头颈外科手术与重建中的预康复

文献信息

中文摘要

背景： 针对恶性肿瘤的头颈外科手术与重建常导致显著的功能、营养和心理并发症，可能延迟康复并损害生活质量。预康复提供了一种多模式、主动的方法，通过针对可改变的危险因素和基线损害，在术前优化患者状态。
方法： 在这篇叙述性综述中，我们综合了预康复6个领域的当前证据和临床指南，包括医学风险评估、营养优化、吞咽治疗、疼痛管理、体能训练和心理支持，为围手术期团队提供实用框架。
结果： 早期识别和治疗烟草、酒精和大麻使用，以及纠正术前贫血，可以减少围手术期并发症和输血需求。在诊断时或接近诊断时启动营养预康复，并理想地在整个新辅助治疗期间持续进行，使用经过验证的筛查工具；个体化饮食咨询；以及在指征明确时，免疫营养和肠内支持，以减轻营养不良并改善伤口愈合。基线吞咽评估包括床旁筛查和仪器检查，随后进行针对性运动计划，有助于保留功能并支持足够的经口摄入。术前多模式镇痛、结构化有氧和抗阻运动（包括呼吸训练），以及心理干预，如心理教育和认知行为治疗，共同增强康复依从性，支持情绪应对，并改善功能恢复。
结论： 多模式、多学科的预康复应被视为接受头颈外科手术和重建患者手术准备的重要组成部分，以患者为中心的护理计划应根据个体风险特征量身定制，以改善术后结局和整体生活质量。

英文摘要

BACKGROUND: Head and neck surgery and reconstruction for malignancy often results in significant functional, nutritional, and psychological morbidity that can delay recovery and impair quality of life. Prehabilitation offers a multimodal, proactive approach to optimize patients before surgery by targeting modifiable risk factors and baseline impairments.
METHODS: In this narrative review, we synthesized current evidence and clinical guidelines across 6 domains of prehabilitation, medical risk assessment, nutritional optimization, swallowing therapy, pain management, physical conditioning, and psychological support, to provide a practical framework for perioperative teams.
RESULTS: Early identification and treatment of tobacco, alcohol, and cannabis use, along with correction of preoperative anemia, can reduce perioperative morbidity and the need for transfusion. Nutritional prehabilitation initiated at or near the time of diagnosis, and ideally continued throughout neoadjuvant therapy, uses validated screening tools; individualized dietetic counseling; and, when indicated, immunonutrition and enteral support to mitigate malnutrition and improve wound healing. Baseline swallowing assessment with bedside screening and instrumental studies, followed by targeted exercise programs, helps preserve function and support adequate oral intake. Preoperative multimodal analgesia, structured aerobic and resistance exercise (including respiratory training), and psychological interventions, such as psychoeducation and cognitive behavioral therapy, collectively enhance adherence to rehabilitation, support emotional coping, and improve functional recovery.
CONCLUSIONS: Multimodal, multidisciplinary prehabilitation should be considered an essential component of surgical preparation for patients undergoing head and neck surgery and reconstruction, with patient-centered care plans tailored to individual risk profiles to improve postoperative outcomes and overall quality of life.