老年普外科患者围手术期疼痛评估与管理的 特殊性

The Specificities of Perioperative Pain Assessment and Management in Elderly General Surgical Patients

摘要: 伴随着人口老龄化的日益严峻，实施普通外科手术的老年患者日渐增多，围术期疼痛处理已经成为决定这一群体术后恢复质量和临床转归的关键步骤。衰老导致的身体机能老化、多脏器系统的常见慢性病变及长期服药史使老年人承受疼痛刺激的能力较弱；但受限于认知水平下降、交流障碍以及缺乏对疼痛的认知等原因，这些人的疼痛体验主观报告并不突出，这无疑为临床的疼痛测评工作增加了难度。而且不合理的镇痛措施，特别是阿片或镇静镇痛药物的应用不当，有可能诱发谵妄、呼吸抑制、摔倒和胃肠动力障碍等并发症的发生概率上升。由此可见，如何在充分镇痛的基础上保障服药的安全性，这是老年普外科患者围术期亟待处理的问题。为此，我们对老年普外科围术期患者术后的疼痛评估及镇痛的特殊性做了循证分析，旨在为针对老年人的个性化、精细化镇痛提供参考。

Abstract: With the development of an increasingly elderly population, older general surgery patients are more and less willing to treat each other in surgery. Perioperative pain management has had an important effect on postoperative recovery and clinical outcomes. With the age-related physiological decline, multiple chronic diseases and long-term medication usage, elderly patients are less emotionally sensitive to pain, but with reduced cognitive function, poor communication, and low awareness of pain, their subjective reporting cannot be effective, making their pain assessment challenging. Furthermore, inappropriate analgesic strategies such as improper or sedative analgesics may cause severe pain-related complications such as delirium, respiratory depression, falls and gastrointestinal symptoms. Hence, a tradeoff between effective analgesia and medication safety has been one of the key issues of perioperative medical management of elderly general surgery surgeons. Based on these considerations, in this review, we systematically discuss individual aspects of perioperative and treating elderly general surgical patients in order to provide a basis for developing personalized and fine analgesic strategies in practice.