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老年人的围手术期评估与管理

Perioperative assessment and management of the elderly.

作者信息

Setiati Siti

机构信息

Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, University of Indonesia-Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

出版信息

Acta Med Indones. 2007 Oct-Dec;39(4):194-201.

Abstract

Around half of people aged 65 years and above will undergo surgery due to various indications. Several common types of surgery in the elderly are cataract extraction, joint replacement, cholecystectomy, and revascularization procedures. Elderly patients planned for surgery are at risk of having substandard or even terrible outcome due to decreased ability to maintain or recover physiologic homeostasis during surgery. Thorough preoperative assessment is important for the elderly. Preoperative assessment should be stressed on identification of risk factors or bad predictors after the surgery. Common comorbidities in the elderly need comprehensive assessment. Special attention should be given for postoperative management in the elderly. The elderly might need longer time to recover compared to young patients, and management programs might be needed such as sub acute management, rehabilitation unit, or home-care treatment. In general the postoperative treatments consists of the use of analgesic agents, early mobilization, proper use of urine catheter, prevention and management of delirium, and use of anticoagulants.

摘要

65岁及以上的人群中,约有一半会因各种适应症接受手术。老年人常见的几种手术类型包括白内障摘除术、关节置换术、胆囊切除术和血管重建手术。由于手术期间维持或恢复生理稳态的能力下降,计划接受手术的老年患者有出现不合标准甚至糟糕结果的风险。全面的术前评估对老年人很重要。术前评估应着重于识别术后的风险因素或不良预测指标。老年人常见的合并症需要综合评估。应特别关注老年人的术后管理。与年轻患者相比,老年人可能需要更长的时间来恢复,可能需要诸如亚急性管理、康复单元或家庭护理治疗等管理方案。一般来说,术后治疗包括使用止痛剂、早期活动、正确使用尿管、预防和管理谵妄以及使用抗凝剂。

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