Стратегии за оптимизиране на резултатите при хирургично лечение на пациенти в старческа възраст със заболявания на тънките и дебелите черва
DOI :
https://doi.org/10.67572/qfmn0p03Ключови думи :
гериатрия, гериатрична хирургия, комплексна гериатрична оценкаАбстракт
УВОД: В последните десетилетия в световен мащаб нараства населението в гериатрична възраст. Хирургичното лечение на пациентите в старческа възраст със заболявания на тънките и дебелите черва е свързано с повишен риск от периоперативна заболеваемост и функционален упадък, което налага прилагането на целенасочени стратегии за оптимизация. Крехкостта е най-силният предиктор на тези лоши резултати, което налага промяна в подхода към тези пациенти.
ЦЕЛ: С цел да се създаде комплексен преглед на най-добрите практики, настоящият обзор използва публикации от базата данни PubMed, както и експертни консенсусни документи и клинични гайдлайни от водещи международни хирургични и гериатрични организации.
МЕТОДИ: Обзорът се фокусира върху трите основни стълба на оптимизация: Цялостна гериатрична оценка, мултимодална прехабилитация и прилагане на модифицирани ERAS протоколи.
РЕЗУЛТАТИ: Комплексната гериатрична оценка, особено скринингът за уязвимост, е основен инструмент за стратификация на риска и определяне на рисковите групи, които се нуждаят от предоперативна оптимизация. Прехабилитацията доказано повишава физиологичния резерв и функционалния капацитет, позволявайки на организма да издържи стреса на операцията. Интегрирането на модифицирани ERAS протоколи, адекватните анестезиологични грижи, въвеждането на минимално инвазивни хирургични техники води до намаляване на периоперативната заболеваемост и смъртност, съкращаване на болничния престой, по- бързо възстановяване и запазване качеството на живот след хирургична интервенция.
ЗАКЛЮЧЕНИЕ: Прилагането на този интегриран, мултидисциплинарен подход е ключово за постигане на оптимални хирургични резултати и запазване на функционалната независимост при възрастни пациенти. Въпреки съществуването на силна доказателствена база, подкрепяща стратегиите за оптимизация, литературата и експертите постоянно подчертават необходимостта от допълнителни проучвания насочени към специфичните нужди на гериатричните пациенти.
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