摘要
衰弱是机体储备能力下降,应激易感性增加,导致不良结局增加的一种多维度综合征。衰弱在心脏手术患者中非常普遍,会导致心脏术后发生并发症的风险增加并加重医疗系统负担,推荐使用一种简单快捷的方法筛选衰弱,对初筛阳性的患者进行针对具体缺陷的更深入评估或全面的老年综合评估,以识别导致衰弱的原因、组成成分及其严重程度,做出适合患者需求的个体化临床方案和治疗策略,优化临床结局。目前识别衰弱主要有“表型模型”和“缺陷累积模型”2种概念,已验证可用于评估衰弱的工具有多种。本文就衰弱的概念、病理生理、心脏手术患者衰弱评估方法及围术期干预措施(包括术前优化、术中麻醉管理和术后处理)等方面的研究进展予以综述,以期为衰弱患者心脏手术围术期管理提供借鉴。
Frailty is a multidimensional syndrome characterized by decreased functional reserves and increased vulnerability to stress,which increases the perioperative risks and leads to adverse outcomes.Frailty is highly prevalent among patients who are undergoing cardiac surgery,which has increased the risk of postoperative complications and has placed a great burden on the healthcare system.It is recommended to use a simple validated scale to screen for frailty and then perform a more detailed assessment of the specific deficit or a comprehensive geriatric assessment for positive patients.These assessments can help to determine the frailty domains and their components with the degree of severity,make a tailored clinical judgement and therapeutic strategies,and optimize the clinical outcomes.There are two basic concepts of frailty(the phenotype model and the cumulative deficit model),which have been well-established to recognize the syndrome.Different assessment approaches have been proposed and validated to evaluate frailty.This review has highlighted the research progress of the definition of frailty,the pathophysiological mechanisms,assessment methods,and perioperative interventions to provide perioperative strategies to mitigate risk for frail patients undergoing cardiac surgery.
作者
冉菊红
杨平亮
彭勇刚
RAN Juhong;YANG Pingliang;PENG Yonggang(Department of Anesthesiology and Perioperative Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052;Department of Anesthesiology,The First Affiliated Hospital of Chengdu Medical College,Chengdu 610050,China;Department ofAnesthesiology and Perioperative Medicine,University of FL Shands hospital,Gainesville 32610,USA)
出处
《麻醉安全与质控》
2024年第1期1-6,共6页
Perioperative Safety and Quality Assurance
关键词
衰弱
评估
围术期管理
心脏手术
frailty
assessment
perioperative management
cardiac surgery
