Perioperative Pulmonary Support of the Elderly.
Perioperative Pulmonary Support of the Elderly.
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DOI：
10.1007/s13670-021-00369-3
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发表时间：
2021
影响因子：
1.2
通讯作者：
Pritts TA
中科院分区：
文献类型：
--
作者：
Entriken C;Pritts TA
随着老年患者人群的预计增加，了解和优化围手术期条件以确保最佳手术结局至关重要。呼吸生理学的变化影响老年患者的外科治疗。本文综述了老年人围手术期肺部管理。与衰老相关的生理变化包括对肺功能有害的物理和生化改变。慢性肺病（如COPD和间质性肺病）的患病率增加，这可能使患者易于发生术后肺部并发症。此外，老年患者，特别是那些患有慢性肺病的患者，有虚弱的风险。已经开发了筛查工具来评估风险并帮助明智地选择手术患者。“术前准备”的概念已经发展到最好的准备手术的患者，可能是更有影响力的减少术后肺部并发症比术后康复。了解年龄相关的药物代谢变化导致术中和术后剂量调整，减少呼吸抑制和肺保护性通气，微创手术减少了术后肺部并发症。老年人群的围手术期管理可分为三个关键领域：术前风险缓解、术中注意事项和术后管理。术前考虑包括患者的选择和全面的病史和体格检查，沿着戒烟和部分患者的早产。手术方面包括麻醉剂的仔细选择，肺保护性通气和外科手术的选择。术后管理应侧重于选择性使用可能导致呼吸抑制的药物和鼓励康复。
With the projected increase in the geriatric patient population, it is of the utmost importance to understand and optimize conditions in the perioperative period to ensure the best surgical outcome. Age-associated changes in respiratory physiology affect the surgical management of geriatric patients. This review focuses on perioperative pulmonary management of elderly individuals. The physiological changes associated with aging include both physical and biochemical alterations that are detrimental to pulmonary function. There is an increased prevalence of chronic lung disease such as COPD and interstitial lung disease which can predispose patients to postoperative pulmonary complications. Additionally, elderly patients, especially those with chronic lung disease, are at risk for frailty. Screening tools have been developed to evaluate risk and aid in the judicious selection of patients for surgical procedures. The concept of “prehabilitation” has been developed to best prepare patients for surgery and may be more influential in the reduction of postoperative pulmonary complications than postoperative rehabilitation. Understanding the age-associated changes in metabolism of drugs has led to dose adjustments in the intraoperative and postoperative periods, reducing respiratory depression and lung protective ventilation and minimally invasive procedures have yielded reductions in postoperative pulmonary complications. The perioperative management of the geriatric population can be divided into three key areas: preoperative risk mitigation, intraoperative considerations, and postoperative management. Preoperative considerations include patient selection and thorough history and physical, along with smoking cessation and prehabilitation in a subset of patients. Operative aspects include careful selection of anesthetic agents, lung protective ventilation, and choice of surgical procedure. Postoperative management should focus on selective use of agents that may contribute to respiratory depression and encouragement of rehabilitation.
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影响因子：
4
作者：
Aceto P;Antonelli Incalzi R;Bettelli G;Carron M;Chiumiento F;Corcione A;Crucitti A;Maggi S;Montorsi M;Pace MC;Petrini F;Tommasino C;Trabucchi M;Volpato S;Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Società Italiana di Gerontologia e Geriatria (SIGG), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia Geriatrica (SICG) and Associazione Italiana di Psicogeriatria (AIP)
通讯作者：
Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Società Italiana di Gerontologia e Geriatria (SIGG), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia Geriatrica (SICG) and Associazione Italiana di Psicogeriatria (AIP)
影响因子：
3.3
作者：
Cortopassi, Felipe;Gurung, Puncho;Pinto-Plata, Victor
通讯作者：
Pinto-Plata, Victor
DOI：
10.1016/j.jamcollsurg.2012.06.017
发表时间：
2012-10-01
影响因子：
5.2
作者：
Chow, Warren B.;Rosenthal, Ronnie A.;Esnaola, Nestor F.
通讯作者：
Esnaola, Nestor F.
影响因子：
18.2
作者：
Cho SJ;Stout-Delgado HW
通讯作者：
Stout-Delgado HW
影响因子：
10
作者：
Dowman, Leona M.;McDonald, Christine F.;Holland, Anne E.
通讯作者：
Holland, Anne E.