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术前强化:仍需要高质量证据。

Prehabilitation: high-quality evidence is still required.

机构信息

Nottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.

Nottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK; Department of Military Internal Medicine and Military Hygiene, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic.

出版信息

Br J Anaesth. 2023 Jan;130(1):9-14. doi: 10.1016/j.bja.2022.09.016. Epub 2022 Nov 1.

Abstract

Prehabilitation comprises multidisciplinary healthcare interventions, including exercise, nutritional optimisation, and psychological preparation, which aim to dampen the metabolic response to surgery, shorten the period of recovery, reduce complications, and improve the quality of recovery and quality of life. This editorial evaluates the potential benefits and limitations of and barriers to prehabilitation in surgical patients. The results of several randomised clinical trials and meta-analyses on prehabilitation show differing results, and the strength of the evidence is relatively weak. Heterogeneity in patient populations, interventions, and outcome measures, with a wide range for compliance, contribute to this variation. Evidence could be strengthened by the conduct of large-scale, appropriately powered multicentre trials that have unequivocal clinically relevant and patient-centric endpoints. Studies on prehabilitation should concentrate on recruiting patients who are frail and at high risk. Interventions should be multimodal and exercise regimens should be tailored to each patient's ability with longitudinal measurements of impact.

摘要

术前康复包括多学科的医疗干预,包括运动、营养优化和心理准备,旨在减轻手术对代谢的影响,缩短康复时间,减少并发症,并提高康复质量和生活质量。这篇社论评估了术前康复在外科患者中的潜在益处、局限性和障碍。几项关于术前康复的随机临床试验和荟萃分析的结果显示出不同的结果,证据的强度相对较弱。患者人群、干预措施和结果测量的异质性,以及依从性的广泛范围,导致了这种差异。通过进行具有明确临床相关性和以患者为中心的终点的大规模、适当加权的多中心试验,可以加强证据。术前康复研究应集中在招募体弱和高风险的患者。干预措施应该是多模式的,运动方案应该根据每个患者的能力进行调整,并进行纵向的影响测量。

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