Cleveland Clinic Florida, Weston, 33331, USA.
Drugs Aging. 2011 Feb 1;28(2):107-18. doi: 10.2165/11586170-000000000-00000.
As the population of the Western world ages, the number of major surgical procedures performed in the elderly population will by necessity increase. Within virtually every surgical specialty, studies have shown that patients should not be denied surgery on the basis of chronological age alone. It has recently been recognized that physiological age is far more important within the decision-making algorithm as to whether or not to proceed with major surgery in the septuagenarian and octogenarian populations and beyond. Not unexpectedly, not only the results of these operations, but also the associated morbidities, are similar in older and younger populations. Therefore, it is not surprising that postoperative ileus (POI) affects patients of all ages. POI is a multifactorial condition that is exacerbated by opioid analgesics, bed rest and other conditions that may be rather prevalent in the postoperative elderly patient. Therefore, as major surgical interventions are considered in this population, appropriate assessment and, ideally, correction of any physiological disturbances should be undertaken along with implementation of standardized enhanced recovery protocols. Ideally, through this combined approach, an appreciable impact can be made on reducing POI while controlling postoperative pain and limiting postoperative thromboembolic, cardiopulmonary, cerebral and infectious complications. This article reviews the potential impact of pharmacological agents, laparoscopy and other manoeuvres on POI in the elderly.
随着西方世界人口老龄化，老年人中进行的主要手术数量将必然增加。几乎在每一个外科专业中，研究表明，不应该仅仅根据年龄来决定是否对老年人和 80 岁以上的人进行手术。最近人们认识到，在决定是否对 70 多岁和 80 多岁以上的人群进行主要手术时，生理年龄远比年龄更重要。毫不奇怪，不仅这些手术的结果，而且相关的发病率，在老年人和年轻人中是相似的。因此，术后肠梗阻（POI）影响所有年龄段的患者也就不足为奇了。POI 是一种多因素的病症，阿片类镇痛药、卧床休息和其他可能在老年术后患者中相当普遍的情况会使其恶化。因此，在考虑对这一人群进行重大手术干预时，应该对任何生理紊乱进行适当的评估，并理想情况下进行纠正，同时实施标准化的强化康复方案。通过这种综合方法，理想情况下可以在控制术后疼痛和限制术后血栓栓塞、心肺、脑和感染并发症的同时，显著减少 POI 的发生。本文综述了药物、腹腔镜和其他手术操作对老年人 POI 的潜在影响。
