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并发心血管病的80 岁以上患者行非心脏手术围术期处理(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2003年第5期
页码:
428-431
栏目:
临床研究
出版日期:
2003-09-01

文章信息/Info

Title:
Perioperative management for noncardiac surgery in elderly patients with cardiovascular disease
作者:
陈绍洋; 朱萧玲; 王强; 董辉; 李扬; 胡胜; 熊利泽; 张英民
第四军医大学西京医院麻醉科, 陕西 西安 710032
Author(s):
CHEN Shao-yang;  ZHU Xiao-ling;  WANG Qiang;  DONG Hui;  LI Yang;  HU Sheng ;  XIONG Li-ze;  ZHANG Ying-min
Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi 710032, China
关键词:
高龄; 心脏病; 非心脏手术; 麻醉; 围术期
Keywords:
senility;  heart disease;  noncardiac surgery;  anesthesia;  perioperation
分类号:
R619
DOI:
-
文献标识码:
A
摘要:
目的:探讨并发心血管疾病的80岁以上高龄患者行非心脏手术围术期处理的特殊性。方法: 总结行这类手术患者94例, 术前行各项检查, 评估心血管系统功能异常程度, 并作相应的准备, 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和心血管事件发生。结果: 术前心血管疾病以心肌供血不足的发生率(83%) 居首位, 其次是高血压或低血压(61%) , 列居第三位的是各种类型心律不齐(46%)。接受扩冠脉血管治疗22 例, 营养心肌治疗62例, 抗高血压治疗41 例, 抗心律失常治疗27例。上腹部手术76% 选用全麻, 下腹部、下肢手术均选用椎管内麻醉。术中心肌供血不足、高血压或低血压和心律不齐的发生率分别较术前下降11%, 5%和6%。结论: 高龄患者并发心血管疾病以心肌供血不足最常见, 术前充分准备、麻醉选择适当、术中调控合理是安全渡过围术期的重要措施。
Abstract:
AIM: To explore speculation of perioperative management for noncardiac surgery in patients aged 80 years or older with cardiovascular disease. MEHTODS: A retrospective study was done in consecutive 94 patients aged 80 years or older with cardiovascular disease who underwent noncardiac surgery in our hospital. Preoperatively the degrees of cardiovascular dysfunctions were assessed by various examinations, and corresponding treatments were performed. Optimal anesthetic procedure, drugs, monitorings and regulated measures were selected. In traoperative myocardial unbalances of oxygen supply and consumption and cardiovascular complicationswere prevented. RESULTS: The most prevalent preoperative cardiovascular disease were myocardial ischemia, hypertension or hypotension and all sorts of arrhythmia in turn, which occurred to 83%, 61% and 46% of the patients respectively. Dilatation of coronary artery, nourishing myocardia, anti-hypertension and anti-arrhythmia were performed in 22, 62, 41 and 27 patients respectively. 76% of the patients who underwent upper abdominal surgery received general anesthesia. Those who underwent lower abdominal and limbs surgery received vertebral anesthesia. The incidence of in traoperative deficiency myocardial blood supply, hypertension or hypotension and arrhythmia decreased by 11%, 5% and 6% respectively, as compared with preoperative incidence. CONCLUSION: The most frequent cardiovascular disease in elderly patients was myocardial ischemia. The following may serve as important measures to safely over the perioperative periods: tide the elderly patients meticulous attention to preoperative preparation, optimal anesthetic procedures and management, and rational regulation in operation.

参考文献/References

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[2] 刘怀琼, 葛衍江, 邓小明. 老年麻醉应注意的循环问题 [M] . 北京: 人民军医出版社, 2001. 51.

[3] Dzankic S, Pastor D, Gonzalez Carlos, et al. The prevalence and predictive value of abnormal preoperative laboratory tests in elderly surgical patients [J] . Anesth Analg, 2001, 93(2):301-308.

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[5] Polanczylc CA, Marcantonio E, Goldman L, et al. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery [J] . Ann Intern Med, 2001, 134(8):637-643.

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备注/Memo

备注/Memo:
收稿日期：2002-06-10.
更新日期/Last Update: 2003-09-01