加速康复外科视角下衰弱患者围手术期的问题及对策

Perioperative problems and countermeasures of patients with frailty in the perspective of enhanced recovery after surgery

衰弱是一种多维度的临床综合征,反映了机体生理储备的下降,衰弱患者常伴发多种疾病。麻醉及围手术期管理不当,患者术后并发症和病死率会显著增加。与传统围手术期处理方法相比,加速康复外科理念能优化围手术期措施,使患者快速康复。目前衰弱患者的围手术期管理仍处于探索阶段。衰弱常见的评估方法是衰弱表型和衰弱指数。本文围绕衰弱患者围手术期相关问题(营养状况低、心理状况差、病情复杂且并发症多、易发生跌倒坠床事件)提出相应对策,为老年医务工作者提供衰弱管理的依据。

Frailty is a multidimensional syndrome,reflecting the decline of the body's physiological reserve.The patients are often accompanied by a variety of diseases.The postoperative complications and mortality were significantly increased on frail patients due to improper anesthesia and perioperative management.Enhanced recovery after surgery optimizes perioperative treatment and achieves rapid recovery compared with traditional measures.However,perioperative management of patients with frailty is still in the exploratory stage.Common assessment methods for weakness are the debilitating phenotype and the debilitating index.This article focuses on the perioperative related problems of debilitated patients(low nutritional status,poor mental condition,complicated condition and many complications,multi-disciplinary collaboration,prone to fall and fall),and provide the basis for the frailty management of elderly medical workers.