并发心血管病的80岁以上患者行非心脏手术围术期处理

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 （6 1% ） ,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 2 2例 ,营养心肌治疗 6 2例 ,抗高血压治疗 4 1例 ,抗心律失常治疗 2 7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

Perioperative management for noncardiac surgery in elderly patients with cardiovascular disease

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. Intraoperative myocardial unbalances of oxygen supply and consumption and cardiovascular complications were 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 intraoperative 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.