老年综合评估在老年患者牙种植围术期管理中的应用

doi:10.3877/cma.j.issn.2095-8757.2026.01.004

随着人口老龄化的快速进展，老年患者多病共存、功能储备下降及多重用药等问题日益突出，老年缺牙的种植修复治疗正从局部条件的可行性评估转向全身风险与功能维护的综合管理。现基于老年综合评估（CGA）核心技术，引入老年医学"5M"框架（Mind、Mobility、Medications、Multicomplexity、Matters Most），系统梳理老年患者牙种植围术期的关键风险要素与分层管理路径，主要包括缺牙与营养不良、肌少症、衰弱、认知障碍等老年常见综合征相互作用的潜在机制，围绕"5M"框架如何展开结构化评估，以及构建以CGA为核心的分层管理路径，从而为老年患者牙种植获益提供临床参考。

关键词: 老年人, 牙种植, 老年综合评估, 衰弱, 围术期管理

With the rapid progression of population aging, issues such as multimorbidity, declining functional reserve, and polypharmacy among older patients have become increasingly prominent. The implant restoration treatment for tooth loss in the elderly is shifting from an evaluation based solely on local anatomical feasibility to comprehensive management that integrates systemic risk assessment and functional maintenance. Based on the core technology of comprehensive geriatric assessment (CGA) and introducing the geriatric "5M" framework (Mind, Mobility, Medications, Multicomplexity, Matters Most), this study systematically reviews the key risk factors and stratified management pathways for the perioperative period of dental implant placement in elderly patients. It primarily focuses on the potential mechanisms underlying the interactions between tooth loss and common geriatric syndromes such as malnutrition, sarcopenia, frailty, and cognitive impairment. It also focuses on how to conduct structured assessment based on the "5M" framework and how to construct a stratified management path centered on CGA, thereby providing clinical references for more benefits for elderly patients undergoing dental implantation.

Key words: Aged, Dental implants, Comprehensive geriatric assessment, Frailty, Perioperative management

表1 根据"5M"框架归类的CGA核心指标及牙种植围术期风险阈值

5M维度	关键指标	警戒阈值	主要风险	处置要点
Mind（认知/情绪）	Mini-Cog、MoCA	筛查异常	依从性差；谵妄/PND↑	方案简化；优先局麻；防谵妄
Mobility（活动能力/功能）	步速/握力	步速<0.8 m/s；握力：男性<28 kg，女性<18 kg	储备差；维护能力不足	微创/分期；修复易维护
Medications（用药管理）	eGFR、INR；抗栓/抗凝史	eGFR<50 mL·min^-1·（1.73 m²）^-1（停药窗延长）	出血/血栓；相互作用	用药调整；停药时窗个性化；必要时MDT
Multicomplexity（多病与复杂性）	METs；HbA1c；抗骨质疏松用药	METs<4；HbA1c>8.5%（衰弱）	心血管事件；感染/骨结合不良；MRONJ	先优化稳态；减创/微创；高危MDT共决策
Matters Most（最重视事项）	获益时间；照护支持	照护支持不足/获益窗不足	维护困难；负担>获益	共同决策；降复杂度；简化/姑息修复

表1 根据"5M"框架归类的CGA核心指标及牙种植围术期风险阈值

5M维度	关键指标	警戒阈值	主要风险	处置要点
Mind（认知/情绪）	Mini-Cog、MoCA	筛查异常	依从性差；谵妄/PND↑	方案简化；优先局麻；防谵妄
Mobility（活动能力/功能）	步速/握力	步速<0.8 m/s；握力：男性<28 kg，女性<18 kg	储备差；维护能力不足	微创/分期；修复易维护
Medications（用药管理）	eGFR、INR；抗栓/抗凝史	eGFR<50 mL·min^-1·（1.73 m²）^-1（停药窗延长）	出血/血栓；相互作用	用药调整；停药时窗个性化；必要时MDT
Multicomplexity（多病与复杂性）	METs；HbA1c；抗骨质疏松用药	METs<4；HbA1c>8.5%（衰弱）	心血管事件；感染/骨结合不良；MRONJ	先优化稳态；减创/微创；高危MDT共决策
Matters Most（最重视事项）	获益时间；照护支持	照护支持不足/获益窗不足	维护困难；负担>获益	共同决策；降复杂度；简化/姑息修复

图1 基于老年综合评估理念的老年患者牙种植围术期分层管理路径注：MDT为多学科协作；MRONJ为药物相关性颌骨坏死；CGA为老年综合评估

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Application of comprehensive geriatric assessment in perioperative management of dental implant therapy in older patients

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Application of comprehensive geriatric assessment in perioperative management of dental implant therapy in older patients