麻醉恢复室老年病人严重呼吸并发症的预防与处理

目的：探讨麻醉恢复室老年病人全麻术后严重呼吸并发症发生原因、预防及有效处理措施。方法：回顾我院麻醉恢复室（PACU）2008年11月至2009年10月老年全麻病人拔管后严重呼吸并发症原因及其处理。结果：PACU收治的1700例全麻术后老年患者中20例需重新插管行呼吸机治疗,发生率为1.2%。造成二次插管的主要原因有呼吸道梗阻（7例）、麻醉药物残余作用（6例）、反流误吸（4例）和低温寒战（3例）等。结论：拔管后严重呼吸并发症应以预防为主。围拔管期应严密观察患者病情变化,根据手术部位及方式、麻醉用药及患者呼吸恢复情况等决定拔管时机,采取相应措施,可有效减少呼吸并发症及二次插管率。

PREVENTION AND TREATMENT OF ELDERLY PATIENTS WITH SEVERE RESPIRATORY COMPLICATIONS IN POSTANESTHESIA CARE UNIT

Objective：To explore the causes and effective avoidance and treatment measures in elderly pa-tients with Severe respiratory complications in postanesthesia care unit.Methods： Cases from 2008/11 to 2009/10 in our hospital postanesthesia care unit were reviewed retrospectively and the causes and treatment of Elderly pa-tients with severe respiratory complications under general anesthesia extubation were analyzed.Results： 1700 cases of elderly patients under general anesthesia in PACU,only 20 cases（1.2%） needed treamentt with reintuba-tion and breathing apparatus.The major causes of reintubation included upper respiratory tract obstruction（7 cas-es）,the residual effects of anesthesia agent（6 cases）,reflux and aspiration（4 cases）,hypothermy（3 cases）.Conclusions： Prevention is the primary measure for elderly patients with Severe respiratory complications after extubation.Extubation should closely observe the patient＇s condition;the time of extubation is based on the surgical site and manner,anesthesia agent and the patients breathing recovery time,Taking crresponding measures,we can reduce respiratory complications and the rate of re-intubation effectively.