高齢者に対する外科周術期の問題と対策
わが国は，2035年には3人に1人が65歳以上という超高齢化社会を迎える．高齢者の周術期管理では術前，すでに複数の慢性疾患を有する場合が多く，特に糖尿病に対する対策は重要である．血糖コントロールの目標は日本糖尿病学会と日本老年医学会合同委員会の目標設定に準じる．周術期における具体的な血糖値は強化インスリン療法ではなく血糖180 mg/dlを目安とし，インスリンを併用する管理が推奨されている．手術に伴うリスク評価では，フレイル，サルコペニアなどに留意し，さらに社会的背景も考慮した高齢者総合的機能評価（CGA）に基づく総合的評価を要する．フレイル，サルコペニアは栄養障害と密接な関係にあり，感染症を...
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| Published in | 日本老年医学会雑誌 Vol. 54; no. 3; pp. 299 - 313 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本老年医学会
25.07.2017
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0300-9173 |
| DOI | 10.3143/geriatrics.54.299 |
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| Abstract | わが国は，2035年には3人に1人が65歳以上という超高齢化社会を迎える．高齢者の周術期管理では術前，すでに複数の慢性疾患を有する場合が多く，特に糖尿病に対する対策は重要である．血糖コントロールの目標は日本糖尿病学会と日本老年医学会合同委員会の目標設定に準じる．周術期における具体的な血糖値は強化インスリン療法ではなく血糖180 mg/dlを目安とし，インスリンを併用する管理が推奨されている．手術に伴うリスク評価では，フレイル，サルコペニアなどに留意し，さらに社会的背景も考慮した高齢者総合的機能評価（CGA）に基づく総合的評価を要する．フレイル，サルコペニアは栄養障害と密接な関係にあり，感染症をはじめとする術後合併症を回避するという観点から，術前および術後における適切な栄養管理とリハビリテーションを行う必要がある．術後は術後回復力強化プログラムが注目されており，高齢者を対象とした研究でも一定の成果を認めている．しかし，高齢者では，術式によりその優位性が明らかとならない場合もあり，対象者の選択基準を詳細に検討するなどの慎重な適用が望まれる．術後せん妄は，多くの高齢者にみられ，また制御に難渋する合併症である．せん妄の治療には，まず原因の除去と環境調整を行い，適切な評価ツールにより鎮静レベルを評価しつつ薬物療法を併用する．周術期感染症管理では栄養状態の維持・改善につとめ，各種ガイドラインを遵守し適切な管理を行う．高齢であることはすでに手術部位感染（SSI）の高リスクであることを念頭におき，手術侵襲に応じた抗菌薬の選択と投与期間を設定する必要がある． |
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| AbstractList | わが国は，2035年には3人に1人が65歳以上という超高齢化社会を迎える．高齢者の周術期管理では術前，すでに複数の慢性疾患を有する場合が多く，特に糖尿病に対する対策は重要である．血糖コントロールの目標は日本糖尿病学会と日本老年医学会合同委員会の目標設定に準じる．周術期における具体的な血糖値は強化インスリン療法ではなく血糖180 mg/dlを目安とし，インスリンを併用する管理が推奨されている．手術に伴うリスク評価では，フレイル，サルコペニアなどに留意し，さらに社会的背景も考慮した高齢者総合的機能評価（CGA）に基づく総合的評価を要する．フレイル，サルコペニアは栄養障害と密接な関係にあり，感染症をはじめとする術後合併症を回避するという観点から，術前および術後における適切な栄養管理とリハビリテーションを行う必要がある．術後は術後回復力強化プログラムが注目されており，高齢者を対象とした研究でも一定の成果を認めている．しかし，高齢者では，術式によりその優位性が明らかとならない場合もあり，対象者の選択基準を詳細に検討するなどの慎重な適用が望まれる．術後せん妄は，多くの高齢者にみられ，また制御に難渋する合併症である．せん妄の治療には，まず原因の除去と環境調整を行い，適切な評価ツールにより鎮静レベルを評価しつつ薬物療法を併用する．周術期感染症管理では栄養状態の維持・改善につとめ，各種ガイドラインを遵守し適切な管理を行う．高齢であることはすでに手術部位感染（SSI）の高リスクであることを念頭におき，手術侵襲に応じた抗菌薬の選択と投与期間を設定する必要がある． |
| Author | 渡部, 晶之 斎藤, 拓朗 根本, 鉄太郎 樋口, 光徳 押部, 郁朗 添田, 暢俊 |
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| Copyright | 2017 一般社団法人 日本老年医学会 |
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| Snippet | わが国は，2035年には3人に1人が65歳以上という超高齢化社会を迎える．高齢者の周術期管理では術前，すでに複数の慢性疾患を有する場合が多く，特に糖尿病に対する対策は... |
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| SubjectTerms | サルコペニア フレイル 周術期 消化器外科手術 |
| Title | 高齢者に対する外科周術期の問題と対策 |
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