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中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 doi: 10.3877/cma.j.issn.2096-1537.2021.00067

指南与规范    

老年非心脏手术围术期风险评估与管理指南2021
中国医师协会危重症分会围手术期管理学组;国家老年疾病临床医学研究中心(解放军总医院)   
  • 收稿日期:2021-05-25 出版日期:2021-07-23
  • 通讯作者: 高德伟(gaodw301@sina.com); 程芮(chengrui2017@163.com); 高凌根(gaolinggen@163.com); 李天志(litianzhi301@sina.com)
  • 基金资助:
    军队后勤科研项目(19BJZ35)
  • Received:2021-05-25 Online:2021-07-23 Published:2021-07-23
      我国已步入老龄化社会,老年人罹患的许多疾病如恶性肿瘤、心血管疾病、骨折、外科急症等需要外科干预,随着老年医学、外科微创技术及麻醉水平的提高,越来越多的高龄患者可以安全地接受手术。但是,老年患者免疫力低下,围术期并存疾病多,重要器官功能发生退行性改变,储备能力和代偿能力减退,在高龄、复杂、危重外科患者人群中,围术期并发症的发生率、致残率、病死率以及医疗费用均较高,这已经成为医患关注的焦点,以保障手术安全为目的的围手术综合管理逐渐受到重视。
      围术期医学是指涵盖术前、术中、术后全过程的治疗模式,旨在为手术患者提供最佳的治疗,直至完全康复,目的是改善结局并减少并发症。对于机体情况较差、手术风险较高的患者,术前应提高其重要器官的储备功能,以提高手术创伤所带来的应激反应的耐受性,待完成加速康复外科(enhanced recovery after surgery,ERAS)路径下的手术治疗后,及时进行术后器官功能维护、术后康复和营养治疗[1]。
      国内外对围术期综合评估和管理高度重视,相关共识与指南陆续发布,美国老年医学会(American Geriatric Society,AGS)和美国外科医师协会(American College of Surgeons,ACS)发布“老年手术患者术前评估专家共识(2012)”[2],之后发布“老年患者围手术期管理指南(2015)”[3];加拿大于2017年发布“非心脏手术心血管评估与管理指南”[4];意大利亦制定老年围手术管理指南[5],提出了围术期综合评估和管理的处置流程和诊治原则,对规范围术期的临床诊治行为、提高诊疗水平提供了重要的参考。国内围术期综合评估与管理相关的共识也陆续发布,如中华医学会老年医学分会和解放军总医院老年学教研室联合制定的“老年患者术前评估中国专家建议(2015)”、“老年患者围手术期管理北京协和医院专家共识”,指出制定手术决策应从综合考虑其功能状态、预期寿命,通过多学科合作的管理模式进行综合术前评估及围术期管理,最大程度地降低手术风险,减少可能的并发症。然而,目前国内尚缺乏在这一领域的临床实践指南,为此,中国医师协会危重症分会围手术期管理学组、国家老年医学中心(解放军总医院)联合解放军总医院第二医学中心综合外科团队,结合35年老年外科围术期保健的丰富临床经验,在上述指南与共识的基础上,按照国际和国内指南制定的方法与步骤,组建多学科指南制定专家工作组,先后经过指南制定调研、评估筹备、相关指南评价分析、临床证据检索及等级评价、形成推荐意见等流程,经专家组8轮讨论,制定了《老年非心脏手术围手术期风险评估与管理指南2021》(简称《指南》)。
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