以质量求发展，以服务铸品牌

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

PDF (PC)

396

赞

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
[1] 韩斌如,李秋萍. 老年患者手术风险评估工具的应用进展[J].护理学报,2017,24(24):31-34.DOI:10.16460/j.issn1008-9969.2017.24.031.
[2] Eslami M H, Saadeddin Z, Rybin D V, et al.Association of Frailty Index with Perioperative Mortality and In-hospital Morbidity after Elective Lower Extremity Bypass[J]. J VASC SURG, 2018, 69(3):863-874.DOI: 10.1016/j.jvs.2018.07.050.
[3] Beckert A K,Huisingh-Scheetz M,Thompson K,et al.Screening for Frailty in Thoracic Surgical Patients[J]. Ann Thorac Surg, 2017, 103(3):956-961.DOI: 10.1016/j.athoracsur.2016.08.078.
[4] Madeleine L B, Thomas G C, Soroush T B, et al.Frailty as a Predictor of Complications after Radical Cystectomy: A Prospective Study of Various Preoperative Assessments[J]. Urol Oncol, 2018, 37(1):40-47. DOI: 10.1016/j.urolonc.2018.10.002.
[5] Bettelli G.Preoperative Evaluation of the Elderly Surgical Patient and Anesthesia Challenges in the XXI Century[J]. Aging Clin Exp Res,2018,30(3):229-235.DOI:10.1007/s40520-018-0896-y.
[6] 应巧燕,刘华平,郭欣颖,等. 老年人衰弱筛查和评估的证据总结[J]. 护理学杂志, 2017,32(1):95-98. DOI:10.3870/j.issn.1001-4152.2017.01.095.
[7] Bose S, Talmor D.Who Is a High-risk Surgical Patient?[J]. Curr Opin Crit Care, 2018, 24(6):547-553. DOI:10.1097/MCC.0000000000000556.
[8] Brennan M S, Barlotta R M, Simhan J.Frailty Assessments in Surgical Practice: What Is Frailty and How Can It Be Used in Prosthetic Health?[J]. Sex Med Rev,2017,6(2):302-309. DOI:10.1016/j.sxmr.2017.06.006.
[9] Huisingh-Scheetz M, Walston J.How Should Older Adults with Cancer Be Evaluated for Frailty?[J]. J Geriatr Oncol, 2016, 8(1):8-15. DOI:10.1016/j.jgo.2016.06.003.
[10] Dicenso A, Bayley L, Haynes R B.Accessing Pre-Appraised Evidence: Fine-tuning the 5s Model into a 6s Model[J]. Evid Based Nurs, 2009,12(4):99-101.DOI:10.1136/ebn.12.4.99-b.
[11] Brouwers M C, Kho M E, Browman G P, et al.AGREE II: Advancing Guideline Development, Reporting and Evaluation in Health Care[J]. J Clin Epidemiol, 2010,63(12):1308-1311.DOI:10.1016/j.ypmed.2010.08.005.
[12] 张方圆,沈傲梅,曾宪涛,等. 系统评价方法学质量评价工具AMSTAR 2解读[J]. 中国循证心血管医学杂志, 2018,10(1):14-18.DOI:1674-4055(2018)01-0014-05.
[13] 王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015,30(11):964-967.DOI:1002-6975(2015)11-0964-04.
[14] Abdullahi Y S, Athanasopoulos L V, Casula R P, et al.Systematic Review on the Predictive Ability of Frailty Assessment Measures in Cardiac Surgery[J]. Interact Cardiovasc Thorac Surg, 2017, 24(4):619-624.DOI:10.1093/icvts/ivw374.
[15] Axley M S, Schenning K J.Preoperative Cognitive and Frailty Screening in the Geriatric Surgical Patient: A Narrative Review[J]. Clin Ther, 2015, 37(12):2666-2675. DOI:10.1016/j.clinthera.2015.10.022.
[16] Partridge J S, Harari D, Martin F C, et al.The Impact of Preoperative Comprehensive Geriatric Assessment on Postoperative Outcomes in Older Patients Undergoing Scheduled Surgery: A Systematic Review[J]. Anaesthesia, 2013, 69(s1):8-16.DOI:10.1111/anae.12494.
[17] Oresanya L B, Lyons W L, Finlayson E.Preoperative Assessment of the Older Patient: A Narrative Review[J]. JAMA, 2014,311(20):2110-2120.DOI:0.1001/jama.2014.4573.
[18] Shem T L, Matot I.Frailty and Anesthesia[J]. Curr Opin Anaesthesiol,2017,30(3):409.DOI:10.1097/ACO.0000000000000456.
[19] Mohanty S, Rosenthal R A, Russell M M, et al.Optimal Perioperative Management of the Geriatric Patient: A Best Practices Guideline from the American College of Surgeons Nsqip and the American Geriatrics Society[J]. J Am Coll Surg,2016,222(5):930-947.DOI:10.1016/j.jamcollsurg.2015.12.026.
[20] Kiselev J.Interventionen zur Präoperativen Unterstützung Geriatrischer Patienten Mit Frailty[J]. AINS, 2017, 52(11/12): 777-783.
[21] Audrey C.Medical and Preoperative Evaluation of the Older Adult[J]. Otolaryngol Clin North Am. 2018, 51(4):835-846. DOI: 10.1016/j.otc.2018.03.010.
[22] Olotu-Steffen C, Gurlit S, Kiefmann R.Präoperative Vorbereitung und Evaluation: Der Ältere Patient[J]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2017, 52(5): 342-355. DOI: 10.1055/s-0042-109286.
[23] Sharon K.American Geriatrics Society Abstracted Clinical Practice Guideline for Postoperative Delirium in Older Adults[J]. J Am Geriatr Soc, 2015, 63(1):142-150.DOI: 10.1111/jgs.13281.
[24] Chow W B, Rosenthal R A, Merkow R P, et al.Optimal Preoperative Assessment of the Geriatric Surgical Patient: A Best Practices Guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society[J]. J Am Coll Surg, 2012, 215(4):453-466.DOI: 10.1016/j.jamcollsurg.2012.06.017.
[25] Alvarez-Nebreda M L, Bentov N, Setia S, et al. Recommendations for Preoperative Management of Frailty from the Society for Perioperative Assessment and Quality Improvement (SPAQI)[J]. J Clin Anesth, 2017,6(47):33-42.DOI: 10.1016/j.jclinane.2018.02.011.
[26] 中华医学会老年医学分会. 老年患者术前评估中国专家建议(2015)[J]. 中华老年医学杂志, 2015, 34(11):1273-1280.DOI: 10.3760/cma.j.issn.0254-9026.2015.11.033.
[27] 中华医学会老年医学分会. 老年患者衰弱评估与干预中国专家共识[J]. 中华老年医学杂志, 2017,36(3):251-256. DOI:10.3760/cma.j.issn.0254-9026.2017.03.007.
[28] 周英凤,胡雁,顾莺,等.基于证据的持续质量改进模式图的构建[J].中国循证医学杂志,2017,17(5):603-606.
[1] 武玉洁, 邢乃姣, 韩丽, 刘盼盼, 赵迪, 赵梦璐, 王爱敏. 社区老年人居家不出危险因素分析及风险预测模型构建[J]. 护理学报, 2020, 27(8): 11-15.
[2] 赵迪, 赵梦璐, 王娜, 付明晶, 梁凤, 张伟, 王爱敏. 青岛市592名社区老年人社会隔离现状及影响因素研究[J]. 护理学报, 2020, 27(11): 6-10.
[3] 李秋萍, 韩斌如, 陈曦. 外科大手术老年患者发生术后低蛋白血症影响因素的队列研究[J]. 护理学报, 2020, 27(11): 66-70.
[4] 杜红娣, 刘彩云, 刘晓萱, 王琳琳, 李莹, 霍晓鹏. 基于蒙台梭利教育理论干预对轻中度老年痴呆患者认知功能及生活质量的影响[J]. 护理学报, 2019, 26(5): 59-62.
[5] 玄令美, 颛孙雯, 陈梦婷, 张立秀. 虚拟现实技术在老年痴呆患者中的研究进展[J]. 护理学报, 2019, 26(3): 17-19.
[6] 杨心悦, 沈琦, 谢芳芳, 易荣, 杨晨, 王冬华. 381例社区老年慢性病患者自主性感知现状及影响因素分析[J]. 护理学报, 2019, 26(3): 46-50.
[7] 靳瑜, 窦丽亚, 马慧珍. 抗阻力运动对老年2型糖尿病伴衰弱患者的应用效果[J]. 护理学报, 2019, 26(3): 51-55.
[8] 胡凯, 王静, 王明霞, 徐飞亚, 汪佳盈. 27例重症急性胰腺炎患者预防ICU获得性衰弱的护理[J]. 护理学报, 2019, 26(3): 59-61.
[9] 黄韵芝, 林清. 格罗宁根衰弱指标的汉化研究[J]. 护理学报, 2019, 26(18): 1-5.
[10] 蒋兴莉, 王冬华. 381例农村老年人积极老化现状及其影响因素分析[J]. 护理学报, 2019, 26(15): 41-45.
[11] 倪洁, 葛兆霞. 衰弱前期老年患者运动衰弱干预试验效果观察[J]. 护理学报, 2019, 26(15): 65-69.
[12] 许可彩, 于卫华. 老年人功能性体适能的影响因素研究进展[J]. 护理学报, 2019, 26(13): 34-37.
[13] 张怡馨,吴思艳,唐欣如,周绍谜,王冬华. 长沙市岳麓区415名社区老年人积极老龄化现状及影响因素分析[J]. 护理学报, 2018, 25(6): 33-36.
[14] 喻雅真,刘海琼,李丹,麦静怡,戴丽,王冬华. 407名社区老年慢性病患者健康赋权与述情障碍相关性研究[J]. 护理学报, 2018, 25(5): 71-74.
[15] 王晓燕,潘洁. 一种充气式甲状腺术后头颈部固定枕的研制[J]. 护理学报, 2018, 25(4): 76-77.
Viewed
Full text


Abstract

Cited
  Shared   
[1] 赵迪, 赵梦璐, 王娜, 付明晶, 梁凤, 张伟, 王爱敏. 青岛市592名社区老年人社会隔离现状及影响因素研究[J]. 护理学报, 2020, 27(11): 6 -10 .
[2] 高莹, 吴玉娥, 张建荣, 崔鑫浩, 陈淑玲, 叶丽芳, 杜秀珍. 基于循证构建轻症急性胰腺炎患者早期经口进食时机评估及管理方案[J]. 护理学报, 2020, 27(11): 11 -15 .
[3] 谢延真, 李壮苗, 张佳宇, 纪秋露, 吴宇欣. 灸法治疗脑卒中后偏瘫的文献计量学分析[J]. 护理学报, 2020, 27(11): 16 -20 .
[4] 练巧兰, 欧阳红莲. 成人ICU患者探视管理研究进展[J]. 护理学报, 2020, 27(11): 21 -25 .
[5] 叶冬婷, 张沁莲, 景霜, 郭佳, 邢雁芬. 家属对ICU患者转出体验的Meta整合[J]. 护理学报, 2020, 27(11): 33 -39 .
[6] 郭晓宇, 史冬立, 张振美, 李娜, 张佩凤, 杨丽娟. 全麻腰椎术后男性患者早期拔除尿管的最佳证据总结[J]. 护理学报, 2020, 27(11): 46 -51 .
[7] 吴静, 姚惠萍, 何巧, 蒋美娜, 郎毅平, 刘仁洋. 成人重症患者血糖管理相关临床实践指南的质量评价[J]. 护理学报, 2020, 27(11): 52 -56 .
[8] 李秋萍, 韩斌如, 陈曦. 外科大手术老年患者发生术后低蛋白血症影响因素的队列研究[J]. 护理学报, 2020, 27(11): 66 -70 .
[9] 李细珍, 曹美嫦, 邓菊英, 曾满萍, 欧利芳. 叙事疗法对鼻咽癌患者癌症复发恐惧与希望水平的影响[J]. 护理学报, 2020, 27(11): 71 -74 .
[10] 徐丽芬, 杨荆艳, 颜巧元, 曾俊, 张燕. 永久性尿路造口患者应用视频版思维导图健康教育的效果观察[J]. 护理学报, 2020, 27(11): 75 -78 .