88岁以上老年人的手术麻醉方法与管理

目的总结88岁以上高龄患者的麻醉方法和管理体会。方法回顾性分析61例88岁以上患者的麻醉处理,采用全麻12例,硬膜外麻醉37例,静脉麻醉5例,臂丛麻醉3例,局麻4例。结果本组手术时间平均66(15～150)min,术中出血平均180(0～500)ml。1例硬膜外麻醉阻滞不全改为全身麻醉,各项生命体征平稳。硬膜外麻醉局麻药初量平均为7.3(4～11)ml,阻滞平面2例为T8,其余均控制在T10以下。所有全麻患者术毕清醒后均拔出气管导管。61例均安全度过手术期并顺利出院。结论术前准确评估和充分准备,选择恰当的麻醉方法,加强围术期监测,及时进行术中、术后并发症防治及麻醉管理,是高龄患者安全度过围术期的重要措施,可减少麻醉风险。

Anesthesia Management of the Operative Patients Aged 88 Years or Above

Objective To summarize the experience of anesthesia management in the elderly patients aged 88 years or above.Method The clinic data of anesthesia management in 61 patients aged 88 years or above were reviewed,including 12 of general anesthesia,37 of epidural anesthesia,5 of intravenous anesthesia,3 of brachial plexus block and 4 of local anesthesia.Results The operative duration was 15 to 150 minutes（averaged 66 minutes）,and the intraoperative blood loss was 0 to 500 ml（averaged 180 ml）.One case of epidural anesthesia converted to general anesthesia because of incomplete blockage.In the epidural anesthesia,the initial dose of local anesthetic was 4 to 11 ml（averaged 7.3 ml）,and the block level reached T8 in 2 cases and T10 below in 31 cases.All general anesthesia patients were extracted the endotracheal catheter successfully.All patients got through the perioperative period safely and discharged from hospital successfully.Conclusion The measures such as accurate evaluation and sufficient preparation befor the operation,appropriate selection of anesthesia method,rigorous perioperative monitoring,timely prevention of perioperative complications,and proper anesthesia management are keys to reduce the anesthesia risk in the aged patients.