Peri‐operative care of the elderly 2014
Peri‐operative care of the elderly 2014
复制标题
2014年老年人围手术期护理
作者：
F. Beech;A. Brown;J. Dhesi;I. Foo;J. Goodall;W. Harrop;J. Jameson;N. Love;K. Pappenheim;Stuart M. White
越来越多的老年患者正在接受越来越多的外科手术。生理储备存在与年龄相关的下降，这可能会因疾病、认知能力下降、虚弱和多种药物而加剧。与年轻手术患者相比，老年人在择期手术和（特别是）急诊手术后的死亡率和发病率相对较高。多学科护理可改善老年手术患者的预后。协议驱动的综合路径有效地指导护理，但必须个性化以适应每位患者。AAGBI强烈支持高级老年病医生在协调老年人手术护理方面发挥更大的作用，并得到高级麻醉师（顾问/助理专家）和外科医生的支持。围手术期护理的目的是及时、有尊严地治疗老年患者，并通过避免术后并发症来优化康复。有效的围手术期护理提高了高龄手术患者返回发病前居住地的可能性，并在住院期间保持社区护理的连续性。老年外科病人术后谵妄是常见的，但诊断不足，并延迟康复。建议采用多模式干预策略预防术后谵妄。围手术期疼痛在老年手术患者中很常见，但未得到充分重视，特别是如果他们有认知障碍。麻醉师应尽可能给予阿片类药物保留镇痛，并遵循已发表的老年人疼痛管理指南。老年患者应该被认为有精神能力对他们的治疗做出决定。良好的沟通对这一过程至关重要。如果他们明显缺乏这种能力，则应寻求替代信息，以确定何种治疗（如果有的话）符合患者的最大利益。麻醉师不得根据年龄分配手术或重症监护，但必须参与讨论手术和/或复苏的效用。为老年人提供围手术期护理的证据基础仍然很差。强烈鼓励麻醉师参与国家审计项目和结果研究，特别是涉及老年手术患者。
Increasing numbers of elderly patients are undergoing an increasing variety of surgical procedures. There is an age‐related decline in physiological reserve, which may be compounded by illness, cognitive decline, frailty and polypharmacy. Compared with younger surgical patients, the elderly are at relatively higher risk of mortality and morbidity after elective and (especially) emergency surgery. Multidisciplinary care improves outcomes for elderly surgical patients. Protocol‐driven integrated pathways guide care effectively, but must be individualised to suit each patient. The AAGBI strongly supports an expanded role for senior geriatricians in coordinating peri‐operative care for the elderly, with input from senior anaesthetists (consultants/associate specialists) and surgeons. The aims of peri‐operative care are to treat elderly patients in a timely, dignified manner, and to optimise rehabilitation by avoiding postoperative complications. Effective peri‐operative care improves the likelihood of very elderly surgical patients returning to their same pre‐morbid place of residence, and maintains the continuity of their community care when in hospital. Postoperative delirium is common, but underdiagnosed, in elderly surgical patients, and delays rehabilitation. Multimodal intervention strategies are recommended for preventing postoperative delirium. Peri‐operative pain is common, but underappreciated, in elderly surgical patients, particularly if they are cognitively impaired. Anaesthetists should administer opioid‐sparing analgesia where possible, and follow published guidance on the management of pain in older people. Elderly patients should be assumed to have the mental capacity to make decisions about their treatment. Good communication is essential to this process. If they clearly lack that capacity, proxy information should be sought to determine what treatment, if any, is in the patient's best interests. Anaesthetists must not ration surgical or critical care on the basis of age, but must be involved in discussions about the utility of surgery and/or resuscitation. The evidence base informing peri‐operative care for the elderly remains poor. Anaesthetists are strongly encouraged to become involved in national audit projects and outcomes research specifically involving elderly surgical patients.
影响因子：
16.8
作者：
Panda A;Arjona A;Sapey E;Bai F;Fikrig E;Montgomery RR;Lord JM;Shaw AC
通讯作者：
Shaw AC
影响因子：
10.7
作者：
Strøm C;Rasmussen LS;Sieber FE
通讯作者：
Sieber FE