Аннотация
Периоперационное ведение пациентов пожилого возраста остается одной из самых сложных задач современной анестезиологии. По сравнению с молодыми пациентами люди старше 60 лет имеют более высокий риск развития неблагоприятных послеоперационных исходов в результате связанного с возрастом снижения физиологических функций, наличия нескольких сопутствующих заболеваний, полипрагмазии, когнитивной дисфункции и специфических гериатрических синдромов, таких как старческая астения. Более четверти этой категории больных имеют хронические заболевания сердечно-сосудистой, нервной, эндокринной систем, органов дыхания, кроветворения, пищеварения, опорно-двигательного аппарата, нередко их сочетание. Возрастная инволюция обменных процессов, уменьшение реактивности и адаптационной способности пожилого организма, наряду с хирургическим, часто большим по объему и травматичности, повреждением, существенно увеличивают риск периоперационных осложнений и летальности.
В методических рекомендациях даны определения понятий пожилого и старческого возраста и представлены основные характеристики возрастных изменений, влияющих на проведение анестезии и интенсивной терапии у этого контингента больных. Указаны ведущие клинические симптомы и синдромы, наиболее важные для прогнозирования неблагоприятного течения периоперационного периода, в том числе старческая астения, нутритивная недостаточность, когнитивная дисфункция. Отдельно представлены методики оценки функциональной активности и риска падений.
Особое внимание уделено принципам диагностики, лечения и профилактики респираторных, сердечно-сосудистых осложнений и послеоперационного делирия.
Описаны основы периоперационного ведения и подходы к выбору метода анестезии у пациентов старшей возрастной группы в зависимости от особенностей хирургических вмешательств и характера сопутствующей патологии.
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