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病人 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 6 4 5 %选用全身麻醉。择期手术 6 8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 。
Objective To analyze the anesthetic management for noncardiac 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 noncardiac 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,mornitoring and treatment during anesthesia were taken.Intraoperative myocardial unbalances of oxygen supply and consumption,postoperative painful stress,hypoxia and cardiovascular complications were prevented.Results The most prevalent preoperative cardiovascular diseases were myocardial ischemia,hypertension/hypotension and angina,of which myocardial ischemia occurred in 86% of patients.The number of preoperative organ dysfunction was increased with the increase in age.According to category of surgery and patient conditions,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,antihypertensive tharapy,antiarrhythmia,decreasing blood sugar.Sixteen patients underwent emergency operations the percentage of requiring breath support,and occurring unstable circulation and neurological complications was 18.8%,37.5% and 18.8% 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 sufficent preoperative preparation,optimal anesthetic procedures and management,and maintenance of balance of myocardial oxygen supply and consumption are the important meaures to decrease anesthetic risk in the patients aged 80 years or older with heart disease.
出处
《临床麻醉学杂志》
CAS
CSCD
2002年第9期466-469,共4页
Journal of Clinical Anesthesiology
关键词
老年人
心脏病
非心脏手术
麻醉
Geriatric
Heart disease
Noncardiac surgery
Anesthesia
