老年心血管病人非心脏手术的麻醉处理

目的　探讨 60岁以上老年心脏病患者行非心脏手术麻醉处理的特殊性。方法　 43例此类手术麻醉病人 ,作充分的术前准备 ,选择合适的麻醉方法、药物、监测 ,术中预防心肌氧供失衡 ,适当运用血管活性药物 ,维持稳定的生命体征 ,防止术后疼痛应激、低氧血症。结果　术中 72 .1%的患者出现血压升高或降低 ,3 9.5 %出现心律失常 ,11.6%为严重心律失常 ,其中一例行电复律 ,6.9%术后仍需呼吸支持 ,围术期无死亡。结论　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是降低老年心脏病患者非心脏手术麻醉风险的重要措施。

Anesthetic Management for Non- cardiac Surgery in the Geriatric Patients With Heart Diseases

Objective To investigate the anesthetic management for non-cardiac surgery in the geriatric patients above 60 years old with heart diseases. Methods A retrospective study was carried out for 43 patients with histories of cardiovascular/heart disease and the patients underwent non-cardiac surgery. Before operation, adequate preoperative preparation, correct method, drug and monitoring of anesthesia were selected. During operation, myocardial unbalances of oxygen supply and consumption should be prevented, so as to keep the vital signs stabilized. After operation, painful stress and hypoxemia were prevented. Results 72.1% of the patients appeared hypertension or hypotension, 39.5% of them appeared arrhythmia, 11.6% of them were serious arrhythmia. One patient received electrical cardioversion. 6.9% of patients still required post-operative breath support. No patient died during the perioperative period. Conclusions In order to reduce anesthetic risk of non-cardiac surgery on the geriatric patients with heart disease, the important measures were sufficient preoperative preparation, selecting the correct anesthetic method and keeping the balance of myocardial oxygen supply and consumption.