Silverman David G, Rosenbaum Stanley H
Department of Anesthesiology, Yale University School of Medicine, Yale-New Haven Hospital, TMP-3, 333 Cedar Street, New Haven, CT 06510, USA.
Anesthesiol Clin. 2009 Dec;27(4):617-31. doi: 10.1016/j.anclin.2009.09.001.
Assessment of the presurgical patient requires interdisciplinary cooperation over the continuum of documentation and optimization of existing disorders, determination of patient resilience and reserve, and planning for subsequent interventions and care. For many patients, evident or suspected morbidities or anticipated surgical disturbance warrant specialty consultation. There may be uncertainty as to the optimal processes for a given patient, a limitation attributable to myriad factors, not the least of which is that there is often a paucity of evidence that is directly relevant to a given patient in a given setting. The present article discusses these limitations and describes a framework for documentation, optimization, risk assessment, and planning, as well as a uniform grading of existing morbidities and anticipated perioperative disturbances for patients requiring integrated assessment and consultation.
对术前患者的评估需要在整个病程中进行跨学科合作，包括记录和优化现有疾病、确定患者的恢复能力和储备能力，以及规划后续干预措施和护理。对于许多患者而言，明显的或疑似的疾病或预期的手术干扰需要专科会诊。对于特定患者的最佳流程可能存在不确定性，这一局限性归因于众多因素，其中一个重要因素是，在特定情况下，往往缺乏与特定患者直接相关的证据。本文讨论了这些局限性，并描述了一个记录、优化、风险评估和规划的框架，以及对需要综合评估和会诊的患者现有疾病和预期围手术期干扰进行统一分级的方法。
