老年脓毒症患者围术期管理专家共识(2021年)

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

doi:10.12290/xhyxzz.2021-0312

老年脓毒症患者围术期管理专家共识(2021年)

doi: 10.12290/xhyxzz.2021-0312

于吉人¹,
王锷²,
王迪芬³,
仓静⁴,
冯艺⁵,
张西京⁶,
杨毅⁷,
杨云梅⁸,
吴水晶⁹,
汪炜健¹⁰,
杜斌¹¹,
尚游¹²,
林茹¹³,
程宝莉⁹,
谢郭豪⁹,
方向明^9, ,

1.
浙江大学医学院附属第一医院胃肠外科，杭州 310003
2.
中南大学湘雅医院麻醉科，长沙 410008
3.
贵州医科大学附属医院重症医学科，贵阳 550004
4.
复旦大学附属中山医院麻醉科，上海 200032
5.
北京大学人民医院麻醉科，北京 100044
6.
空军军医大学西京医院重症医学科，西安 710032
7.
东南大学附属中大医院重症医学科，南京 210009
8.
浙江大学医学院附属第一医院老年医学科，杭州 310003
9.
浙江大学医学院附属第一医院麻醉科，杭州 310003
10.
温州医学院附属第一医院麻醉科，温州 325000
11.
中国医学科学院北京协和医学院北京协和医院内科ICU，北京 100730
12.
华中科技大学同济医学院附属协和医院重症医学科，武汉 430022
13.
浙江大学医学院附属儿童医院体外循环-体外生命支持科，杭州 310051

基金项目:

国家重点研发计划 2018YFC2001904

详细信息

通讯作者:
方向明电话: 0571-88208006, E-mail: xmfang@zju.edu.cn

中图分类号: R631;R782.05+3
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- 被引次数: 0
出版历程
- 收稿日期: 2021-04-06
- 录用日期: 2021-04-29
- 刊出日期: 2021-07-30

Expert Consensus on Perioperative Management of Elderly Septic Patients (2021)

YU Jiren¹,
WANG E²,
WANG Difen³,
CANG Jing⁴,
FENG Yi⁵,
ZHANG Xijing⁶,
YANG Yi⁷,
YANG Yunmei⁸,
WU Shuijing⁹,
WANG Weijian¹⁰,
DU Bin¹¹,
SHANG You¹²,
LIN Ru¹³,
CHENG Baoli⁹,
XIE Guohao⁹,
FANG Xiangming^{9
, ,}

1.
Department of Gastrointestinal Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
2.
Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha 410008, China
3.
Department of Critical Care Medicine, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
4.
Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
5.
Department of Anesthesiology, Peking University People's Hospital, Beijing 100044, China
6.
Department of Critical Care Medicine, Xijing Hospital, Air Force Medical University, Xi'an 710032, China
7.
Department of Critical Care Medicine, Zhongda Hospital Southeast University, Nanjing 210009, China
8.
Department of Geriatrics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
9.
Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
10.
Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
11.
Medical Intensive Care Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
12.
Department of Intensive Care Unit, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
13.
Department of Extracorporeal Circulation and Extracorporeal Life Support, the Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310051, China

Funds:

National Key Research and Development Program of China 2018YFC2001904

More Information

Corresponding author: FANG Xiangming Tel: 86-571-88208006, E-mail: xmfang@zju.edu.cn

摘要

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。
- 脓毒症 /
- 老年患者 /
- 围术期管理 /
- 专家共识
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.
- sepsis /
- elderly patients /
- perioperative management /
- expert consensus
注释:

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

HTML全文

表 1 SOFA评分标准^[1]

器官系统	评分
器官系统	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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老年脓毒症患者围术期管理专家共识(2021年)

doi: 10.12290/xhyxzz.2021-0312

通讯作者:
方向明电话: 0571-88208006, E-mail: xmfang@zju.edu.cn

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Expert Consensus on Perioperative Management of Elderly Septic Patients (2021)

Corresponding author: FANG Xiangming Tel: 86-571-88208006, E-mail: xmfang@zju.edu.cn

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留言板

老年脓毒症患者围术期管理专家共识(2021年)

doi: 10.12290/xhyxzz.2021-0312

通讯作者: 方向明 电话: 0571-88208006, E-mail: xmfang@zju.edu.cn

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出版历程

Expert Consensus on Perioperative Management of Elderly Septic Patients (2021)

Corresponding author: FANG Xiangming Tel: 86-571-88208006, E-mail: xmfang@zju.edu.cn

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出版历程

目录

通讯作者:
方向明电话: 0571-88208006, E-mail: xmfang@zju.edu.cn