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摘要: 随着人口老龄化加剧,老年患者手术量呈指数上升。一些危险因素如共病、用药前状态、营养不良、虚弱和免疫系统功能受损等与老年患者脓毒症的高易感性相关,这些因素不仅增加了脓毒症的发生风险,还可导致更严重的感染,并可能与更高的死亡率相关。与非老年患者相比,老年脓毒症患者的预后更差,但其治疗并无显著差异。此外,老年脓毒症幸存者的生活质量也较差。因此,为优化老年脓毒症患者围术期管理,相关学科临床专家就该问题进行讨论并制订了此共识。Abstract: As the increasing of the aging population, the number of elderly surgical patients has increased exponentially.In elderly patients, a number of risk factors, such as comorbidities, premedication status, malnutrition, weakness, and impaired function of the immune system (or immune senescence), which are associated with a higher susceptibility to sepsis.These factors not only increase the risk of sepsis, but also lead to more severe manifestations of infection and may be associated with higher mortality.Elderly patients with sepsis had a poor prognosis compared to non-elderly patients, but there was no significant difference in the treatment.In addition, the survivors of elderly septic patients also had poorer quality of life.Therefore, in order to optimize the perioperative management of elderly patients, clinical experts from relevant disciplines discussed this issue and formulated this consensus.
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Key words:
- sepsis /
- elderly patients /
- perioperative management /
- expert consensus
作者贡献:方向明教授牵头组织了专家共识撰写小组,建立了编辑委员会(编委会),并任命吴水晶、谢郭豪负责编委会对共识的撰写工作;吴水晶、谢郭豪共同起草了专家共识初稿,并在方向明教授的组织下联合编委会其他成员对共识进行修订、凝练推荐意见;于吉人、王锷、王迪芬、仓静、冯艺、张西京、杨毅、杨云梅、吴水晶、汪炜健、杜斌、尚游、林茹、程宝莉、谢郭豪、方向明共同参与了共识的三轮修订工作;在方向明教授的指导下,吴水晶、谢郭豪对专家共识终稿全文进行审校,所有作者均通过了共识终稿,并形成共识定稿。利益冲突:无 -
表 1 SOFA评分标准[1]
器官系统 评分 0 1 2 3 4 呼吸系统 PaO2/FiO2(mm Hg) ≥400 <400 <300 <200 <100 呼吸支持 - - - 需要 需要 凝血系统 血小板(×109/L) ≥150 <150 <100 <50 <20 肝脏 胆红素(μmol/L) <20 20~32 33~101 102~204 >204 循环系统 平均动脉压(mm Hg) ≥70 <70 - - - 儿茶酚胺类药物a [μg/(kg·min)] - - 多巴胺<5或任何剂量的多巴酚丁胺 多巴胺5.1~15或肾上腺素≤0.1或去甲肾上腺素≤0.1 多巴胺>15或肾上腺素>0.1或去甲肾上腺素>0.1 中枢神经系统 GCS评分 15 13~14 10~12 6~9 <6 肾脏b 肌酐(μmol/L) <110 110~170 171~299 300~440 >440 24 h尿量(mL) - - - <500 <200 SOFA:序贯性器官衰竭评分;PaO2/FiO2:动脉血氧分压与吸入气氧浓度的比值,即氧合指数;GCS:格拉斯哥昏迷指数;a儿茶酚胺类药物的使用时间至少为1 h; b肌酐或24 h尿量一项达到标准即评为3分或4分;-:不需要或未给出标准 -
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