老年胃癌合并心血管疾病的围手术期处理体会

目的探讨老年胃癌患者合并心血管疾病的围手术期处理。方法对116例合并心血管疾病的胃癌患者的临床资料进行回顾性分析。结果术后重度血压升高7例，严重低血压1例，充血性心力衰竭5例，心绞痛2例，心肌梗死1例，各类心律失常28例。并发切口裂开1例，切口感染1例，肺部感染2例，低血糖昏迷1例，吻合口瘘1例，吻合口出血1例。围手术期死亡3例。术后心血管并发症发生率、其他并发症发生率、围手术期死亡率分别为37．9％（44／116）、6．0％（7／116）、2．6％（3／116）。结论老年胃癌合并心血管疾病增加了手术的风险性，但加强围手术期处理可提高手术的安全性，降低围手术期死亡率和并发症发生率。

Perioperative management of elderly patients with gastric cancer complicated with cardiovascular disease

Objective To explore the perioperative management of elderly patients with gastric cancer complicated with cardiovascular disease. Methods The clinical data of 116 cases of gastric cancer complicated with cardiovascular disease in elderly patients in our institution from January 2003 to Decem- ber 2007 were analyzed retrospectively. Results Postoperative complications included ： stage 3 hypertension （ 7 cases） , severe hypotension （ 1 case） , congestive heart failure （ 5 cases ） , angina pectoris （ 2 cases ） , acute myocardial infarction （ 1 case ） , cardiac arrhythmia （ 28 cases） , wound dehiscence （ I case） , wound in- fection（ 1 case ） , pneumonia （ 2 cases ） , hypoglyeemic coma （ 1 case ） , anastomotic leakage （ 1 case ） , and anastomotic hemorrhage（ 1 case）. Three eases died in postoperative period. The incidence of cardiovascular disease complications was 37.9% ,the incidence of postoperative complications was 6.0% and the perioperative mortality was 2.6%. Conclusion The cardiovascular disease increases the risk of surgical proce- dures in elderly patients with gastric cancer, but intensive perioperative management can increase the suc- cess rate of operation and decrease the operative mortality and incidence of complication.