老年人非心脏手术后急性左心衰竭

目的旨在探讨老年人非心脏手术的内科保障水平，减少术后心血管危重并发症的发生。方法复习老年人大中型非心脏手术１０８８例临床资料，分析其中９例术后急性左心衰竭的可能诱发因素，探讨发病机理及防治方法。结果９例的平均年龄为７３．８岁，术前诊断冠心病７例，可疑冠心病１例；２例曾有心功不全。因术中输血、输液过快诱发３例，术后持续心动过速、血压增高，因疼痛、精神紧张诱发３例，高热、嗜铬细胞瘤发作及快速心房颤动诱发各１例。心力衰竭发生时，６例出现心肌缺血的心电图表现。结论老年心脏病患者非心脏手术时，术中应控制输液量及输液速度；术后积极控制血压，充分止痛，及时发现心力衰竭早期征象，早期处理，防止血液动力学进一步恶化。

Elderly patients with acute left heart failure after non cardiac surgical operation: nine case report

Objective To reduce postoperative acute heart failure after non cardiac surgic al operation. Methods The clinical records of 1 088 cases of non cardiac surgical operation elderly were reviewed and 9 cases of acute heart failure were identified for analyzing the causes and mechanisms in order to find proper management. Results The average age of these 9 patient swas 73 8 years(66 84).Seven of them were associated with coronary heart disease (CHD),and one suspected of CHD.The heart failure was caused by rapid overinfusion in 3 cases,pain and nervous tension in 3 cases,the other 3 had high fever,attack of pheochromocytoma and rapid atrial fibrillation,respectively.Electrocardiographic ischemia appeared in 6 patients during heart failure. Conclusions It is important for elderly patients undergone non cardiac surgical operation:(1)to avoid overinfusion during operation.(2)to relieve pain and nervousness.(3)to control high blood pressure and(4) to detectearly signs of heart failure and give early effective management.