摘要
目的探讨80岁以上高龄心脏病患者行非心脏手术麻醉处理的特殊性。方法总结近年行这类手术麻醉患者84例,术前全面了解各重要脏器病变严重程度及代偿能力,并作相应的术前准备,选择合适的麻醉方法、药物、监测及调控措施,预防术中心肌氧供需失衡、术后疼痛应激、低氧血症及心血管事件发生。结果术前心血管系统异常以心肌供血不足的发生率居首位,为86%;其次是高血压/低血压,心绞痛发生率列居第3位;术前合并脏器功能异常的数量随年龄增长而增加;麻醉方法主要取决于病情和手术种类,上腹部手术64.5%选用全身麻醉。择期手术68例患者,术前给予相应的极化液、降血压、抗心律失常、降血糖和抗感染等治疗。16例急诊手术患者术后需行呼吸支持、循环不稳定和中枢神经功能障碍者分别为18.8%、37.5%和18.8%;择期手术患者分别为4.4%、13.2%和4.4%。47例术后行PCA镇痛;术后死亡率为7.1%。结论在高龄心脏病患者,充分的术前准备,选择合适的麻醉方法、加强麻醉管理和维持心肌氧供需平衡,是降低手术麻醉风险的重要措施。
Objective To analyze the anesthetic management for noneardiae surgery in the geriatric patients with heart diseases. Methods A retrospective study was carried out in consecutive 84 patients aged 80 years or older, with histories of cardiovascular/heart disease, and underwent noncardiae surgery. Preoperative vital organ function and compensational ability were assessed, and corresponding treatment was performed. The proper preperative preparation, anesthetic selection of technic and drug, mormitoring and treatment during anesthesia were taken. Intraoperative myocardial unbalances of oxygen supply and con - sumption, postoperative painful stress, hypoxia and cardiovascular complications were prevented. Results The most prevalent preoperative cardiovascular diseases were myocardial ischemia, hypertension/hypoten -sion and angina, of which myocardial isehemia occurred in 86% of patients. The number of preoperative or - gan dysfunction was increased with the increase in age. According to category of surgery and patient eondi - tions, 64.5% of patients underwent upper abdominal surgery under general anesthesia. Sixty - eight patients underwent elective operations were given compositive treatments including polarized liquid, infusion, antihy - pertensive therapy, antiarrhythmia, decreasing blood sugar. Sixteen patients underwent emergency opera - tions the percentage of requiring breath support, and occurring unstable circulation and neurological eompli - cations was 18. 8% , 37.5 % andl 8.8 % of patients respectively, which was 4. 4% , 13. ：2% and 4.4% in patients underwent elective operations. Forty - seven patients received post - operative analgesia. The mortality rate was 7. 1%. Conclusion A sufficient preoperative preparation, optimal anesthetic procedures and man - agement, and maintenance of balance of myocardial oxygen supply and consumption are the important mearues to decrease anesthetic risk in the patients aged 80 years or older with heart disease.
出处
《中国医学创新》
CAS
2011年第10期49-52,共4页
Medical Innovation of China
关键词
老年
心脏病
非心脏手术
麻醉
Geriatric
Heart disease
Noneardia surgery
Anesthesia
