Break through the penalty area!Patients with a multidisciplinary team for the elderly surgery period to protect patients

An old man in his 80s just finished the orthopedic surgery of the spine side bend yesterday. Now he is walking back and forth in the ward. Woolen cloth!"

This scene occurred in the orthopedic ward of Xuanwu Hospital of the Capital Medical University. When people are still worried about the risk of spine surgery and prefer to endure the pain, the patients here, even the elderly patients who undergo spinal surgery, will start to move down the day after the operation.

"This is due to the escort of the multidisciplinary management team of our elderly surgery." Professor Lu Shibao, director of the orthopedic department of Xuanwu Hospital of the Capital Medical University, said that the elderly orthopedic surgery is not the restricted area. Orthopedic surgery, under the one -stop guardian of the multidisciplinary team, most patients do not need to enter the ICU after surgery, and they can get out of bed the next day to achieve zero death.

In addition, in order to further improve the surgical safety of patients with elderly spine, the team cooperated with the one-stop multidisciplinary assessment auxiliary decision-making system (Apple-MDT) of elderly patients. At the same time, the team also organized the "Consensus of Chinese Experts (ERAS) Chinese Experts" in the siege period of elderly spine patients, and proposed the Chinese plan for the management of elderly spine patients.

"This is the question we want to answer!"

In 2017, the National Elderly Disease Clinical Medicine Research Center unveiled at Xuanwu Hospital. How to promote the future development of the center was a major issue in front of Professor Zhao Chaodong, the director of the Central Office, and Professor Lu Shibao, director of the orthopedics who had just taken over the relay stick, was thinking about how Find the discipline positioning of orthopedics. Professor Wang Tianlong, director of the Anesthesiology Branch of the Chinese Medical Association Anesthesiology Branch, collided with a different spark in the communication process with Professor of the Chao Dynasty and Professor Lu Shibao.

Patients (≥75 years old) in the past usually do not consider orthopedic surgery because of high risk and difficulty. However, with the improvement of the per capita life expectancy and the pursuit of the quality of life for the elderly, how to ensure the safety and effectiveness of orthopedic surgery of elderly patients have become urgent problems.

"This is the question we are going to answer! The three of us are closed." Professor of the dynasty, but the security problem of ensuring the siege during the elderly surgery must not be shot. Can you surgery? What should I pay attention to during the operation? What indicators need to be monitored? How to recover quickly after surgery? "This requires scientific evaluation methods, reasonable medication solutions, superb surgical skills, comprehensive postoperative monitoring and rehabilitation guidance. Multiple disciplines such as internal medicine, surgery, anesthesiology, and pharmacy must be involved. Patients provide one -stop services. "At this time, the multidisciplinary management team of the elderly surgery period has already taken shape in the minds of the three.

After the discussion, Professor of the Chaodong immediately reported to the dean. The dean supported the promotion of the project and assisted in the promotion of related work by the Medical Office. In December 2017, an elderly surgery perinatal multi -disciplinary management team composed of anesthesia surgery, orthopedics, neurology, elderly medical department, nutrition department, pharmacy, cardiac departmental department and other departments was formally established.

In the past five years, patients who need to discuss countermeasures for multi -disciplinary teams need consultation almost every day. Every week, multi -disciplinary teams will hold regular meetings to discuss and evaluate cases. At the same time, multi -disciplinary evaluation database is established to build big data centers for senior surgery. "At present, we have completed 500 elderly spine orthopedic surgery. The number of examples in the country is the largest, zero death."

Intelligent system helps the risk assessment of the elderly surgery

Professor Wang Tianlong said that elderly patients are like a mottled old wall that stands for decades and has gone through wind and rain. When the wall appears cracks, the doctor will repair it. Perhaps the resection of the tumor, maybe it is orthopedic orthopedic. The main role of anesthesia doctors is to ensure that in the process of repairing cracks, this wall will not completely collapse, let alone be more harmful, help patients maintain a stable state of life and ensure rapid recovery after surgery.

Elderly elderly people often merge a variety of chronic diseases. Therefore, reasonable medication is also an important part of ensuring the safety of patients. What are the effects of commonly used drugs? Patients using anticoagulant drugs need to stop medicine before surgery. When will it stop? When will it be recovered? How to ensure safety? Is there a history of drug allergies? These are important contents of pre -surgery evaluation, and they are inseparable from the guidance of pharmacists.

"In order to ensure the safety of medication during the perioperative period of elderly patients, our team wrote the only internationally internationally" Catalog of High Risk Drugs for the Elderly perioperative surgery ", which involves a total of 86 categories of drugs. Proposal of medication. "Professor Yan Suying, deputy director of the Ministry of Pharmacy, introduced that this is the first drug catalog of drug risk for the elderly at home and abroad to fill the gap in the field. "With this catalog, the evaluation of the safety of the perioperative medication during the elderly patients has a scientific basis."

In addition, the Joint Information Center of the Elderly Surgery Period also developed a complete set of elderly patient perioperative multidisciplinary assessment and decision-making assistance systems (Apple-MDT). This system has functions such as automatic extraction, data storage, auxiliary decision -making. After input the patient's basic information, evaluation, etc., the system will automatically display the patient's evaluation score, including predicting thrombosis, postoperative delirium, and other complications. Risk of occurrence. Based on the judgment of this system, multi -disciplinary teams can take protective measures in advance, thereby reducing the risk of adverse events and improving the efficiency and accuracy of multidisciplinary teamwork.

Based on the Apple-MDT system, from 2018-2021, Xuanwu Hospital conducted a total of 3306 patients (80 years old) patients with surgery, with a postoperative mortality rate of 0.76%, and a postoperative complications of 6.62%. Provide a promotional model for our elderly anesthesia. Professor Wang Tianlong introduced that the development of this system took nearly half a year, and after use, he also experienced many details of the details and improvements. "It is not easy to reflect the medical problems in the eyes of a doctor into a system language. Therefore, it is not easy. Therefore, in the future, it should focus on cultivating more high -level composite talents that understand both medicine and software, both knowing surgery and anesthesia. By then, we will make greater progress, and our clinical questions will be more perfectly answered. "

Multi -discipline collaboration promotes the rapid recovery process

Patients with elderly spinal surgery do not enter the ICU after surgery, and can get out of bed the next day after surgery. It sounds incredible, but it is accustomed to the orthopedics department of Xuanwu Hospital. Process. "Professor Lu Shibao introduced that the core issues of rapid recovery include several aspects: the first is the pre -surgery and postoperative evaluation of multidisciplinary; the second cannot be separated from the support of the anesthesiology department. , Nausea, vomiting, etc., third, complete surgery at a high level to ensure the safety and effectiveness of patient surgery at the technical level.

In multidisciplinary assessment, nutritional support is also an important part. Professor Li Yan, director of the nutrition department, pointed out that the risk of surgery for elderly elderly people is higher. If there is malnutrition, it is undoubtedly worse. The nutritional status, while helping patients go through the difficulty of surgery, also promotes postoperative recovery, shorten the hospitalization time, and ensure surgical efficacy.

Professor of the Chaodong said that on the one hand, neurologists must evaluate the risks of the perioperative nervous system of elderly patients, reducing risks such as delirium, brain infarction, and declining cognition after surgery. It can guide clinical care and health counseling to regulate patients' emotions and sleep problems.

Professor Yin Chunlin, Deputy Director of Heart Department, emphasized that heart risk assessment should pay attention to individualization. There was an elderly patient who needed spinal surgery. The elderly had a history of hypertension and diabetes. The coronary CT prompted the precipitation of the front and the severe stenosis. Many hospitals refused to surgery due to high heart risk. The old man found the team of Professor Lu Shibao. Professor Yin Chunlin found that when he asked the medical history, although patients had heart risk, there were no typical symptoms such as myocardial ischemia and angina pectoris in daily life.

Because the spine problem may cause the quality of life to decline, and even the operational is inconvenient. If the heart problem is treated first at this time, the double anti -treatment treatment of 9-12 months after the bracket is placed, and the timing of the surgery is delayed, but if it is placed in the bracket The risk of thrombosis of patients will increase. Faced with the dilemma, Professor Yin Chunlin decisively enforced based on previous clinical experience and related research evidence: It is recommended that patients first perform spinal surgery on the basis of strict second -level prevention treatment. After surgery, cardiologists closely monitor patients' heart function. In the end, the patient achieved the expected treatment effect and was discharged from the hospital.

The senior medical discipline is overall for patients' pre -surgery evaluation. "The whole body of elderly patients is relatively fragile. For example, weakening assessment and the assessment of bleeding ischemia risk. The risk of perioperative surgery, and whether he can withstand anesthesia and surgery. "Professor Li Jing, director of the Department of Medicine (Comprehensive), pointed out that although multi -disciplinary teams are composed of various departments, everyone is an organic whole. They are promoting each other, helping each other, and actively providing patients with high -quality medical services to ensure the normal life of patients. "The elderly's desire for health is urgent, especially for patients with orthopedics. In the face of possible bed risk, patients are willing to take risks to undergo surgical treatment. This is a great trust in doctors, and we are willing to make every effort to make every effort The patient returns to a healthy life. "

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