指南针┃SOAP(2019): 剖宫产术后快速康复共识

答：剖宫产术后快速康复(Enhanced Recovery after Cesarean ,ERAC)流程旨在规范孕产妇的围术期管理。通过减少临床举措的差异和创建一个具体的循证管理路径，以期改善孕产妇和胎儿的临床结局【1-4】。在本共识中，我们提出了剖宫产术后快速康复方案的核心价值和要素，即该方案需包含结局改进的客观衡量指标。

许多要素借鉴自其它成功的加速康复外科(enhanced recovery after surgery, ERAS)项目，最主要是来自直结肠术后的快速恢复。每个要素被赋予了证据水平，其方法是基于美国心脏病学会(American College of Cardiology ,ACC)和美国心脏协会(American Heart Association,AHA)的分级标准经验(附录)，并可能随着证据的进一步充分而调整。跨学科的合作与交流是所有快速康复计划重要特点，这包括参与患者医疗管理过程中的方方面面，如：麻醉科医生、产科医生、母胎医学专业医生、儿科医生、新生儿科医生、护理、哺乳师、药剂师、医院管理层、患者及其家属亲友。

临床行为改变的挑战性一如既往，利益相关各方的接受度也各不相同，各专业领域的临床实践还需基于循证医学证据。而且，ERAC的成功实施不一定会减少母亲和/或新生儿的住院时间，也不一定能降低费用，但ERAC使命是提高全球的医疗质量及优化剖宫产后的恢复质量。

答：ERAC的目标是通过一系列标准化、多学科的方法，帮助所有产妇获得有循证依据的、以患者为中心的医疗管理措施，从而优化剖宫产术后的恢复，改善产妇和新生儿的临床结局。其核心是一种通过不断改进流程和多学科协作而形成严格审视和应用最新知识的医疗文化。

答：ERAC应该被认为是一个持续的临床管理过程，始于妊娠前宣教、产前优化至分娩管理，包括麻醉，结束于产后院内临床管理和出院后回访。

答：在本指南中，我们将重点关注剖宫产术前、术中和术后的临床要素，如下表所示。

答：有些要素可能无法在您的医院实施，而其它要素可能已经是您日常工作流程和管理模式的一部分。ERAC项目的成功在于跨学科合作。

答：委员会已经确定了一些ERAC项目所必须的核心要素，这些核心要素由每个表中带有星号**的粗体文本标示。

答：择期剖宫产ERAC路径已经成型，然而，该路径的许多要素可以应用于非择期剖宫产。

答：各种ERAC相关文件的范例，包括患者教育材料，可以在附录中找到，以帮助成功实施。

针对每个建议都进行了文献回顾。 评估了每个核心要素的现有证据，因为它们与剖宫产术后产妇和新生儿的快速康复相关。基于现有的最佳证据，我们将2016年美国心脏病学会(ACC)和美国心脏协会(ACC/AHA)临床指南建议的分类系统1应用于每一个核心要素的推荐。该分类系统可在附录中找到。

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