Array ( [id] => 684 [catid] => 29 [title] => 中国加速康复外科临床实践指南(2021)：(二) 肝胆外科手术部分 [thumb] => [keywords] => [description] => [hits] => [uid] => 1 [author] => 系统管理员 [status] => 9 [url] => https://www.anes-guide.com/show/684.html [link_id] => 0 [tableid] => 0 [inputip] => 14.105.95.222 [inputtime] => 2024-01-11 15:13:24 [updatetime] => 2024-01-11 15:13:24 [displayorder] => 0 [nrjc] => Array ( ) [nrsh] => Array ( ) [xzl] => 0 [dzl] => 0 [wailian] => [demo_url] => [zjpjff] => GRADE [zjfj] => [tjqd] => [nianfen] => 2021 [guojia] => 中华医学会外科学分会；中华医学会麻醉学分会 [pdf] => [tjyjyw] => [lyyw] => [laiyuan] => 对于创伤大的肝胆外科手术，实施全静脉或静吸复合全身麻醉联合硬膜外阻滞或区域神经阻滞；术后镇痛以连续神经阻滞（竖脊肌阻滞、胸椎旁阻滞和腹横肌平面阻滞）或局麻药切口浸润镇痛为基础，联合静脉使用NSAIDs药物和（或）低剂量阿片类药物+止吐药的多模式镇痛方案，覆盖术后48～72h以上。实施预防性镇痛有助于术中应激控制和术中术后全程疼痛管理。（证据等级：高；推荐强度：强推荐） [znzldj] => C [_inputtime] => 1704957204 [_updatetime] => 1704957204 [_nrjc] => [_nrsh] => )

Array ( [id] => 685 [catid] => 31 [title] => 中国加速康复外科临床实践指南(2021)：(二) 肝胆外科手术部分 [thumb] => [keywords] => [description] => [hits] => [uid] => 1 [author] => 系统管理员 [status] => 9 [url] => https://www.anes-guide.com/show/685.html [link_id] => 0 [tableid] => 0 [inputip] => 14.105.95.222 [inputtime] => 2024-01-11 15:13:24 [updatetime] => 2024-01-11 15:13:24 [displayorder] => 0 [nrjc] => Array ( ) [nrsh] => Array ( ) [xzl] => 0 [dzl] => 0 [wailian] => [demo_url] => [zjpjff] => GRADE [zjfj] => [tjqd] => [nianfen] => 2021 [guojia] => 中华医学会外科学分会；中华医学会麻醉学分会 [pdf] => [tjyjyw] => [lyyw] => [laiyuan] => 在肝脏外科手术中实施控CLCVP（CVP＜5cmH2O）技术以减少术中出血。在循环、容量和全身器官灌注的监测下应用动态液体管理、完善的麻醉及联合使用去甲肾上腺素等综合措施，避免CLCVP相关并发症。（证据等级：中；推荐强度：强推荐） [znzldj] => C [_inputtime] => 1704957204 [_updatetime] => 1704957204 [_nrjc] => [_nrsh] => )

Array ( [id] => 686 [catid] => 39 [title] => 中国加速康复外科临床实践指南(2021)：(二) 肝胆外科手术部分 [thumb] => [keywords] => [description] => [hits] => [uid] => 1 [author] => 系统管理员 [status] => 9 [url] => https://www.anes-guide.com/show/686.html [link_id] => 0 [tableid] => 0 [inputip] => 14.105.95.222 [inputtime] => 2024-01-11 15:13:24 [updatetime] => 2024-01-11 15:13:24 [displayorder] => 0 [nrjc] => Array ( ) [nrsh] => Array ( ) [xzl] => 0 [dzl] => 0 [wailian] => [demo_url] => [zjpjff] => GRADE [zjfj] => [tjqd] => [nianfen] => 2021 [guojia] => 中华医学会外科学分会；中华医学会麻醉学分会 [pdf] => [tjyjyw] => [lyyw] => [laiyuan] => 围手术期血糖水平应控制在6.0~10.0mmol/L范围内，对血糖控制不佳的病人（如糖尿病病人）可行胰岛素治疗。通过围手术期抗应激措施防治应激性高糖血症及过度炎性反应。（证据等级：中；推荐强度：强推荐） [znzldj] => C [_inputtime] => 1704957204 [_updatetime] => 1704957204 [_nrjc] => [_nrsh] => )

Array ( [id] => 687 [catid] => 38 [title] => 中国加速康复外科临床实践指南(2021)：(二) 肝胆外科手术部分 [thumb] => [keywords] => [description] => [hits] => [uid] => 1 [author] => 系统管理员 [status] => 9 [url] => https://www.anes-guide.com/show/687.html [link_id] => 0 [tableid] => 0 [inputip] => 14.105.95.222 [inputtime] => 2024-01-11 15:13:24 [updatetime] => 2024-01-11 15:13:24 [displayorder] => 0 [nrjc] => Array ( ) [nrsh] => Array ( ) [xzl] => 0 [dzl] => 0 [wailian] => [demo_url] => [zjpjff] => GRADE [zjfj] => [tjqd] => [nianfen] => 2021 [guojia] => 中华医学会外科学分会；中华医学会麻醉学分会 [pdf] => [tjyjyw] => [lyyw] => [laiyuan] => 实施腹腔镜手术、术后当天进食及早期活动等均有助于病人快速康复。（证据等级：高；推荐强度：强推荐） [znzldj] => C [_inputtime] => 1704957204 [_updatetime] => 1704957204 [_nrjc] => [_nrsh] => )

Array ( [id] => 688 [catid] => 32 [title] => 中国加速康复外科临床实践指南(2021)：(二) 肝胆外科手术部分 [thumb] => [keywords] => [description] => [hits] => [uid] => 1 [author] => 系统管理员 [status] => 9 [url] => https://www.anes-guide.com/show/688.html [link_id] => 0 [tableid] => 0 [inputip] => 14.105.95.222 [inputtime] => 2024-01-11 15:13:24 [updatetime] => 2024-01-11 15:13:24 [displayorder] => 0 [nrjc] => Array ( ) [nrsh] => Array ( ) [xzl] => 0 [dzl] => 0 [wailian] => [demo_url] => [zjpjff] => GRADE [zjfj] => [tjqd] => [nianfen] => 2021 [guojia] => 中华医学会外科学分会；中华医学会麻醉学分会 [pdf] => [tjyjyw] => [lyyw] => [laiyuan] => 围手术期应避免容量负荷过重，术后尽早恢复肠内营养，及时停用静脉补液。（证据等级：中；推荐强度：强推荐） [znzldj] => C [_inputtime] => 1704957204 [_updatetime] => 1704957204 [_nrjc] => [_nrsh] => )

Array ( [id] => 689 [catid] => 27 [title] => 中国加速康复外科临床实践指南(2021)：(二) 肝胆外科手术部分 [thumb] => [keywords] => [description] => [hits] => [uid] => 1 [author] => 系统管理员 [status] => 9 [url] => https://www.anes-guide.com/show/689.html [link_id] => 0 [tableid] => 0 [inputip] => 14.105.95.222 [inputtime] => 2024-01-11 15:13:24 [updatetime] => 2024-01-11 15:13:24 [displayorder] => 0 [nrjc] => Array ( ) [nrsh] => Array ( ) [xzl] => 0 [dzl] => 0 [wailian] => [demo_url] => [zjpjff] => GRADE [zjfj] => [tjqd] => [nianfen] => 2021 [guojia] => 中华医学会外科学分会；中华医学会麻醉学分会 [pdf] => [tjyjyw] => [lyyw] => [laiyuan] => 应遵循肝胆外科手术围手术期抗生素使用规范。对于术前胆管引流的病人，术中应常规留取胆汁行病原学培养，并针对性给予抗生素治疗。（证据等级：高；推荐强度：强推荐） [znzldj] => C [_inputtime] => 1704957204 [_updatetime] => 1704957204 [_nrjc] => [_nrsh] => )

Array ( [id] => 638 [catid] => 297 [title] => European guidelines on perioperative venousthromboembolism prophylaxis：Chronic treatments with antiplatelet agents [thumb] => [keywords] => [description] => [hits] => [uid] => 1 [author] => 系统管理员 [status] => 9 [url] => https://www.anes-guide.com/show/638.html [link_id] => 0 [tableid] => 0 [inputip] => 14.105.95.222 [inputtime] => 2024-01-11 15:13:23 [updatetime] => 2024-01-11 15:13:23 [displayorder] => 0 [nrjc] => Array ( ) [nrsh] => Array ( ) [xzl] => 0 [dzl] => 0 [wailian] => https://journals.lww.com/ejanaesthesiology/fulltext/2018/02000/european_guidelines_on_perioperative_venous.12.aspx [demo_url] => [zjpjff] => GRADE [zjfj] => [tjqd] => [nianfen] => 2017 [guojia] => European Society of Anaesthesiology [pdf] => [tjyjyw] => [lyyw] => In patients receiving APA chronically, we recommend thromboprophylaxis in cases of moderate/high VTE risk, whilst assessing the risk of perioperative bleeding. (1B) [laiyuan] => 对于长期接受抗血小板药物（APA）治疗的患者，我们建议在中/高度静脉血栓栓塞症（VTE）风险的情况下采取血栓预防措施，同时评估围术期出血的风险。（证据级别：中；推荐强度：强推荐） [znzldj] => B [_inputtime] => 1704957203 [_updatetime] => 1704957203 [_nrjc] => [_nrsh] => )

Array ( [id] => 639 [catid] => 297 [title] => European guidelines on perioperative venousthromboembolism prophylaxis：Chronic treatments with antiplatelet agents [thumb] => [keywords] => [description] => [hits] => [uid] => 1 [author] => 系统管理员 [status] => 9 [url] => https://www.anes-guide.com/show/639.html [link_id] => 0 [tableid] => 0 [inputip] => 14.105.95.222 [inputtime] => 2024-01-11 15:13:23 [updatetime] => 2024-01-11 15:13:23 [displayorder] => 0 [nrjc] => Array ( ) [nrsh] => Array ( ) [xzl] => 0 [dzl] => 0 [wailian] => [demo_url] => [zjpjff] => GRADE [zjfj] => [tjqd] => [nianfen] => 2017 [guojia] => European Society of Anaesthesiology [pdf] => [tjyjyw] => [lyyw] => In patients receiving APA chronically, if the risk of VTE outweighs the risk of bleeding, we suggest pharmacological (anticoagulant) prophylaxis (LMWH,direct oral anticoagulants, fondaparinux depending on the indication) . (1C) [laiyuan] => 对于长期接受抗血小板药物（APA）治疗的患者，如果静脉血栓栓塞症（VTE）风险大于出血风险，我们建议采取药物（抗凝剂）预防（低分子肝素、直接口服抗凝剂、视适应症而用磺达肝癸）。（证据级别：低；推荐强度：弱推荐） [znzldj] => B [_inputtime] => 1704957203 [_updatetime] => 1704957203 [_nrjc] => [_nrsh] => )

Array ( [id] => 640 [catid] => 297 [title] => European guidelines on perioperative venousthromboembolism prophylaxis：Chronic treatments with antiplatelet agents [thumb] => [keywords] => [description] => [hits] => [uid] => 1 [author] => 系统管理员 [status] => 9 [url] => https://www.anes-guide.com/show/640.html [link_id] => 0 [tableid] => 0 [inputip] => 14.105.95.222 [inputtime] => 2024-01-11 15:13:23 [updatetime] => 2024-01-11 15:13:23 [displayorder] => 0 [nrjc] => Array ( ) [nrsh] => Array ( ) [xzl] => 0 [dzl] => 0 [wailian] => [demo_url] => [zjpjff] => GRADE [zjfj] => [tjqd] => [nianfen] => 2017 [guojia] => European Society of Anaesthesiology [pdf] => [tjyjyw] => [lyyw] => In patients treated with dual antiplatelet therapy (recent coronary stent implantation) undergoing a procedure associated with a high risk of VTE, we suggest resuming APA shortly after the procedure, prioritising over pharmacological VTE prevention. (2C) [laiyuan] => 对于接受双联抗血小板疗法（近期行冠状动脉支架植入术）的患者，在接受与静脉血栓栓塞症（VTE）相关的高风险手术时，我们建议在手术后不久恢复抗血小板药物（APA）治疗，优先使用药物预防VTE。（证据级别：低；推荐强度：弱推荐） [znzldj] => B [_inputtime] => 1704957203 [_updatetime] => 1704957203 [_nrjc] => [_nrsh] => )

Array ( [id] => 641 [catid] => 297 [title] => European guidelines on perioperative venousthromboembolism prophylaxis：Chronic treatments with antiplatelet agents [thumb] => [keywords] => [description] => [hits] => [uid] => 1 [author] => 系统管理员 [status] => 9 [url] => https://www.anes-guide.com/show/641.html [link_id] => 0 [tableid] => 0 [inputip] => 14.105.95.222 [inputtime] => 2024-01-11 15:13:23 [updatetime] => 2024-01-11 15:13:23 [displayorder] => 0 [nrjc] => Array ( ) [nrsh] => Array ( ) [xzl] => 0 [dzl] => 0 [wailian] => [demo_url] => [zjpjff] => GRADE [zjfj] => [tjqd] => [nianfen] => 2017 [guojia] => European Society of Anaesthesiology [pdf] => [tjyjyw] => [lyyw] => If an anticoagulant is associated with an APA, we suggest the administration of the lowest approved dose. (2C) [laiyuan] => 如果抗凝剂与抗血小板药物（APA）联用，建议使用最低批准剂量。（证据级别：低；推荐强度：弱推荐） [znzldj] => B [_inputtime] => 1704957203 [_updatetime] => 1704957203 [_nrjc] => [_nrsh] => )