老年患者围手术期治疗

目的总结分析老年患者围手术期治疗的经验。方法回顾性分析258例老年外科手术患者的临床资料,对其效果进行分析。结果死亡4例,其余老年患者均临床治愈出院。术后发生血压升高31例,心力衰竭9例（既往均有慢性心脏疾病）,心律失常13例,给予护心对症治疗后症状缓解;并发肺部感染19例,1例死亡,其余经抗感染、祛痰治疗后治愈;并发泌尿系感染4例,均为直肠癌术后留置尿管时间较长患者;发生离子紊乱21例,低血糖7例,高血糖27例,下肢静脉血栓5例,肺梗死1例,心肌梗死3例,脑梗死7例,除死亡患者其余患者经积极给予对症治疗后均治愈或好转。死亡病例为肺梗死和急性心肌梗死患者各1例,呼吸衰竭1例,肿瘤晚期术后并发多脏器功能衰竭1例。结论对老年患者认真进行手术风险评估,作好充足的术前准备,术中仔细、规范操作,术后系统对症治疗,预防并发症,体现整体医疗水平,这对于降低老年外科患者病死率、提高治愈率有着十分重要的意义。

Perioperative treatment for elderly patients

Objective To analysis and summarize the experience on perioperative treatment for elderly patients.Methods A retrospective analysis was made on the clinical data of 258 elderly patients who received surgery treatment, along with their treatment effects.Results There were 4 death cases, and the other patients were cured and left the hospital. There were 31 cases with postoperative hypertension, 9 cases with cardiac failure （all with past chronic heart disease）, 13 cases with arrhythmia, and their symptoms were all relieved after receiving symptomatic heart protection treatment. There were 19 cases with concurrent pulmonary infection; 1 case of them died, and others healed after receiving anti-infection and phlegm elimination treatment. There were 4 cases with concurrent urinary system infection, which all had a long time of ureter retention after rectal cancer surgery. There were 21 cases with ion disorder, 7 cases with hypoglycemia, 27 cases with hyperglycemia, 5 cases with thrombus of lower extremity veins, 1 case with pulmonary infarction, 3 cases with myocardial infarction, and 7 cases with cerebral infarction, and all patients were healed after symptomatic treatment except for death cases. The death cases included 1 case of pulmonary infarction, 1 case of acute myocardial infarction, 1 case of respiratory failure, and 1 case of advanced tumor postoperative complications of multiple organ failure.Conclusion The operation risk assessment should be accomplished seriously for elderly patients. Preoperative preparation, intraoperative standard operation, and postoperative symptomatic treatment and complication prevention are all important for reflecting medical level, reducing morality in elderly surgical patients, and improving cure rate.