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老年创伤：初步评估和处理

Author
Christopher Colwell, MD
Section Editor
Maria E Moreira, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
陈虞, 主治医师

引言

由于期望寿命的延长和出生率的下降，几乎每一个发达国家中60岁以上人群的人口比例增长都最为迅速[1]。因此，有更多老年人因创伤而至急诊科就诊[2]。此外，慢性疾病治疗水平的提高使越来越多的老年人拥有了更活跃的生活方式，也使他们更易受伤[3]。

虽然在所有年龄段人群中，创伤仍是致病与致死的主要原因，老年患者与其相对应的较年轻患者的明显区别在于，老年患者的共存疾病更多[4,5]，严重残疾与死亡的风险也更高[6,7]。老年患者更容易因为轻微机制而受伤，而且较难代偿由创伤带来的伤害。老年人更有可能使用多种药物来治疗其慢性疾病，其中一些药物会降低他们对创伤性生理应激的反应，从而增加并发症的风险[8]。

本专题将总结关于老年患者创伤的初步评估与处理的重要内容。成年人创伤治疗和各类具体损伤的治疗的详细讨论参见其他专题。 (参见“成人创伤的早期处理”)

定义

界定“老年”创伤患者确切年龄范围的问题始终存在争议，甚至有人建议从50岁开始[9]。一项大型观察性研究显示，校正损伤严重程度后，70岁患者的死亡率有所增加，表明70岁是界定老年人群的恰当临界值[9]。但是，大部分研究都以65岁来界定老年患者，尽管没有证据支持。评估患者创伤后损伤的相对危险度时，以整体的健康状态为前提考虑患者年龄可能比单独考虑年龄更重要。在本专题中，我们将65岁以上定义为“老年”。

损伤的流行病学与机制

摔伤和机动车辆车祸是老年人最常见的受伤机制。但最重要的是，无论何种受伤机制，老年创伤患者的死亡率都高于相对应的较年轻患者[7,10,11]。在就诊时创伤严重度评分(Injury Severity Score, ISS)高于15的老年患者中，预计有多达1/3会死于院内。

                            

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-24.
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