Department of Anesthesiology and Perioperative Medicine, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Cardiothoracic Surgery, 481457University of Pittsburgh Medical center, Pittsburgh, PA, USA.
Semin Cardiothorac Vasc Anesth. 2022 Dec;26(4):295-303. doi: 10.1177/10892532221130922. Epub 2022 Oct 2.
The concept of "pre-habilitation" comprises screening for and identification of pre-existing disorders followed by medical optimization. This is performed for many types of surgeries, but may have profound impacts on outcomes, particularly in cardiac surgery given the multiple comorbidities typically carried by these patients. Components of pre-habilitation include direct medical intervention by preoperative specialists as well as significant care coordination and shared decision-making. In this second part of a two-part review, the authors describe existing evidence to support the optimization of various preoperative problems and present a few institutional protocols utilized at out center for cardiac presurgical care. This second installment will focus on alcohol and smoking cessation and the management of frailty, malnutrition, respiratory disease, and depression.
“预康复”的概念包括对预先存在的疾病进行筛查和识别，然后进行医学优化。这在许多类型的手术中都有进行，但可能会对结果产生深远的影响，特别是在心脏手术中，因为这些患者通常伴有多种合并症。预康复的组成部分包括术前专科医生的直接医疗干预，以及大量的护理协调和共同决策。在这篇综述的第二部分中，作者描述了支持优化各种术前问题的现有证据，并介绍了我们中心用于心脏术前护理的一些机构协议。这一部分将重点介绍戒酒和戒烟以及虚弱、营养不良、呼吸疾病和抑郁的管理。
