老年手术患者麻醉处理

目的回顾78例老年患者手术麻醉过程,总结降低麻醉风险有效干预措施。方法对我院外科收治78例老年患者手术麻醉过程回顾性分析,探讨围麻醉期的处理经验。结果根据老年患者不同身体状况选择不同麻醉方式,我院78例患者中行硬膜外麻醉32例,静脉、吸入复合麻醉46例,分别从术前检查、心理抚慰、术后监测、并发症防治4方面入手,所有患者均安全度过麻醉期,手术顺利进行,并发症及时得到处理。结论积极有效的围麻醉期处理是保证老年患者手术麻醉安全顺利的关键。     

老年阵发性心房颤动导管消融术的围术期抗凝护理

目的探讨老年阵发性心房颤动患者行导管消融术治疗围术期抗凝药物的应用和护理。方法对33例房颤导管消融术患者术前行华法林等抗凝治疗以达手术预期,术中予肝素并动态监测抗凝状态,术后继续抗凝治疗并适时调整治疗强度。结果患者顺利度过围术期,术后发生1例出血并发症。结论围术期抗凝药物应遵照医嘱使用,加强健康教育及病情观察,提高患者的抗凝依从性,可达到安全、有效的抗凝状态。     

老年食管癌贲门癌合并糖尿病105例的外科治疗

目的探讨食管癌及贲门癌合并糖尿病患者围手术期的治疗。方法回顾性分析105例合并糖尿病的老年食管癌、贲门癌的外科治疗,将重点放在对糖尿病的监测、控制及并发症的防治上。结果105例均行择期手术,术后发生各类并发症30例,围手术期死亡2例,其余患者均安全度过围手术期。结论严格控制血糖和尿糖是老年食管癌、贲门癌合并糖尿病患者安全度过围手术期的关键。     

老年慢性中耳炎患者围手术期的治疗研究

目的研究老年慢性中耳炎患者中耳手术的围手术期治疗特点。方法回顾性分析2007年1月～2009年6月笔者所在医院收住的37例老年慢性中耳炎患者术前检查情况、手术方式、手术前后全身及局部系统的药物治疗情况。结果经系统地有针对性地围手术期治疗后,患者均安全度过手术期,无1例发生严重手术并发症。结论老年患者经系统有针对件的围手术期治疗后行中耳手术是安全有效的。     

缺血性脑血管病患者行骨科手术的麻醉处理

目的 探讨缺血性脑血管病患者行骨科手术麻醉处理的特殊性.方法 行骨科手术的缺血性脑血管病麻醉患者42例,术前详细了解脑血管病变的严重程度并做相应的术前准备,选择合适的麻醉方法、药物以及调控措施,预防脑血管事件的发生.结果 术前缺血性脑血管病以脑梗死最多,占47.62%(20/42);其次是脑供血不足,占35.71%(15/42),短暂性脑缺血发作占16.67%(7/42).麻醉方法主要取决于病情以及手术种类:脊柱以及两个以上部位的手术采用全麻(8例);上肢手术采用臂丛神经阻滞(7例);下肢手术采用椎管内阻滞(27例).择期手术患者35例,术前给予相应的控制血压、血糖、改善神经功能等治疗;所有患者均安全渡过围手术期,未见加重或新发的神经系统症状.结论 在缺血性脑血管病患者中,详细了解病史,术前准备充分,加强麻醉管理以及维持围手术期的循环功能稳定是降低手术以及麻醉风险的重要措施.     

泌尿外科患者并发糖尿病的围手术期处理

通过回顾性分析24例并发糖尿病外科患者的诊断及治疗,发现该组患者中,比较常见的是老年以及糖尿病II型,且术后的感染率较高,病情隐匿。其中泌尿系统感染2例,伤口感染4例。所以,安全度过围手术期的关键是合理使用药物来严格控制血糖,我们从而总结到并发糖尿病外科患者的围手术期处理方法及病情特点。     

肥胖患者麻醉处理分析

目的探讨肥胖病人的麻醉处理方法。方法选取临床2009年2月—2012年6月收治的肥胖患者行手术治疗60例,对手术中的麻醉处理方法进行分析。结果肥胖患者行腰麻-硬膜外阻滞麻醉34例,全麻26例,效果更为完善、手术中生命体征更加平稳,而且还能将患者的不利因素降低到最低限度。结论肥胖患者麻醉方法的选择应考虑肥胖患者的手术方法,要求麻醉医师选用最安全、最简便、最熟练的麻醉方法,以保证患者安全度过围手术期,提高麻醉质量,保证患者安全和减少麻醉药物总用量等优点。     

泌尿外科患者并发糖尿病的围手术期处理

通过回顾性分析24例并发糖尿病外科患者的诊断及治疗,发现该组患者中,比较常见的是老年以及糖尿病Ⅱ型,且术后的感染率较高,病情隐匿.其中泌尿系统感染2例,伤口感染4例.所以,安全度过围手术期的关键是合理使用药物来严格控制血糖,我们从而总结到并发糖尿病外科患者的围手术期处理方法及病情特点.     

病态窦房结综合征患者植入临时心脏起搏器的围手术期护理体会

目的探讨临时心脏起搏器在并发病态窦房结综合征患者围手术期的临床应用。方法74例患者术前安置临时心脏起搏器,术中与术后监测心电活动、血压、脉搏。结果全部病例均安全渡过麻醉及手术期,所有患者围手术期血压和脉搏稳定。结论围手术期临时心脏起搏器的应用能有效防治病态窦房结综合征患者的心律失常,提高麻醉手术的安全性。     

腹腔镜手术治疗老年人妇科肿瘤26例体会

目的探讨腹腔镜手术治疗老年人妇科肿瘤的可行性及意义。方法回顾分析江苏省宿迁市工人医院4年来腹腔镜手术治疗的26例老年妇科肿瘤,对患者的一般情况、并发症、对手术和麻醉的耐受能力等进行分析。结果全部患者均安全度过麻醉期和手术期,恶性病变组的手术持续时间、术中出血量和术后住院时间均较良性病变组为高。结论老年妇科患者能够耐受妇科腹腔镜手术,但是要做好充分的术前准备,并且要有完善的围手术期处理。     

老年心房颤动159例临床分析

目的分析老年人心房颤动病因、临床特点和抗凝治疗的状况。方法选择1998年至今在我院住院的患者，年龄〉65岁，有心房颤动史159例，观察心电图、动态心电图、超声心动图及甲状腺功能的血清学检查等，对患者的临床资料进行回顾性分析。结果老年心房颤动病因复杂，多数伴有基础疾病或全身其他疾病。基础疾病依次为：冠心病71例（44．65％），高血压病37例（23．27％），老年性瓣膜病13例（8．18％）。病因不明38例（23．89％）。老年心房颤动患者中持久性房颤比率高（73．58％）。心房颤动患者血栓栓塞事件发生率为31．06％。结论老年人心房颤动常见原因是冠心病、高血压性心脏病。老年心房颤动患者中持久性房颤比率高。血栓栓塞是房颤的重要并发症，抗凝治疗应得到重视。     

老年腹腔镜胆囊切除术的临床护理

目的探讨老年腹腔镜胆囊切除术（LC）患者的病理生理特点和围手术期的护理方法。方法对我院70例老年胆囊疾病患者行LC，并采取相应的围手术期护理方法。结果所有患者均成功地施行了LC，无死亡病例，4例中转开腹手术。术后均恢复良好，腹部伤口一期愈合，1例出现心房颤动，1例出现肺部感染，无护理并发症，术后3～7d痊愈出院。结论重视围手术期护理，采用合理的护理措施，对老年患者行LC是安全可行的。     

社区老年房颤患者抗凝治疗现状单中心横断面调查分析

目的:了解社区65岁及以上老年房颤患者抗凝治疗和社区随访情况,为进一步规范抗凝治疗提供理论基础和建议.方法:采用回顾性分析方法,入选2017-2018年本社区65岁及以上老年人心电图或动态心电图诊断房颤的166例患者,通过查阅居民电子健康档案、门诊随访和电话随访方式,记录性别、年龄、主要疾病诊断、CHA2DS2-VAS...     

钙拮抗剂治疗老年快速室上性心律失常的疗效观察

目的 观察静脉注射维拉帕米、地尔硫革对老年快速室上性心律失常的疗效和安全性。方法 对53例快速室上性心律失常的老年患者，根据全身状况和基础病变，采用个体化用药原则，分别给予上述两种药物。结果 两种药物对室上性心动过速、心房颤动、心房扑动治疗的总有效率均在80％以上，对室上性心动过速总有效率分别为92％和94％。结论 只要掌握好个体化用药原则，上述两种抗心律失常药物，均可安全有效地用于治疗老年快速室上性心律失常。     

Incidence of chronic atrial fibrillation in general practice and its treatment pattern

The object of this article was to estimate the incidence rate of chronic atrial fibrillation (AF) in a general practice setting, to identify factors predisposing to its occurrence, and to describe treatment patterns in the year following the diagnosis. The method used was a population-based cohort study using the General Practice Research Database (GPRD) in the UK. We identified patients aged 40-89 years with a first ever recorded diagnosis of AF. The diagnosis was validated through a questionnaire sent to the general practitioners. A nested case-control analysis was performed to assess risk factors for AF using 1,035 confirmed incident cases of chronic AF and a random sample of 5,000 controls from the original source population. The incidence rate of chronic AF was 1.7 per 1,000 person-years, and increased markedly with age. The age adjusted rate ratio among males was 1.4 (95% CI 1.2-1.6). The major risk factors were age, high BMI, excessive alcohol consumption, and prior cardiovascular comorbidity, in particular, valvular heart disease and heart failure. Digoxin was used in close to 70% of the patients, and close to 15% did not receive any antiarrhythmic treatment. Close to 40% did not receive either warfarin or aspirin in the 3 months period after the diagnosis. Among the potential candidates for anticoagulation only 22% of those aged 70 years or older were prescribed warfarin in comparison to 49% among patients aged 40-69 years. Chronic AF is a disease of the elderly, with women presenting a lower incidence rate than men specially in young age. Age, weight, excessive alcohol consumption, and cardiovascular morbidity were the main independent risk factors for AF. Less than half of patients with chronic AF and no contraindications for anticoagulation received warfarin within the first trimester after the diagnosis.     

福辛普利对高血压病合并房颤患者的血管紧张素Ⅱ的影响

目的观察福辛普利治疗高血压病合并房颤患者的临床疗效,探讨福辛普利治疗高血压病合并房颤患者的机制,分析房颤与血管紧张素Ⅱ（AngⅡ）相关性。方法将确诊的1~2级高血压病合并阵发性房颤的患者随机分为两组：福辛普利组（A组）80～160mg/d;胺碘酮＋非洛地平缓释片（波依定）组（B组）5～10mg/d。观察服药12月后各组房颤复发率;测定每组患者服药前与服药后3月、12月收缩压（SBP）、舒张压（DBP）及AngⅡ;再分析房颤复发与AngⅡ的相关性。结果①两组患者服药后3月血压达标,控制在140/90mmHg以下,与服药前比较明显降低,差异有统计学意义（P〈0.05）。②两组患者服药后3月与服药前相比AngⅡ改变不明显,差异无统计学意义（P〉0.05）。③两组患者服药后12月AngⅡA组、B组均改变,两组比较差异有统计学意义（P〈0.05）;房颤复发率：A、B组之间比较,差异无统计学意义（P〉0.05）。④相关分析显示：高血压病合并房颤患者的房颤复发与AngⅡ明显相关（P〈0.001）。结论福辛普利对高血压病合并房颤患者的治疗有效。     

心房颤动120例临床分析

目的分析心房颤动的病因,临床特点。方法对我院1999~20004年120例心房颤动患者的临床资料进行回顾性分析。结果120例患者中阵发性、持续性和持久性房颤分别占31例(25.8%)、24例(20.0%)、65例(54.2%);最常见为冠心病、高血压、风湿性心脏病分别占31.7%、24.2%、18.3%;应用抗血栓治疗患者87例(72.5%),120例患者中发生动脉栓塞25例(20.8%),脑栓塞18例(15.0%)。阵发性房颤多采用复律治疗(62.6%),以胺碘酮为主(71.0%),心律平(19.0%);慢性房颤患者,试行复律者不足1/2,主要采用控制心室率治疗(87.0%),药物主要有地高辛(42.0%)、β-受体阻滞剂(38.0%)和钙离子拮抗剂(20.0%)。结论房颤常见病因是冠心病、高血压、风湿性心脏病,栓塞是其重要并发症,预防卒中,高危组需用华法林,低危组可用阿司匹林。     

Drug therapy of atrial fibrillation

The authors summarize the up-to-date knowledge relating to the pharmacological treatment of atrial fibrillation. They emphasize that drug treatment continues to be in the forefront of the therapy of the arrhythmia, which can now be considered to constitute a cardiovascular epidemic. In the era following the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AF-FIRM) trial, the strategy of pharmacological treatment will certainly change: in place of "rhythm control", which in recent decades has been overforced in patients identical with the elderly, cardiac patients with an impaired left ventricular function who were enrolled into AFFIRM, there will be a more frequent use of ventricular "rate control". Naturally, this does not mean that, in certain patient groups, an effort should not be made to restore and maintain the sinus rhythm. In cases involving congestive heart failure and structural heart disease complicated by a depressed left ventricular systolic function, atrial fibrillation is currently treated with antiarrhythmic drugs possessing low proarrhythmic activity that prolong refractory period (Class 3), and with the even safer mortality-reducing beta-receptor blockers. The classical antiarrhythmic drugs (quinidine, procainamide, disopyramide) are being increasingly forced into the background, and the areas of indication of the novel Na(+)-channel blocker antiarrhythmics (propafenone, flecainide) have also narrowed: they are administered only in the event of atrial fibrillation in patients with a structurally intact heart or left ventricular hypertrophy. After a brief survey of the more important aspects of ventricular rate control, and of the drugs available, the research trends aimed at the progression of the pharmacological treatment of atrial fibrillation are outlined. The clinical introduction of procedures based on myocardial gene therapy is now a realistic therapeutic approach as concerns atrial fibrillation too.     

Atrial fibrillation after open-heart surgery--incidence, prevention and treatment

Atrial fibrillation is a common problem in the postoperative period following open-heart surgery. The pathogenesis of postoperative atrial fibrillation is likely to be multifactorial, however increased sympathetic activation may play a significant role. The aim of the study was to detect the incidence and possible reasons of atrial fibrillation in the first three postoperative days after open-heart surgery. Atrial fibrillation was detected in a total of 48 patients (mean age 64.8 +/- 8.8 years) of the 302 consecutive patients included in the study. The incidence of atrial fibrillation was 15.9%. In the history of patients with atrial fibrillation paroxysmal or persistent atrial fibrillation occurred in 18 cases. Acute ischaemia, hypopotassemia, high dose catecholamines contributed to the development of arrhythmias in 6, 4 and 4 cases, respectively. Lack of perioperative beta-blocker treatment was seen in 35 cases. Postoperative bleeding and reoperation occurred prior to the onset of atrial fibrillation in 9 instances. The applied antiarrhythmic therapy was metoprolol, amiodarone, propafenon and electrical cardioversion in 33, 21, 4 and 2 cases, respectively. Incidence of atrial fibrillation was found significantly lower in patients receiving beta-blocker premedication (13/181 [7.18%] versus 35/121 [28.9%]). There was no correlation between the incidence of atrial fibrillation and the length of the surgery, aortic-cross clamp time and the number of bypass grafts. Absence of preoperative beta-blocker treatment, previous atrial fibrillation and combined surgery were found to be strong predictors of atrial fibrillation. There was weaker association with increased age. On the basis of the outcome of our study beta-blocker premedication is suggested in most patients undergoing open-heart surgery.     

老年心房颤动患者抗凝治疗影响因素分析

目的调查老年心房颤动（房颤）患者抗凝治疗的主要影响因素，为老年房颤患者安全有效的抗凝治疗提供依据。方法筛查2002年1月-2007年10月在解放军总医院南楼住院且资料完整的房颤患者病历资料，共入选老年男性非瓣膜病性房颤患者99例，年龄65～98岁，根据病历记载的危险因素确定是否具备抗凝治疗指征，并结合并存疾病与当前治疗情况进行统计分析，以寻找影响抗凝治疗的主要因素。结果99例房颤患者中75例（75．8％）有抗凝治疗指征，该比值随增龄而增加，表明血栓栓塞的危险随增龄而增加，但实际接受抗凝治疗的患者仅12例（16．0％），且随增龄而降低。抗凝治疗强度基本达到指南要求，华法林平均剂量为2．25±0．57mg/d，末次监测INR值平均为2．11±0．43。本组中72例（72．7％）患者接受抗血小板治疗，主要用药为阿司匹林、氯吡格雷或二者联用。年龄≥75岁是血栓栓塞危险增加而抗凝治疗不足的分水岭。结论年龄是影响抗凝治疗的主要因素，而与房颤类型以及是否合并冠心病、高血压、糖尿病、卒中史等疾病无关。因此有必要制定更加具体的针对老年房颤患者的危险分层策略，摸索合适的治疗窗，以便于指导抗凝治疗，减少出血风险，从根本上预防血栓栓塞并发症。