Shepherd Stephen J, Klein Andrew A, Martinez Guillermo
St. Bartholomew's Hospital, London.
Department of Anaesthesia and Intensive Care Medicine, Papworth Hospital, Cambridge, United Kingdom.
Curr Opin Anaesthesiol. 2018 Feb;31(1):30-38. doi: 10.1097/ACO.0000000000000537.
Both surgical workload and the age of those patients being considered for radial pulmonary resection are increasing. Enhanced recovery programmes are now well established in most surgical disciplines and are increasingly reported in thoracic procedures. This review will discuss the relevant principles of these programmes as applied to an increasing elderly population.
Elderly patients undergoing less radial surgical resections without lymphadenectomy have comparable outcomes to those undergoing classical curative treatment. Patients require careful assessment and self-reported quality of life metrics or function may be a better marker of outcome than static measures such as lung function. Hypotension, low values for bispectral index and low anaesthetic gas mean alveolar concentration values are common and independent predictors of mortality in the elderly. Paravertebral blockade is preferred to epidural anaesthesia because of a more favourable side-effect profile and comparable efficacy. As yet no robust work has examined the efficacy of an integrated enhanced recovery programme in thoracic surgery.
Elderly patients are suitable for enhanced recovery programmes but these must be tailored to individual circumstance. Further work is required to comprehensively assess their value in a modern healthcare setting.
接受肺叶切除术患者的手术工作量及患者年龄均在增加。目前，强化康复计划在大多外科领域已得到充分确立，且在胸科手术中的报道也日益增多。本综述将讨论这些计划应用于老年人口增多情况时的相关原则。
未行淋巴结清扫的老年患者接受肺叶切除手术量减少，其结果与接受传统根治性治疗的患者相当。患者需要仔细评估，自我报告的生活质量指标或功能可能比肺功能等静态指标更能作为预后的良好标志。低血压、脑电双频指数低值和麻醉气体平均肺泡浓度低值是老年人死亡的常见且独立预测因素。由于副作用较小且疗效相当，椎旁阻滞优于硬膜外麻醉。目前尚无有力研究探讨综合强化康复计划在胸外科手术中的疗效。
老年患者适合强化康复计划，但这些计划必须根据个体情况量身定制。需要进一步开展工作以全面评估其在现代医疗环境中的价值。
