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Prehabilitacja – jakie są jej cele i wskazania?

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Prehabilitacja, czyli kompleksowe przygotowanie pacjenta do zabiegu operacyjnego, ma na celu zagwarantowanie sprawnego, niepowikłanego procesu terapii i szybkiego powrotu do zdrowia. Na czym polega prehabilitacja i w jakich przypadkach warto ją wdrażać?

Prehabilitacja to bardzo istotna dziedzina medycyny okołooperacyjnej. Jej założeniem jest kompleksowe działanie w celu uzyskania jak najlepszego stanu zdrowia pacjenta, co pozwoli na osiągnięcie dobrych efektów zabiegu oraz szybkiej rekonwalescencji. W niektórych przypadkach kompleksowa prehabilitacja może zmniejszyć ryzyko wystąpienia powikłań pooperacyjnych nawet dwukrotnie.

Ważna aktywność pacjenta

Jak zwraca uwagę prof. dr hab. n. med. Tomasz Banasiewicz, specjalista chirurgii ogólnej, którego jednym z głównych obszarów zainteresowań zawodowych jest szeroko rozumiana kompleksowa opieka okołooperacyjna, skuteczna prehabilitacja wymaga dużej świadomości zdrowotnej i aktywności ze strony pacjenta. Jak tłumaczy ekspert, założeniem prehabilitacji jest jak najbardziej efektywne wykorzystanie przez pacjenta czasu oczekiwania na zabieg operacyjny lub terapię.

Cztery kierunki działań

Prehabilitacja opiera się na czterech kierunkach działań: eliminacji nałogów, przygotowaniu żywieniowym, ćwiczeniach fizycznych oraz wsparciu psychologicznym.

Eliminacja nałogów (przede wszystkim palenia papierosów) u pacjenta ma nie tylko służyć wyeliminowaniu ryzyka związanych z nimi chorób, ale też zapobiec pojawieniu się powikłań, których nałogi mogą być przyczyną, takich jak zapalenie płuc czy zakażenie rany pooperacyjnej.

Przygotowanie żywieniowe ma duże znaczenie zwłaszcza w przypadku chorych z ciężkim niedożywieniem, które zwiększa ryzyko powikłań pooperacyjnych. Odpowiednie żywienie jest jednak istotne także w przypadku pozostałych grup pacjentów, ponieważ wpływa na szybkość rekonwalescencji po zabiegu i może zmniejszyć ryzyko powikłań. Zakres przygotowania żywieniowego jest zależny od indywidualnych potrzeb pacjenta oraz od rodzaju i skomplikowania wykonywanego zabiegu lub terapii.

Kolejnym ważnym aspektem prehabilitacji jest wdrożenie odpowiednio dobranych ćwiczeń. Wprowadzenie nawet bardzo prostych ćwiczeń poprawia wydolność organizmu pacjenta, wspomaga procesy anaboliczne. Ćwiczenia fizyczne są szczególnie istotne u pacjentów cierpiących z powodu otyłości.

Prehabilitacja obejmuje także wsparcie psychologiczne. Ma ono na celu zmniejszenie lęku i stresu pacjenta, które mogą negatywnie wpływać na proces leczenia. Wsparcie psychologiczne ma szczególne znaczenie w przypadku chorych onkologicznych.

Edukacja i organizacja

W Europie Zachodniej prehabilitacja stanowi od wielu lat obowiązującą strategię przygotowania pacjentów do zabiegów chirurgicznych i innych rodzajów terapii. W polskiej medycynie to jednak stosunkowo nowy kierunek. Jak zauważa prof. dr hab. n. med. Tomasz Banasiewicz, propagator wprowadzenia prehabilitacji do praktyki klinicznej na szeroką skalę, konieczne jest podjęcie działań edukacyjnych zarówno w stosunku do personelu medycznego, jak i pacjentów, ponieważ obie te grupy mają w Polsce wciąż zbyt małą świadomość znaczenia, jakie ma dla powodzenia terapii odpowiednie, kompleksowe przygotowanie.

Ekspert wskazuje także, że należy rozpocząć działania organizacyjne skupione na powołaniu specjalistycznych placówek prehabilitacyjnych i wypracowaniu standardów tego rodzaju postępowania. W 2020 roku w Polsce mają powstać pierwsze poradnie prehabilitacyjne, w których pacjent będzie mógł otrzymać konkretne instrukcje i wiedzę dotyczącą efektywnego przygotowania do zabiegu.

Źródło: https://prehabilitacja.pl/

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