Author/Editor		Rems, Miran; Jurekovič, Vlado; Studen Pauletič, Polona
Title		Kirurgija s pospešenim okrevanjem pri bolnikih s kolorektalnim rakom v Sloveniji 2012
Type		članek
Vol. and No.		Letnik 83, št. 2
Publication year		2014
Volume		str. 115-126
ISSN		1581-0224 - Zdravniški vestnik
Language		slv
Abstract		Izhodišča: Kirurgija s pospešenim okrevanjem (KsPO) je model oboperacijske obravnave bolnika, pri katerem z optimizacijo procesov zdravljenja vplivamo na hitrost bolnikovega okrevanja. Uresničevanje načel KsPO pri operacijah raka debelega črevesa in danke je zahteven proces, ki terja strokovne in organizacijske ukrepe. Metode: Vsem trinajstim predstojnikom abdominalnih kirurških oddelkov v Sloveniji, kjer operirajo bolnike z rakom debelega črevesa in danke, smo poslali anketni vprašalnik o KsPO. Vprašalnik smo analizirali s programom Microsoft Excel. Rezultati: Vsi predstojniki se delno ali v celoti strinjajo, da je KsPO upoštevanja vreden klinični koncept. Sedem oddelkov ima izdelano klinično pot, deloma ali v celoti pa uporabljajo načela KsPO na 12 oddelkih. Zelo malo dejavnosti je pred sprejemom, zlasti manjka pogovor z dietetikom in fizioterapevtom. Manj kot polovica bolnikov prejme glukozni napitek pred operacijo, enako velja tudi za preprečevanje slabosti in bruhanja po operaciji. Več kot dve tretjini bolnikov je še vedno deležnih čiščenja črevesa pred operacijo. Več kot polovica bolnikov ima vstavljen centralni venski kateter in so po operaciji sprejeti v enoto intenzivne terapije. Prvi dan po operaciji tri četrtine bolnikov ne vstaja ali ne sedi na postelji. Več kot polovica bolnikov ima vstavljeno nazogastrično sondo. Laparoskopska tehnika se pogosteje uporablja pri debelem črevesu kot pri danki. Zaključki: V primerjavi s podobno analizo iz leta 2004 lahko ugotovimo pomemben napredek v skrajšanju povprečne načrtovane ležalne dobe. Kljub temu večine bolnikov ne operirajo po načelih KsPO. Uresničevanje načel KsPO v Sloveniji je žal dokaj borno in ne takšno, kot bi pričakovali glede na dokazane pozitivne učinke, čeprav je primerljivo z izkušnjami drugih.Background: Enhanced recovery after surgery (ERAS) protocol is a model of perioperative patient management where process optimisation helps to shorten patients' recovery time. Application of ERAS protocol in colorectal cancer surgery is a demanding process, challenging our professional and organisational measures. Methods: A questionnaire regarding ERAS was sent to all thirteen heads of departments performing surgical treatment of colorectal cancer patients in Slovenia. The questionnaire was analyzed using Microsoft Excel Program. Results: There is a strong agreement among all the respondents that ERAS is a relevant clinical concept. Only seven clinical departments have developed a clinical pathway consistent with ERAS protocol, but principles of ERAS are followed at least partly or completely in twelve clinical departments. The most obvious is lack of activity before surgery, and particularly the educational interview with a dietitian and a physiotherapist. Less than half of the patients drink the glucose drink before surgery, and the same applies to the prophylaxis of nausea and vomiting. More than two thirds of patients are still subjected to mechanical bowel preparation before surgery. More than half of them have a central line and are admitted to intensive care unit (ICU) after surgery. More than 75% of the patients do not sit up in bed or stand up on day 1 after surgery. More than half of them still have the nasogastric tube. Laparoscopy is used more frequently for colon and less for rectal surgery. Conclusions: Comparing this analysis with the one done in 2004, we can conclude that there is an important shortening of average planned hospital stay. Nevertheless, still the majority of patients are not managed according to the ERAS protocol. The implementation of ERAS concept in Slovenia is rather poor, contrary to what we would expect considering evidence-based positive effects, but nevertheless comparable to other's experience.
Keywords		bolezni prebavil rak na želodcu Helicobacter pylori diskusije