朱鸣雷;黄宇光;刘晓红;张保中;刘颖;刘大为;于健春;陈伟;何小东;朱兰;康琳;唐帅;秦明伟;李子健;姚海源;

• 1:中国医学科学院北京协和医学院北京协和医院老年医学科
• 2:中国医学科学院北京协和医学院北京协和医院麻醉科
• 3:中国医学科学院北京协和医学院北京协和医院骨科
• 4:中国医学科学院北京协和医学院北京协和医院物理医学康复科

摘要(Abstract)：

老年患者进行手术具有较高风险,需手术科室、麻醉科、老年医学科、内科、重症医学科、物理医学康复科、肠内肠外营养科等多学科团队分工协作,共同管理。手术目标的制定,需从老年患者整体出发,考量手术获益和患者意愿;术前应综合评估老年患者的身体状况、认知能力、情绪、谵妄风险、营养、功能状态、衰弱、用药、疼痛、康复等情况,将老年患者术前状态调整至最佳;术中应关注老年患者的麻醉方式、体温保护等特殊问题;术后应有效控制呕吐、疼痛,强化营养支持,预防谵妄,维持功能,保证医疗的连续性。北京协和医院相关科室专家就上述问题讨论制定了该共识,以更好地开展老年患者围手术期管理。

关键词(KeyWords)： 北京协和医院;老年患者;围手术期管理;老年医学团队;术前评估;专家共识

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 朱鸣雷;黄宇光;刘晓红;张保中;刘颖;刘大为;于健春;陈伟;何小东;朱兰;康琳;唐帅;秦明伟;李子健;姚海源;

Email:

DOI:

参考文献(References)：

• [1]中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016)[J].中华外科杂志,2016,54:413-418.
• [2]Chow WB,Rosenthal RA,Merkow RP,et al.American College of Surgeons National Surgical Quality Improvement Program;American Geriatrics Society.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,2012,215:453-466.
• [3]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,2016,222:930-947.
• [4]Schlitzkus LL,Melin AA,Johanning JM,et al.Perioperative management of elderly patients[J].Surg Clin North Am,2015,95:391-415.
• [5]中华老年医学分会.老年患者术前评估中国专家建议(2015)[J].中华老年医学杂志,2015,34:1273-1280.
• [6]Reuben DB,Herr KA,Pacala JT,et al.Geriatrics at your fingertips[M].19th edition.New York:the American Geriatrics Society,2017:1-5.
• [7]刘晓红,朱鸣雷.老年医学速查手册[M].北京:人民卫生出版社,2014:6-51.
• [8]张宁,朱鸣雷,刘晓红.美国老年医学会发布防治老年患者术后谵妄临床指南解读[J].中华老年医学杂志,2015,33:1-2.
• [9]中华医学会老年医学分会.老年患者术后谵妄防治中国专家共识[J].中华老年医学杂志,2016,35:1257-1262.
• [10]Kondrup J,Rasmussen HH,Hamberg O,et al.Nutritional risk screening(NRS 2002):a new method based on an analysis of controlled clinical trials[J].Clin Nutr,2003,22:321-336.
• [11]Revenig LM,Canter DJ,Kim S,et al.Report of a simplified frailty score predictive of short-term postoperative morbidity and mortality[J].J Am Coll Surg,2015,220:904-911.
• [12]Kristensen SD,Knuuti J,Saraste A,et al.2014 ESC/ESA Guidelines on non-cardiac surgery:cardiovascular assessment and management:The Joint Task Force on non-cardiac surgery:cardiovascular assessment and management of the European Society of Cardiology(ESC)and the European Society of Anaesthesiology(ESA)[J].Eur Heart J,2014,35:2383-2431.
• [13]Fleisher LA,Fleischmann KE,Auerbach AD,et al.2014ACC/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].Circulation,2014,130:e278.
• [14]中华医学会麻醉学分会老年人麻醉学组.中国老年患者围术期麻醉管理指导意见[J].国际麻醉学与复苏杂志,2014,35:1057-1069.
• [15]Nordquist D,Halaszynski TM.Perioperative multimodal anesthesia using regional techniques in the aging surgical patient[J].Pain Res Treat,2014,2014:902174.