[ERAS Guidelines] Cesarean Section 剖腹生產手術(術前、術中、術後)臨床照顧建議指引

剖腹生產 (Cesarean Section/Cesarean Delivery) 為已開發國家中最常見的手術,在美國也從1970年佔所有生產的4.5%,成長到了2015年的31.9%。考量到手術與麻醉的成功攸關母親與胎兒的生命安全,ERAS Society 組成了專家小組整理過去的文獻資料對19項處置給予evidence levelrecommendation grade的分級,制定了ERAS官方建議照顧指引,分成三篇(術前、術中、術後)於2018年12月至2019年9月發表於American Journal of Obstetrics and Gynecology


其中 high evidence level 及 strong recommendation 的包含:

  • Preoperative maternal comorbidity optimization
    • - Maternal obesity (BMI >40 kg/m2 ) 顯著增加產婦與胎兒併發症風險,懷孕期間需體重管理與管理,手術複雜度的增加也需跨領域的計畫與準備。
    • - Maternal hypertension 顯著增加產婦與胎兒併發症風險,需有效的控制與管理。
    • - Maternal gestational diabetes mellitus 顯著增加產婦與胎兒併發症風險,需於懷孕前與懷孕中進行有效的控制與管理。
    • - Maternal cigarette smoking 有嚴重的併發症與生殖影響,需於懷孕前或懷孕初期戒菸。
  • Preoperative bowel preparation
    • - Oral or mechanical bowel preparation 不應使用於剖腹產手術。
  • Preoperative fasting
    • - 直到術前2小時,可飲用 clear fluids (pulp-free juice, coffee, or tea without milk)
    • - 直到術前6小時,可食用 light meal (不含油脂)
  • Preoperative antimicrobial prophylaxis
    • -下刀前60分鐘給予第一代 Cephalosporin 抗生素,若已破水則建議加上 Azithromycin
  • Prevention of intraoperative hypothermia
    • - 使用 forced air-warming、IV fluid warming、提升開刀房溫度,都能有效減少失溫
  • Perioperative nutritional care
    • - 建議產婦於術後兩小時內恢復正常飲食 (regular diet)




論文連結:

Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1)

R. Douglas Wilson et. al.

Published 18 September, 2018


Guidelines for intraoperative care in cesarean delivery: Enhanced Recovery After Surgery Society Recommendations (Part 2)

Aaron B. Caughey et. al.

Published 14 August, 2018


Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3)

George A. Macones et. al.

Published 14 April, 2019