高龄患者脊柱融合术加速康复外科临床实践专家共识

Expert consensus on the implementation of enhanced recovery after surgery in spinal fusion surgery for advanced age patients

随着我国人口老龄化越来越严重,罹患脊柱疾病的高龄(>75岁)患者越来越多。对于症状严重、保守治疗无效的患者来说,手术仍然是最有效的解决办法。在排除手术和麻醉技术失败因素外,影响术后并发症发生率的关键因素是手术应激反应和术后身体对器官功能要求的增加。高龄患者耐手术打击能力较差,通过实施加速康复外科(ERAS)减少手术应激反应对高龄脊柱手术患者更为重要。为使更多脊柱外科医生熟悉高龄脊柱ERAS的具体措施,北京医学会骨科分会老年学组和中华医学会麻醉学分会老年人麻醉学组专家以循证医学为依据,根据现有的临床经验和公开发表的相关资料,通过多次讨论、投票,总结形成了以下共识,供广大脊柱外科医师在临床工作中参考。

Chinese society is progressively aging,and more and more patients suffer from spinal diseases in advanced age patients(>75 years).Surgery is still the most effective solution for patients who have failed conservative treatment or who present with progressively worsening symptoms.Excluding surgical and anesthetic technical failures,the key factors affecting the incidence of postoperative complications are the stress response to surgery and the increased demands on organ function after surgery.Late old patients generally have a poor ability to withstand surgical shock,the implementation of enhanced recovery after surgery(ERAS)to reduce surgical stress response is more important for late old patients undergoing spinal surgery.Specific measures to familiarize more spinal surgeons with older spinal ERAS.On the basis of evidence‑based medicine,experts from the Geriatric Group of Orthopaedic Branch of Beijing Medical Association,Geriatric Anesthesiology Group of Anesthesiology Branch of Chinese Medical Association reached the following expert consensus through multiple discussions and votes based on the existing clinical experience and published relevant data,for the reference of academic colleagues.