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护理学报 ›› 2019, Vol. 26 ›› Issue (7): 34-39.doi: 10.16460/j.issn1008-9969.2019.07.034

• 循证护理 • 上一篇    下一篇

老年衰弱患者术前评估管理证据汇总

杨继平a, 石泽亚b, 周毅峰a, 陈诚c, 尹淑慧d, 袁浩e   

  1. 湖南师范大学第一附属医院湖南省人民医院 a.手术部; b.护理部; c.肾内科; d.儿科; e.检验科,湖南 长沙 410005
  • 收稿日期:2019-02-25 发布日期:2020-07-14
  • 通讯作者: 石泽亚(1964-),女,湖南长沙人,博士研究生学历,主任护师,硕士研究生导师。
  • 作者简介:杨继平(1990-),女,湖南长沙人,本科学历,硕士研究生在读,护师。
  • 基金资助:
    长沙市科技计划项目暨技术及产品开发项目(kq1706034)

Evidence Summary of Preoperative Evaluation and Management of Older Patients with Frailty

YANG Ji-pinga, SHI Ze-yab, ZHOU Yi-fenga, CHEN Chengc, YIN Shu-huid, YUAN Haoe   

  1. a. Dept. of Operating Room; b. Dept. Nursing Administration; c. Dept. of Nephrology; d. Dept. of Pediatrics; e. Dept. of Laboratory Medicine, Hunan Provincial People’s Hospital, Hunan Normal University, Changsha 410005, China
  • Received:2019-02-25 Published:2020-07-14

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摘要： 目的 检索并获取老年衰弱患者术前评估和管理的相关证据,为老年衰弱患者的术前评估提供参考,以降低其手术并发症的风险。方法 针对老年衰弱患者的手术风险提出问题,应用循证护理的方法,检索国内外医学数据库中关于老年衰弱术前评估的指南,证据总结,最佳实践信息册,推荐实践,系统评价、专家共识类文献,由2名研究者对文献质量进行评价和证据提取。结果 共纳入14篇文献,其中指南7篇,专家共识2篇,系统评价5篇,汇总出32条老年衰弱患者术前评估与管理的证据。临床专家应用FAME原则对证据进行专业判断,制定审查指标指导临床进行老年衰弱术前评估与管理,建议临床对老年手术患者进行包含衰弱、意识、活动功能及相关并发症在内的术前评估,并依据评估结果进行生理机能、病情管理、运动锻炼、药物治疗、营养状况、行动能力等方面的改善、调节。结论 临床应及时更新衰弱患者术前评估的证据,在证据应用的过程中评估临床情景及现有的医疗环境、应用证据的促进因素及阻碍因素、患者意愿及偏好等针对性的选择证据。基于证据的科学护理方法的术前评估,可改善衰弱患者术前的身体失能状态,增强其应对手术及相关损伤应激源的能力,降低手术相关的风险。

关键词: 老年人, 衰弱, 术前评估, 手术风险, 术后并发症

Abstract: Objective To search and obtain relevant evidences of preoperative evaluation and management of older patients with frailty, to provide references for their preoperative evaluation, and to reduce the surgical complication risk. Methods Operation risk for older frailty patients was assessed and guidelines, evidence summary (ES), best practice information sheet (BPIS), recommended practices (RP), system evaluation (SR) of preoperative evaluation on preoperative assessment of older patients with frailty were searched in medical databases at home and abroad. JBI evidence-based nursing practice model was used to screen the literatures, and 2 researchers evaluated the literatures quality and extracted the evidence independently. Results Fourteen articles including 7 guidelines,2 expert consensus and 5 systematic reviews were identified and 32 evidences of preoperative evaluation and management of older patients with frailty were summarized. Clinical experts made professional judgments on evidences by employing FAME principle, and developed review indicators to guide pre-operative assessment and management of older patients with frailty. Preoperative evaluation included frailty, consciousness, activity function and related complications for older patients with frailty. Patients' physiological function, condition disease management, exercise, medication, nutrition, and mobility should be improved according to the evaluation results. Conclusion Medical staff should update the latest best evidences for preoperative assessment of older frailty patient and evidences should be employed based on clinical context, existing medical environment, facilitating factors and obstacles of the applied evidence, patient's intention and preference. The preoperative evaluation of evidence-based scientific nursing methods is conducive to improving preoperative physical incapacity of patients with frailty, enhance their ability to cope with surgery and related injury stressors, and reduce related surgery risk.

Key words: geriatric, frailty, preoperative evaluation, surgery risk, postoperative complications

中图分类号: 

  • R473.59
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