael Attard, who had surgery for bowl cancer
Mr Jenkins says not: ‘No one is discharged unless we have evidence all their systems are working properly again and they are well.’
Indeed, despite a much reduced hospital stay, readmission rates are unchanged since the approach was introduced at St Mark’s.
Other results are impressive: the rates of chest infection have dropped from four per cent to less than two per cent and wound infections from 11.5 per cent to 3.8 per cent.
Average hospital stays have been cut from around two to three weeks to just three to five days.
For some, moving again so soon after surgery can be difficult, but more than 80 per cent of patients are able to tolerate the Enhanced Recovery programme, according to St. Mark’s research.
The techniques are also being used in other specialities.
Rob Middleton, a consultant orthopaedic surgeon at the Royal Bournemouth Hospital, Dorset, says: ‘Before we introduced Enhanced Recovery for hip and knee surgery around five per cent of patients would write to thank the staff - now it’s up to 30 per cent’, says Mr Middleton.
ER is clearly a success story, yet there are just 72 UK hospitals using the techniques to some degree.
And now the programme, launched by the Department of Health, is being wound down.
A Department of Health spokeswoman said the programme ‘was only intended to run for two years and after March 2011 this work will be carried on by the NHS’.
However, there are concerns that the work will be left to the good will of time-pressed surgeons.
Michael Attard, who is now free from bowel cancer, needs no convincing of the benefits.
‘My body didn’t have to go through the trauma of getting over surgery; it was left to concentrate on keeping my cancer at bay,’ he says.
Last updated at 11:42 PM on 27th September 2010
中文翻譯：
Michael Attard目前已經擺脫腸癌之苦，享受到這令人信服的好處。我的身體不用受癌症手術之苦。
英文原文：
Even people who have never had surgery know the drill - don’t eat anything before an op.
For more than 100 years medical protocol has been to starve patients up to 12 hours before surgery.
And if you’ve had abdominal surgery, you could end up having to fast for up to a week after the op, too. You would also be left immobilised in bed for weeks on end.
|
| For more than 100 years medical protocol has been to starve patients up to 12 hours before surgery, but a radical new approach could change all that |
Not surprisingly, patients - particularly the frail and elderly - often suffer dramatic weight loss; they are left weak and vulnerable to infection and take longer to recover.
But a radical new approach pioneered by bowel cancer surgeons in the UK could change all that. It goes against conventional advice - instead of fasting, patients are given carbohydrate-laden meals such as potatoes and pasta up to six hours before surgery, and high-energy drinks up to two hours before.
After surgery they are encouraged to eat as soon as possible. They are also urged to get up and about the next day, rather than just resting in bed.
Research confirms this approach works; patients have fewer complications, their recovery time is dramatically speeded up, and hospital stays can be cut in half -patients can be home in as little as three or four days, instead of the usual several weeks for abdominal surgery, for instance.
This potentially saves the NHS a fortune - and, crucially, patients feel better sooner.
Michael Attard, a bowel cancer patient at St Mark’s Hospital, London - one of the first hospitals to use the new approach - has recently benefited from this ‘enhanced recovery’ programme.
‘My surgeon told me I’d need 6 in of my bowel cut out, because of a cancerous polyp, and then have my colon joined back together. It sounded fairly drastic,’ says Michael, 78, a retired engineer, from north west London.
|
| Fighting fit: Michael Attard, who had surgery for bowl cancer |
Mr Jenkins says not: ‘No one is discharged unless we have evidence all their systems are working properly again and they are well.’
Indeed, despite a much reduced hospital stay, readmission rates are unchanged since the approach was introduced at St Mark’s.
Other results are impressive: the rates of chest infection have dropped from four per cent to less than two per cent and wound infections from 11.5 per cent to 3.8 per cent.
Average hospital stays have been cut from around two to three weeks to just three to five days.
For some, moving again so soon after surgery can be difficult, but more than 80 per cent of patients are able to tolerate the Enhanced Recovery programme, according to St. Mark’s research.
The techniques are also being used in other specialities.
Rob Middleton, a consultant orthopaedic surgeon at the Royal Bournemouth Hospital, Dorset, says: ‘Before we introduced Enhanced Recovery for hip and knee surgery around five per cent of patients would write to thank the staff - now it’s up to 30 per cent’, says Mr Middleton.
ER is clearly a success story, yet there are just 72 UK hospitals using the techniques to some degree.
And now the programme, launched by the Department of Health, is being wound down.
A Department of Health spokeswoman said the programme ‘was only intended to run for two years and after March 2011 this work will be carried on by the NHS’.
However, there are concerns that the work will be left to the good will of time-pressed surgeons.
Michael Attard, who is now free from bowel cancer, needs no convincing of the benefits.
‘My body didn’t have to go through the trauma of getting over surgery; it was left to concentrate on keeping my cancer at bay,’ he says.
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