老年慢性肾脏病患者衰弱现状及康复策略

随着全球人口老龄化的不断加剧,慢性肾脏病患病率也越来越高,已成为目前较为突出的公共健康问题之一。与普通老年人相比,患有慢性肾脏病的老年人更容易发生衰弱,出现行走障碍、功能受限,甚至严重失能。由此可见,衰弱会增加老年慢性肾脏病患者的住院率和死亡风险,降低患者的生活质量,是肾病科及老年科医生必须重视的临床问题。鉴于衰弱与老年慢性肾脏病患者不良预后的关系密切,仅对患者进行传统意义上的专科治疗远远不够,应当着力于转变治疗方式和管理模式,注重患者整体机能的康复,制定以患者为中心的个体化疾病管理方案,防止患者病情进展及发生跌倒、失能等,最大限度地提高患者的生活质量。本文通过综述老年慢性肾脏病患者发生衰弱的机制及衰弱的管理,发现应从整体评估、制定护理计划、制定营养方案及制定个体化运动方案等方面进行衰弱的管理。

Research updates of weakness in elderly patients with chronic kidney disease and related rehabilitation strategies

With the increasingly aging of population worldwide, the prevalence of chronic kidney disease (CKD) is also increasing, and CKD has become a major threat to public health. Compared with the general elderly population, those diagnosed with CKD are more susceptible to weakness, walking impairment, functional limitations, or even severe disabilities. Therefore, weakness is associated with increased hospitalization rate and mortality risk, as well as poorer quality of life in elderly patients with CKD, which needs attention of both nephrologists and geriatrists. As there is a strong correlation between weakness and poor prognosis in elderly patients with CKD, conventional specialized treatment alone is far from enough. Instead, it is important to transform treatment modalities and management modes, focus on holistic functional rehabilitation, develop patient-centered and individualized weakness management regimen, prevent disease progression, reduce fall, disability and other risks, and maximize patient quality of life. This article reviews the mechanism of weakness and its management in elderly patients with CKD, and identifies several critical aspects of weakness management, including overall evaluation, development of nursing plan, development of nutritional regimen, and development of individualized exercise program.