Department of Surgery, Division of Trauma, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, 51 North 39th Street, MOB 1, Suite 120, Philadelphia, PA 19104, USA.
Department of Surgery, Division of Trauma, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, 51 North 39th Street, MOB 1, Suite 120, Philadelphia, PA 19104, USA; Surgical Services, Section of Surgical Critical Care and Emergency General Surgery, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA.
Surg Clin North Am. 2023 Dec;103(6):1231-1251. doi: 10.1016/j.suc.2023.06.003. Epub 2023 Jul 24.
Emergency surgery in patients with significant comorbidities benefits from a structured approach to preoperative evaluation, intra-operative intervention, and postoperative management. Providing goal concordant care is ideal using shared decision-making. When operation cannot achieve the patient's goal, non-operative therapy including Comfort Care is appropriate. When surgical therapy is offered, preoperative physiology-improving interventions are far fewer than in other phases. Reevaluation of clinical care progress helps define trajectory and inform goals of care. Palliative Care Medicine may be critical in supporting loved ones during a patient's critical illness. Outcome evaluation defines successful strategies and outline opportunities for improvement.
对于合并症严重的患者，急诊手术需要采用结构化的方法来进行术前评估、术中干预和术后管理。采用共同决策来提供目标一致的治疗是理想的。如果手术无法实现患者的目标，那么非手术治疗（包括舒适护理）是合适的。当提供手术治疗时，术前改善生理机能的干预措施比其他阶段要少得多。重新评估临床护理进展有助于确定轨迹并告知护理目标。在患者病危期间，姑息治疗医学可能对支持患者的亲人至关重要。结果评估确定了成功的策略，并为改进提供了机会。
