Реалізація протоколів прискореного післяопераційного відновлення у хворих
із метаболічним синдромом в абдомінальній хірургії (огляд літератури)

Тодуров І. М., Плегуца О. І., Перехрестенко О. В., Косюхно С. В.,

Калашніков О. О., Троц А. В., Кирик В. О., Гриневич А. А.

https://doi.org/10.57105/2415-7252-2023-6-01

Резюме

Прагнення до стандартизації методів периопераційного ведення хворих спонукали до створення відпо– відних алгоритмів. Стрімкий розвиток сучасної хірургії, впровадження малоінвазивних оперативних методик, удосконалення анестезіологічної служби, а також розстановка акцентів на поглиблення в патофізіологічні процеси того чи іншого захворювання значно сприяли досягненню максимальної результативності лікування та безпеки пацієнтів. Так розпочалась ера впровадження в практику протоколів прискореного післяопераційного відновлення хворих (ERAS). Водночас, така тактика, в певних випадках, не враховувє індивідуальних супутніх станів у хворих, що можуть ускладнити пере– біг периопераційного періоду та поставити під загрозу життя та здоров’я пацієнта. Метаболічний синдром є саме таким станом, неврахування якого є легковажним з боку лікаря, оскільки зі значно більшими ризиками може провокувати розвиток серцево-судинних, респіраторних, інфекційних та інших ускладнень, що погіршує прогнози лікування, а також збільшує економічні витрати на лікуван- ня таких пацієнтів. Парадоксальність полягає у тому, що незважаючи на його значну поширеність у світовій популяції, існує відносно небагато наукових праць, де досліджується влив метаболічного синдрому на перебіг периопераційного періоду в контексті ERAS. Враховуючи частоту поширення даного стану серед популяції та наявність прихованих форм метаболічних порушень, метаболічний синдром, однозначно, заслуговує додаткової умаси тіла з боку лікаря та, можливо, потребує проведення додаткових досліджень щодо розробки та впровадження нових стратегій протоколів пришвидшеного післяопераційного відновлення з урахуванням даної патології у довгостроковій перспективі.

У цій статті представлено основні компоненти протоколів ERAS в колоректальній та абдомі- нальній хірургії з акцентом на особливості їх реалізації у пацієнтів з метаболічним синдромом. Зокрема, надаються певні деталі як хірургічного, так і анестезіологічного шляхів ERAS в аспекті передоперацій- ного, післяопераційного та післяопераційного догляду.

Ключові слова: метаболічний синдром, ожиріння, цукровий діабет, протоколи прискореного після- операційного відновлення, ERAS, раннє післяопераційне відновлення.

Implementation of enhanced recovery after surgery (ERAS) protocols in patients

with metabolic syndrome in abdominal surgery

Todurov IM, Plehutsa OI, Perekhrestenko OV, Kosiukhno SV, Kalashnikov OO, Trots AV, Kyryk VO, Hrynevych AA

Abstract

Efforts to standardize methods of perioperative management of patients prompted the creation of appropriate algorithms. The rapid development of modern surgery, the introduction of minimally invasive surgical techniques, the improvement of anesthesiological services, and also the placing of emphasis on the deepening of pathophysiological processes, which are important for achieving the maximum effectiveness of treatment and patient safety. Thus began the era of implementation of enhanced recovery after surgery (ERAS) protocols on the practice. At the same time, such tactics, in certain cases, do not take into account individual concomitant conditions of patients, which can complicate the course of the perioperative period and endanger the life and health of the patient. Metabolic syndrome is just such a condition, the neglect of which is frivolous on the part of the doctor, because with much greater risks it can provoke the development of cardiovascular, respiratory, infectious and other complications, which worsens the prognosis of treatment and also increases the economic costs of treating such patients. The paradox is that, despite its significant prevalence in the world population, there are relatively few scientific works investigating the influence of metabolic syndrome on the course of the perioperative period in the context of ERAS. Considering the prevalence of this condition among the population and the presence of hidden forms of metabolic disorders, the metabolic syndrome clearly deserves additional attention from the doctor and may require additional research on the development and implementation of new strategies for enhanced recovery after surgery protocols taking into account this pathology in the long term. This article presents the main components of ERAS protocols in colorectal and general abdominal surgery with an emphasis on the specifics of their implementation in patients with metabolic syndrome. In particular, specific details of both the surgical and anesthetic pathways of ERAS are provided in terms of preoperative, postoperative, and postoperative care.

Key words: metabolic syndrome, obesity, diabetes, enhanced recovery after surgery protocols, ERAS, early postoperative recovery

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