[慢性病:手术内和手术后管理的关键点]
Toshihito Gomibuchi1, Tatsuichiro Seto
1Division of Cardiovascular Surgery, Department of Surgery, Shinshu University, Matsumoto, Japan.
Kyobu geka. The Japanese journal of thoracic surgery
|December 6, 2023
概括
经历心脏手术的慢性病 (CKD) 的老年患者的管理需要谨慎的术后策略. 在手术前停止服用糖共运输体2 (SGLT2) 抑制剂,并在术后恢复服用,对于脏保护至关重要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心脏病学 心脏病学
- 老年医学 老年医学
背景情况:
- 慢性病 (CKD) 在接受心脏手术的老年患者中存在重大挑战.
- 在这种患者群体中,手术期间和术后的治疗非常重要.
- 糖共运输体2 (SGLT2) 抑制剂提供脏保护性益处,但需要特殊的术后管理.
研究的目的:
- 为接受心脏手术的CKD老年患者概述脏保护性术后管理策略.
- 详细介绍CKD 3-5阶段的方法.
- 讨论透析模式在术后护理中的不断变化的作用.
主要方法:
- 对慢性病患者的术后管理方案的审查.
- 围绕手术进行SGLT2抑制剂管理的讨论.
- 对3-5阶段的CKD策略的分析,包括血压控制,营养和透析.
- 探索连续置换疗法 (CRRT) 与多式透析方法的对比.
主要成果:
- 建议在手术前三天停止使用SGLT2抑制剂,并在可能摄入食物后恢复使用.
- 对于3至4阶段的CKD,脏保护管理涉及量身定制的方法,强调血压控制和营养咨询.
- 五期慢性脏病的术后管理包括重症监护室的循环管理和合理使用血液透析.
- 多式透析方法正在成为CRRT的替代方案,有可能减少创伤并改善结果.
结论:
- 针对老年心脏外科手术患者进行量身定制的术后管理是必不可少的.
- 精心安排SGLT2抑制剂的治疗时间对于脏保护至关重要.
- 在特定的术后情景中,采用多式透析可能比CRRT提供优势.
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