使用 "术后强化恢复 "方法优化神经外科胶质母细胞瘤患者的治疗流程:文献综述

J. V. Isacker, Wendy Sterckx, Johannes van Loon
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引用次数: 0

摘要

目的:本研究旨在创建一个精心设计的 "术后强化康复 "方法版本,特别适用于神经外科胶质母细胞瘤患者。简介胶质母细胞瘤是一种绝症,中位生存期仅为 14.6 个月。由于缺乏护士和训练有素的护士来解决神经外科问题,医疗保健系统压力过大。加强术后恢复有利于患者、医疗团队和社会。方法:采用两种不同的搜索策略进行文献综述。首先,确定了胶质母细胞瘤患者的需求和期望。来自 PubMed、Embase、CINAHL 和 Cochrane Library 四个数据库的 75 篇论文符合条件。本研究共收录了 14 篇论文。其次,研究了现有的术后强化恢复方案。两名独立研究人员共筛选了 3521 篇论文,其中 82 篇符合纳入标准,50 篇被确定与本研究相关。通过这种方式,根据胶质母细胞瘤患者的需求,创建了精心设计的 "术后强化康复 "方法。研究结果胶质母细胞瘤患者可能面临众多需求。由于诊断不准确和未来不确定,他们可能会感到痛苦和焦虑。患者希望从医护人员那里获得更多的信息、支持和服务。因此,医护人员必须确保患者在确诊后不会失去所有希望,因为失去希望会导致抑郁和生活质量下降。所有这些需求都被纳入了 "术后恢复强化方案",并与文献中的新见解相结合。针对胶质母细胞瘤患者的 "术后强化康复 "中的第一组建议属于术前阶段,包括:信息和教育、术前康复、营养支持和禁食时间、饮酒和吸烟、合并症和药物治疗。术中阶段包括有关抗生素、体温、开颅手术、缝合和拔管的建议。最后,术后阶段包括有关血栓栓塞、恶心和呕吐、镇痛药、口服营养、输液、侵入性管路、移动、导尿、引流、出院、电话随访以及社会和情感支持的建议。结论需要根据新证据不断调整既定方案。只有通过适当的多学科合作,并深思熟虑地引入 "术后强化恢复",新的 "术后强化恢复 "方案的实施和可持续性才能在日常实践中取得成功。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Optimization of the Treatment Flow of Neurosurgical Patients with a Glioblastoma using the Enhanced Recovery After Surgery Methodology: A Literature Review
Purpose: This study aims to create an elaborated version of the Enhanced Recovery After Surgery methodology, specifically applied to neurosurgical patients with a glioblastoma. Introduction: Being diagnosed with a glioblastoma is a terminal diagnosis with a median survival rate of 14,6 months. The introduction of an Enhanced Recovery After Surgery can provide a solution for current challenges such as the under-pressure health care system because of a lack of nurses and welltrained nurses in neurosurgical problems. Enhanced Recovery After Surgery benefits the patient, healthcare teams and society. Methods: A literature review with two different search strategies was conducted. First, the needs and expectations of patients with a glioblastoma were identified. Seventy-five papers from four databases, PubMed, Embase, CINAHL and Cochrane Library, were eligible. Fourteen papers were included in this study. Second, the existing Enhanced Recovery After Surgery protocols were examined. A total of 3,521 papers were screened by two independent researchers, of which 82 met the inclusion criteria and 50 were determined relevant for this study. In this way, an elaborated version of the Enhanced Recovery After Surgery methodology based on the needs of patients with a glioblastoma is created. Results: Patients with a glioblastoma may face numerous needs. Due to a poor diagnosis and uncertain future, they could feel distressed and anxious. Patients expect more information, support and availability from health professionals. Therefore, it is important for healthcare professionals to make sure that patients do not lose all hope after the diagnosis because losing hope is associated with depression and a poorer quality of life. All these needs were integrated in the Enhanced Recovery After Surgery protocol and combined with new insights from the literature. The first bundle of recommendations in the Enhanced Recovery After Surgery for patients with a glioblastoma belongs to the preoperative phase and includes: information and education, prehabilitation, nutrition support and fasting time, alcohol and smoking, comorbidities and medication. The intraoperative phase includes advice about antibiotics, body temperature, craniotomy, stitches and extubating. Finally, the postoperative phase includes recommendations regarding thromboembolism, nausea and vomiting, analgesics, oral nutrition, fluids, invasive lines, mobilization, urinary catheter, drains, discharge, telephone follow-up and social and emotional support. Conclusion: The established protocol needs to be constantly adapted to new evidence. Only with an appropriate multidisciplinary collaboration and thoughtful introduction of the Enhanced Recovery After Surgery, the implementation and sustainability of the new Enhanced Recovery After Surgery protocol will succeed in daily practice.
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