老年保健人群围手术期综合评估与管理效果分析  

Impact of perioperative evaluation and management of elderly healthcare population undergoing surgery

作　　者：王彬[1] 范利[2] 高凌根[1] 勇琴歌[3] 刘斌[4] 贺晶[1] 高萌[1] 宋思敏 高远[5] Wang Bin;Fan Li;Gao Linggen(Department of Comprehensive Surgery,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第二医学中心综合外科、国家老年疾病临床医学研究中心,北京100853 [2]解放军总医院第二医学中心 [3]解放军总医院第二医学中心护理部 [4]解放军总医院服务保障中心 [5]解放军总医院第一医学中心护理部

出　　处：《中华保健医学杂志》2023年第5期531-534,共4页Chinese Journal of Health Care and Medicine

基　　金：国家重点研发计划(2022YFC3602405);国家老年疾病临床医学研究中心多中心RCT临床研究项目(NCRCG-PLAGH-2023003)。

摘　　要：目的 探讨全科、全程、全方位“三全”综合管理体系在老年保健人群围手术期的应用效果。方法 采用回顾性对照研究方法选取2003年1月~2012年12月解放军总医院第二医学中心需行手术治疗的906例60岁以上患者为对照组,给予传统管理;入选2013年1月~2022年12月收治的需行手术治疗的1 090例老年患者为试验组,采取“三全”综合管理方案。比较两组患者术后发生出血、感染、谵妄、血栓、心脑血管事件的发生、患者满意度等方面的差异。结果 将“三全”综合管理方案应用在老年围手术期管理中,试验组患者术后发生感染(37.1%vs. 42.3%)、谵妄(28.9%vs. 34.5%)、血栓(23.9%vs. 36.5%)、心脑血管事件(25.6%vs. 31.1%)等发生率明显低于对照组,差异有统计学意义(χ^(2)=5.622、7.043、37.548、7.198,P<0.05);试验组全因死亡率低于对照组(0.64%vs. 1.43%),但差异无统计学意义(χ^(2)=3.314,P> 0.05);试验组患者满意度明显高于对照组(100%vs. 99.7%),两组间差异均有统计学意义(χ^(2)=3.025,P<0.05)。结论 “三全”综合管理方案在老年围手术期应用效果确切,可降低死亡率、减低感染率、减少并发症,提高康复质量。Objective To explore the effect of comprehensive management in the perioperative period of the elderly.Methods Retrospective control study was constructed.The study recruited 906 participants aged over 60 years who underwent non-cardiac surgery at the Second Medical Center of General Hospital of Chinese People′s Liberation Army from January 2003 to December 2012 as the control group,and the routine management were administrated;1090 patients who need surgical treatment from January 2013 to December 2022 were recruited as the test group,and the comprehensive management scheme was adopted.The differences of perioperative bleeding,infection,delirium,thrombosis,cardio-cerebrovascular events and patient satisfaction were compared between the two groups.Results The incidence of bleeding,infection,delirium,thrombosis,cardio-cerebrovascular events,etc.in the patients in the test group was significantly lower than that in the control group after operation.The patient satisfaction of the observation group was significantly higher than that of the control group,and the difference between the two groups was statistically significant(P<0.05).The incidence of infection(37.1%vs.42.3%),delirium(28.9%vs.34.5%),thrombosis(23.9%vs.36.5%),cardio-cerebrovascular events(25.6%vs.31.1%),etc.in the patients in the test group was significantly lower than that in the control group after operation(χ^(2)=5.622,7.043,37.548,7.198,P<0.05).The all-cause mortality in the observation group was lower than that in the control group(0.64%vs.1.43%),but the difference was not statistically significant(χ^(2)=3.314,P>0.05).The patient satisfaction of the observation group was significantly higher than that of the control group(100%vs.99.7%),and the difference between the two groups was statistically significant(χ^(2)=3.025,P<0.05).Conclusion The application of the comprehensive management program in the elderly perioperative period is effective,which can reduce mortality,infection rate,complications and improve the quality of rehabilitation.

关 键 词：老年 保健 围手术期 综合管理 

分 类 号：R592[医药卫生—老年医学]