胸外科的多模式康复:从基本概念到实用模式。
Multi-Modal Prehabilitation in Thoracic Surgery: From Basic Concepts to Practical Modalities.
发表日期:2024 May 08
作者:
Marc Licker, Diae El Manser, Eline Bonnardel, Sylvain Massias, Islem Mohamed Soualhi, Charlotte Saint-Leger, Adrien Koeltz
来源:
Anaesthesia Critical Care & Pain Medicine
摘要:
在过去的二十年中,随着技术的进步和更好的诊断工具,胸外科的侵入性有所下降,而患者的合并症和虚弱模式却有所增加,并且可以从治愈性切除中受益的早期癌症阶段的数量也有所增加。有氧适能差、营养缺陷、肌肉减少症和久坐行为、吸烟和饮酒等“有毒”行为是主要术后并发症的可改变危险因素。增强患者在手术前的生理储备的过程称为预康复。预康复计划的组成部分包括优化医疗、制定结构化运动计划、纠正营养缺乏以及教育患者采取更健康的行为。所有患者都可以从预康复中受益,这是加速康复外科 (ERAS) 计划的一部分。低风险患者的功能恢复预计会更快,而高风险和身体不适的患者则有更好的临床结果和更短的住院时间。
Over the last two decades, the invasiveness of thoracic surgery has decreased along with technological advances and better diagnostic tools, whereas the patient's comorbidities and frailty patterns have increased, as well as the number of early cancer stages that could benefit from curative resection. Poor aerobic fitness, nutritional defects, sarcopenia and "toxic" behaviors such as sedentary behavior, smoking and alcohol consumption are modifiable risk factors for major postoperative complications. The process of enhancing patients' physiological reserve in anticipation for surgery is referred to as prehabilitation. Components of prehabilitation programs include optimization of medical treatment, prescription of structured exercise program, correction of nutritional deficits and patient's education to adopt healthier behaviors. All patients may benefit from prehabilitation, which is part of the enhanced recovery after surgery (ERAS) programs. Faster functional recovery is expected in low-risk patients, whereas better clinical outcome and shorter hospital stay have been demonstrated in higher risk and physically unfit patients.