Surgery (Oxford, Oxfordshire)最新文献

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Test yourself: MCQ and single best answer 测试自己：MCQ和单一最佳答案

Surgery (Oxford, Oxfordshire)

Pub Date : 2025-12-01 DOI: 10.1016/j.mpsur.2025.11.001

Adrian Ben Cresswell

引用次数: 0

Preoperative evaluation of the patient with cardiorespiratory diseases 心肺疾病患者的术前评价

Surgery (Oxford, Oxfordshire)

Pub Date : 2025-12-01 DOI: 10.1016/j.mpsur.2025.10.011

Pooja Kumar Subramanyam, Mahesh Balakrishnan

Cardiorespiratory complications constitute a major cause of postoperative morbidity and mortality and represent a considerable economic burden to the NHS. Patients with pre-existing cardiorespiratory disease can be identified in the preoperative setting through comprehensive history-taking and targeted investigations. Systematic preoperative evaluation, incorporating formal risk assessment and stratification, facilitates the early identification of patients at increased perioperative risk. This in turn allows for evidence-based optimization of co-morbidities, formulation of an individualized anaesthetic plan, modification of the surgical strategy where appropriate, and allocation of suitable postoperative care. Such interventions are integral components of perioperative risk reduction and contribute to improved patient safety and clinical outcomes.

心肺并发症是术后发病率和死亡率的主要原因，对NHS来说是一个相当大的经济负担。术前可通过全面的病史记录和有针对性的调查确定既往存在心肺疾病的患者。系统的术前评估，包括正式的风险评估和分层，有助于早期识别围手术期风险增加的患者。这反过来又允许循证优化合并症，制定个体化麻醉计划，在适当的情况下修改手术策略，并分配适当的术后护理。这些干预措施是降低围手术期风险的组成部分，有助于改善患者安全和临床结果。

引用次数: 0

Neurological conditions in the perioperative period 围手术期的神经系统状况

Surgery (Oxford, Oxfordshire)

Pub Date : 2025-12-01 DOI: 10.1016/j.mpsur.2025.10.012

Harriet Morton, Christopher Johnson

The wide spectrum of neurological disorders and their effects on the function of the central and peripheral nervous system can cause an extensive array of symptoms and significant morbidity and mortality. Morbidity and mortality are often amplified in the perioperative period with an elevated risk of anaesthetic complications and adverse events. However, the number of patients with neurological disease requiring surgery is unlikely to diminish, and therefore this anaesthetic risk must be met and managed effectively. Here we aim to examine a range of different neurological conditions, exploring the possible complications and complexities encountered in the perioperative period, in addition to discussing strategies to minimize the risk of adverse outcomes and ensure the delivery of safe anaesthesia and good perioperative care.

广泛的神经系统疾病及其对中枢和周围神经系统功能的影响可引起广泛的症状和显著的发病率和死亡率。围手术期伴随着麻醉并发症和不良事件的增加，发病率和死亡率往往会增加。然而，需要手术的神经系统疾病患者的数量不太可能减少，因此必须有效地应对和管理这种麻醉风险。在这里，我们的目的是检查一系列不同的神经系统疾病，探讨围手术期可能遇到的并发症和复杂性，以及讨论最小化不良后果风险的策略，确保安全麻醉和良好的围手术期护理。

引用次数: 0

Preoperative cardiopulmonary exercise testing: physiological basis and investigation 术前心肺运动试验：生理基础与调查

Surgery (Oxford, Oxfordshire)

Pub Date : 2025-12-01 DOI: 10.1016/j.mpsur.2025.10.010

Anurag Vats, Rhona Martin, Manik Chandra

For over 20 years cardiopulmonary exercise testing (CPET) has been used in the perioperative setting. Over 30,000 tests are performed annually by an increasing number of centres in the UK. Each test produces a large volume of detailed data on the integrative exercise responses of various body systems. Interpretation of CPET data requires thorough understanding of basic exercise physiology and its clinical application. CPET data are incorporated into a global preoperative assessment to provide a personalized risk estimate of perioperative complications and death. Individualized risk assessment can be discussed within the multidisciplinary team and during patient encounters to inform best interests decisions. Such decisions also help in optimizing the use of resources in an increasingly pressured healthcare setting. As CPET services expand we explore how it can contribute to managing peri-operative risk and planning individualized care.

20多年来，心肺运动试验（CPET）一直被用于围手术期。在英国，越来越多的中心每年进行超过30,000次检查。每次测试都会产生大量关于不同身体系统综合运动反应的详细数据。对CPET数据的解释需要对基本运动生理学及其临床应用有透彻的了解。CPET数据被纳入全球术前评估，以提供围手术期并发症和死亡的个性化风险估计。个性化风险评估可以在多学科团队和患者接触期间进行讨论，以告知最佳利益决策。这样的决策还有助于在压力越来越大的医疗环境中优化资源利用。随着CPET服务的扩展，我们探索它如何有助于管理围手术期风险和规划个性化护理。

引用次数: 0

The patient with renal disease 肾病患者

Surgery (Oxford, Oxfordshire)

Pub Date : 2025-12-01 DOI: 10.1016/j.mpsur.2025.10.014

Ian Nesbitt, Rikzing Bhutia

The incidence of chronic renal failure is increasing throughout the world. The perioperative management of patients with chronic kidney disease (CKD) is complicated by both the underlying renal dysfunction, with associated disturbances of fluid and electrolyte homeostasis and altered drug clearance, and the presence of associated co-morbid conditions. Preoperative assessment for these complex patients requires a multidisciplinary approach from anaesthetic, surgical and nephrology teams. Preservation of normal physiology along with prevention of further kidney injury are central to the management of patients with CKD. This article focuses on the perioperative care of patients, including pharmacological considerations of common medications used.

慢性肾衰竭的发病率在世界范围内呈上升趋势。慢性肾脏疾病（CKD）患者的围手术期管理是复杂的，包括潜在的肾功能障碍，相关的体液和电解质稳态紊乱和药物清除改变，以及相关的合并症的存在。术前评估这些复杂的病人需要多学科的方法从麻醉，外科和肾脏病小组。保持正常的生理机能以及预防进一步的肾损伤是CKD患者管理的核心。本文重点介绍围手术期患者的护理，包括常用药物的药理学考虑。

引用次数: 0

Day case surgery 日间手术

Surgery (Oxford, Oxfordshire)

Pub Date : 2025-12-01 DOI: 10.1016/j.mpsur.2025.10.017

Rakesh Bhandary

Day case surgery, where the patient is admitted, undergoes an intervention and is discharged on the same day, is an important aspect of service provision in the NHS. This article addresses the recommendations and logistics of the provision of day case surgery in the present-day NHS.

日间病例手术，即患者入院、接受干预并在同一天出院，是NHS服务提供的一个重要方面。这篇文章解决的建议和后勤提供日案件手术在当今的国民保健服务。

引用次数: 0

Challenging patient groups 具有挑战性的患者群体

Surgery (Oxford, Oxfordshire)

Pub Date : 2025-12-01 DOI: 10.1016/j.mpsur.2025.10.015

Sneha Prasad

Patients present for surgery at all stages of their lives. Some patients have systemic co-morbidities, and these are discussed in other articles. This article focuses on those patients that do not necessarily fit a systems-based approach of classification. Many of these patients present challenges to the clinicians involved with perioperative care so it is important to have a good understanding of how they should be managed. This article will focus on elderly patients, pregnant patients presenting for non-obstetric surgery, obese patients, and immunocompromised patients. We have chosen to focus on key aspects of preoperative, intraoperative and postoperative care for each patient group, highlighting the physiological basis of such recommendations.

病人在生命的各个阶段都要接受手术。一些患者有全身合并症，这些在其他文章中讨论。本文关注的是那些不一定适合基于系统的分类方法的患者。这些患者中的许多人对参与围手术期护理的临床医生提出了挑战，因此很重要的是要充分了解他们应该如何管理。本文将重点关注老年患者、非产科手术孕妇、肥胖患者和免疫功能低下患者。我们选择将重点放在每个患者组的术前、术中和术后护理的关键方面，强调这些建议的生理基础。

引用次数: 0

Safe sedation practice for surgeons 外科医生的安全镇静练习

Surgery (Oxford, Oxfordshire)

Pub Date : 2025-12-01 DOI: 10.1016/j.mpsur.2025.10.018

Jon Walton

Sedation is increasingly used to enable patients to tolerate uncomfortable or painful surgical procedures, avoiding the use of a general anaesthetic. Historically, inappropriately administered or monitored sedation was associated with a high morbidity and mortality. National guidance now exists which sets standards for safe sedation for healthcare procedures. This article uses this guidance as a framework to discuss the generic principles and practice of sedation and should not be seen as a substitute for more formal training.

镇静越来越多地用于使患者能够忍受不舒服或痛苦的外科手术，避免使用全身麻醉。历史上，不适当的给药或监测镇静与高发病率和死亡率相关。目前存在的国家指南为医疗程序的安全镇静设定了标准。本文使用该指南作为框架来讨论镇静的一般原则和实践，不应被视为替代更正式的培训。

引用次数: 0

Preoperative optimization and enhanced recovery after surgery 术前优化，术后恢复增强

Surgery (Oxford, Oxfordshire)

Pub Date : 2025-12-01 DOI: 10.1016/j.mpsur.2025.10.016

Sarah L. Cooper, Paul Panesar, John Davidson

Enhanced recovery pathways have been repeatedly shown to reduce length of stay and complication rates for patients undergoing elective major surgery across multiple surgical specialties. The success of the enhanced recovery approach relies on excellent patient preparation and reliable implementation of evidence-based, standardized care components at each stage of the surgical journey. Multidisciplinary team engagement and continuous audit of outcomes are crucial in sustaining a successful enhanced recovery after surgery programme.

增强的恢复途径已多次被证明可以减少住院时间和并发症发生率的患者接受选择性大手术跨越多个外科专业。增强恢复方法的成功依赖于出色的患者准备和在手术过程的每个阶段可靠地实施循证、标准化的护理成分。多学科团队的参与和持续的结果审计对于维持成功的增强术后恢复方案至关重要。

引用次数: 0

Management of patients with musculoskeletal disease and burns 肌肉骨骼疾病和烧伤患者的管理

Surgery (Oxford, Oxfordshire)

Pub Date : 2025-12-01 DOI: 10.1016/j.mpsur.2025.10.013

Rakesh Bhandary

Musculoskeletal disorders include a wide range of disorders which affect the locomotor system, i.e. muscles, bones, joints, and associated connective tissues like tendons and ligaments, which are listed in Chapter XV of the International Classification of Diseases (ICD-11). While the primary pathology affects locomotor system, a number of these disorders are associated with systemic complications, resulting in increased morbidity and mortality in the perioperative period.

Burns are an acute emergency and require anaesthetic or critical care input for assessment of injuries, early surgical intervention or organ support. Major burns are a multisystem disorder and although they account for less than 5% of all new burns cases, their management is complex and requires multidisciplinary approach in a specialized centre. This chapter highlights the important considerations for perioperative management of these conditions.

肌肉骨骼疾病包括影响运动系统的各种疾病，即肌肉、骨骼、关节和相关结缔组织，如肌腱和韧带，这些疾病列在《国际疾病分类》（ICD-11）第十五章中。虽然主要病理影响运动系统，但许多这些疾病与全身并发症相关，导致围手术期发病率和死亡率增加。烧伤是一种急症，需要麻醉或重症监护投入，以评估损伤、早期手术干预或器官支持。严重烧伤是一种多系统疾病，虽然它们占所有新发烧伤病例的不到5%，但它们的治疗是复杂的，需要在一个专门的中心采用多学科方法。本章强调了这些情况围手术期管理的重要考虑因素。

引用次数: 0

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