Anaesthesia and Critical Care Research Area, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
Anaesthesia. 2019 Jan;74 Suppl 1:36-42. doi: 10.1111/anae.14507.
The pre-operative optimisation of comorbidities is increasingly recognised as an important element of the pre-operative pathway. These efforts have primarily focused on physical comorbidities such as anaemia and the optimisation of exercise and nutrition. However, there is a growing recognition of the importance of psychological morbidity. Increasingly, evidence suggests that psychological factors have an impact on surgical outcomes in both the short and long term. Pre-operative anxiety, depression and low self-efficacy are consistently associated with worse physiological surgical outcomes and postoperative quality of life. This has led to the emergence of psychological prehabilitation and the trimodal approach to prehabilitation, incorporating psychological intervention as well as exercise and nutritional optimisation. However, there is currently insufficient evidence to be sure that pre-operative psychological interventions are of benefit, or which interventions are most effective, because their impact has been mixed. There is an urgent need for high quality, contemporaneous prospective trials with baseline psychological evaluation, well-described interventions and agreement on the most appropriate psychological, quality of life and physiological outcomes measures.
围手术期合并症的优化越来越被认为是围手术期管理的一个重要环节。这些努力主要集中在身体合并症上，如贫血和运动及营养的优化。然而，人们越来越认识到心理疾病的重要性。越来越多的证据表明，心理因素对短期和长期的手术结果都有影响。术前焦虑、抑郁和低自我效能感与更差的生理手术结果和术后生活质量相关。这导致了心理康复前和三联康复前方法的出现，将心理干预与运动和营养优化结合起来。然而，目前还没有足够的证据表明术前心理干预是有益的，或者哪种干预措施最有效，因为它们的效果不一。迫切需要高质量、同期前瞻性试验，进行基线心理评估，描述良好的干预措施，并就最合适的心理、生活质量和生理结果测量达成一致。
