老年病患心臟術後的預後

Functional Outcomes in Older Cardiac Surgery Patients

歐乃欣(Nai-Hsin Ou) ； 黃姿蒨(Tzu-Chien Huang) ； 郭雯芳(Wen-Fang Kuo) ； 蔡旻璇(Min-Hsuan Tsai) ； 陳佳慧(Cheryl Chia-Hui Chen)

《台灣老年醫學暨老年學雜誌》 8卷2期 (2013/05) Pp. 135-145

https://doi.org/10.29461/TGG.201305_8(2).0006

摘要

臺灣一年約近35萬人次接受心臟手術中，65歲（含）以上患者佔了54.2%。儘管高齡手術的安全性已大幅提高，但老年病患仍伴隨較高機率的術後合併症、身體活動功能下降、甚至是死亡。本文回顧老年心臟術後患者功能恢復的現況、並簡介導致功能恢復不易的因素。結果發現老年心臟術後患者不但有較高的併發症和死亡率，且術後功能恢復的時間也較為延遲；而生理系統的退化、多重共病性、手術壓力反應、及不利恢復的術後情境（如身體活動受限、術後瞻妄、營養攝取不足及持續的憂鬱症狀）等均是造成老年心臟術後病患功能恢復不易、合併症及死亡率高的原因。期望能藉本文提升醫護人員對老年病患心臟術後合併症及整體功能恢復的認識，進而能早期發現早期介入。

關鍵字

住院老年病患 ； 心臟手術 ； 功能下降 ； 日常活動功能

並列摘要

In Taiwan, 54.2% of cardiac surgical procedures in 2010 were performed on older patients (≥65 years) with higher rates of surgical complications, functional decline, and even death reported. Despite the large number of older patients undergoing cardiac surgery with the goal of improving functional capacity, the literature in this area is limited. This article aimed to briefly review the causes and prevalence rates of surgical complications, functional decline, and death among older patients undergoing cardiac surgery. Reduced physiological reserves, high comorbid disease burden, altered surgical stress response, and less than optimal inpatient care and iatrogenic complications (including inactivity, decreased intake, postoperative delirium, and persistent depressive symptoms) are factors attributing to poor functional outcomes. We hope by increasing the awareness among professionals, early detection and timely intervention could be taken to facilitate functional recovery in older cardiac surgery patients.

並列關鍵字

older hospitalized patients ； cardiac surgery ； functional decline ； activity of daily living