老年患者麻醉术前评估的研究进展

doi:10.3760/cma.j.issn.1007-1245.2024.06.013

摘要/Abstract

摘要：

随着全球人口老龄化的趋势日益明显，老年人对手术和围手术期护理的需求正在急剧增加。因此，优化老年患者的麻醉管理策略，以减少手术并发症和改善长期预后，变得尤为重要。本文旨在全面审视老年患者术前评估，以系统解决这一特殊人群在手术过程中可能面临的多种挑战，为临床提供依据。

关键词:

老年患者, 麻醉, 管理, 围手术期, 术前评估, 进展

Abstract:

As the global population ages, the demand for surgical and perioperative care among the elderly is increasing dramatically. Therefore, it is particularly important to optimize anesthetic management strategies in elderly patients to reduce the surgical complications and improve the long-term prognosis. This article aims to comprehensively review the preoperative evaluation of elderly patients to systematically address the various challenges that this special population may face during surgery and provide a clinical basis.

Key words:

Elderly patients, Anesthesia, Management, Perioperative period, Preoperative evaluation, Progress

吴侨侨.

老年患者麻醉术前评估的研究进展 [J]. 国际医药卫生导报, 2024, 30(6): 946-948.

Wu Qiaoqiao.

Research progress in pre-anesthetic evaluation of elderly patients [J]. International Medicine and Health Guidance News, 2024, 30(6): 946-948.

参考文献

[1] Partridge JS, Harari D, Martin FC, et al. The impact of pre-operative comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery: a systematic review[J]. Anaesthesia, 2014, 69 Suppl 1: 8-16. DOI: 10.1111/anae.12494.
[2] Eamer G, Taheri A, Chen SS, et al. Comprehensive geriatric assessment for older people admitted to a surgical service[J]. Cochrane Database Syst Rev, 2018, 1(1): CD012485. DOI: 10.1002/14651858.CD012485.pub2.
[3] Wozniak SE, Coleman J, Katlic MR. Optimal preoperative evaluation and perioperative care of the geriatric patient: a surgeon's perspective[J]. Anesthesiol Clin, 2015, 33(3): 481-489. DOI: 10.1016/j.anclin.2015.05.012.
[4] Knittel JG, Wildes TS. Preoperative assessment of geriatric patients[J]. Anesthesiol Clin, 2016, 34(1):171-183. DOI: 10.1016/j.anclin.2015.10.013.
[5] Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons[J]. J Am Geriatr Soc, 2011, 59(1):148-157. DOI: 10.1111/j.1532-5415.2010. 03234.x.
[6] Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living[J]. Gerontologist, 1969, 9(3):179-186.
[7] Robinson TN, Wallace JI, Wu DS, et al. Accumulated frailty characteristics predict postoperative discharge institutionalization in the geriatric patient[J]. J Am Coll Surg, 2011, 213(1):37-44. DOI: 10.1016/j.jamcollsurg. 2011.01.056.
[8] Xue DD, Cheng Y, Wu M, et al. Comprehensive geriatric assessment prediction of postoperative complications in gastrointestinal cancer patients: a meta-analysis[J]. Clin Interv Aging, 2018, 13:723-736. DOI: 10.2147/CIA.S155409.
[9] Mohanty S, Rosenthal RA, Russell MM, et al. Optimal perioperative management of the geriatric patient: a best practices guideline from the American College of Surgeons NSQIP and the American Geriatrics Society[J]. J Am Coll Surg, 2016, 222(5):930-947. DOI: 10.1016/j.jamcollsurg.2015.12.026.
[10] Chow WB, Rosenthal RA, Merkow RP, et al. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society[J]. J Am Coll Surg, 2012, 215(4): 453-466. DOI: 10.1016/j.jamcollsurg. 2012.06.017.
[11] Brookmeyer R, Evans DA, Hebert L, et al. National estimates of the prevalence of Alzheimer's disease in the United States[J]. Alzheimers Dement, 2011, 7(1):61-73. DOI: 10.1016/j.jalz.2010.11.007.
[12] Seitz DP, Gill SS, Gruneir A, et al. Effects of dementia on postoperative outcomes of older adults with hip fractures: a population-based study[J]. J Am Med Dir Assoc, 2014, 15(5): 334-341. DOI: 10.1016/j.jamda. 2013.12.011.
[13] Borson S, Scanlan J, Brush M, et al. The mini-cog: a cognitive "vital signs" measure for dementia screening in multi-lingual elderly[J]. Int J Geriatr Psychiatry, 2000, 15(11): 1021-1027. DOI: 10.1002/1099-1166(200011)15:11<1021::aid-gps234>3.0.co;2-6.
[14] Leibowitz D, Abitbol C, Alcalai R, et al. Perioperative atrial fibrillation is associated with increased one-year mortality in elderly patients after repair of hip fracture[J]. Int J Cardiol, 2017, 227:58-60. DOI: 10.1016/j.ijcard.2016.11.067.
[15] Braghiroli KS, Braz JRC, Rocha B, et al. Perioperative and anesthesia-related cardiac arrests in geriatric patients: a systematic review using meta-regression analysis[J]. Sci Rep, 2017,7(1):2622. DOI: 10.1038/s41598-017-02745-6.
[16] Nunes JC, Braz JR, Oliveira TS, et al. Intraoperative and anesthesia-related cardiac arrest and its mortality in older patients: a 15-year survey in a tertiary teaching hospital[J]. PLoS One, 2014,9(8):e104041. DOI: 10.1371/journal.pone.0104041.
[17] Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines[J]. J Am Coll Cardiol, 2014, 64(22):e77-137. DOI: 10.1016/j.jacc.2014.07.944.
[18] Rich MW, Chyun DA, Skolnick AH, et al. Knowledge gaps in cardiovascular care of the older adult population: a scientific statement from the American Heart Association, American College of Cardiology, and American Geriatrics Society[J]. J Am Coll Cardiol, 2016, 67(20): 2419-2440. DOI: 10.1161/CIR.0000000000000380.
[19] Li C, Friedman B, Conwell Y, et al. Validity of the Patient Health Questionnaire 2 (PHQ-2) in identifying major depression in older people[J]. J Am Geriatr Soc, 2007, 55(4): 596-602. DOI: 10.1111/j.1532-5415.2007. 01103.x.
[20] Drudi LM, Ades M, Turkdogan S, et al. Association of depression with mortality in older adults undergoing transcatheter or surgical aortic valve replacement[J]. JAMA Cardiol, 2018, 3(3): 191-197. DOI: 10.1001/jamacardio.2017.5064.
[21] Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients[J]. J Am Coll Surg, 2010, 210(6): 901-908. DOI: 10.1016/j.jamcollsurg.2010.01.028.
[22] Khan M, Jehan F, Zeeshan M, et al. Failure to rescue after emergency general surgery in geriatric patients: does frailty matter? [J]. J Surg Res, 2019, 233: 397-402. DOI: 10.1016/j.jss.2018.08.033.
[23] Shen Y, Hao Q, Zhou J, et al. The impact of frailty and sarcopenia on postoperative outcomes in older patients undergoing gastrectomy surgery: a systematic review and meta-analysis[J]. BMC Geriatr, 2017, 17(1): 188. DOI: 10.1186/s12877-017-0569-2.
[24] Watt J, Tricco AC, Talbot-Hamon C, et al. Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis[J]. BMC Med, 2018, 16(1):2. DOI: 10.1186/s12916-017-0986-2.
[25] Ko FC. Preoperative frailty evaluation: a promising risk-stratification tool in older adults undergoing general surgery[J]. Clin Ther, 2019, 41(3): 387-399. DOI: 10.1016/j.clinthera.2019.01.014.
[26] 张晶晶,刘辉,王亮. 2种剂量瑞马唑仑在衰弱老年肺叶切除术患者麻醉中的效果及安全性分析[J]. 转化医学杂志,2023,12(4):198-203. DOI: 10.3969/j.issn.2095-3097. 2023.04.014.
[27] 陈虹烨,徐海丽,段纷雨,等. 瑞马唑仑复合瑞芬太尼麻醉应用在衰弱患者腹腔镜下结肠癌根治术的麻醉效果[J]. 中外医疗,2023,42(22):136-139,148. DOI: 10.16662/j.cnki.1674-0742.2023.22.136.
[28] 魏端高,高巨. 衰弱与无痛消化道内镜麻醉[J]. 中国科技成果,2023,24(8):58-59,64. DOI: 10.3772/j.issn.1009-5659. 2023.08.024.
[29] 谢郭豪,刘正律,周瑞,等. 老年患者静脉麻醉下消化内镜微创治疗术后早期恢复与衰弱的关系[J]. 中华麻醉学杂志,2022,42(9):1035-1038. DOI: 10.3760/cma.j.cn131073. 20220605.00903.
[30] 刘炽艺,李斌飞,古晨. 衰弱患者围手术期麻醉管理的研究进展[J/CD]. 中华普通外科学文献(电子版),2022,16(3):236-240. DOI: 10.3877/cma.j.issn.1674-0793.2022. 03.017.