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目的探讨合并心血管病高龄结直肠癌病人的围手术期处理。方法根据ACC/AHA制定的非心脏手术围手术期心血管评估指南标准,将2004年1月至2006年12月间在上海交通大学医学院附属新华医院手术的306例70岁以上合并心血管病结直肠癌病人分为高危、中危和低危3级后进行围手术期干预并做回顾性分析。结果高危20例,中危70例,低危216例。术后重度血压升高22例,充血性心力衰竭10例,心绞痛3例,心肌梗死1例,各类心律失常102例。切口裂开3例,肺部感染34例,糖尿病酮症酸中毒1例,肾功能不全4例,吻合口漏6例,应激性溃疡8例。围手术期死亡4例,其中评估为高危者2例,中危者2例。结论术前合并心血管疾病增加了手术的风险,但完善术前评估、加强围手术期的处理可提高手术的安全性,降低手术死亡率和并发症发生率。

Preoperative management of 306 advanced age patients combined cardiovascular disease with colorectal cancer

Objective To explore the preoperative management of 306 advanced age patients combined cardiovascular disease with colorectal cancer.Methods The clinical data of 306 cases over 70 years old of colorectal cancer combined cardiovascular disease admitted between January 2004 to December 2006 were evaluated and classified with ACC/AHA 2001 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery to 3 risk levels and the preoperative management was analyzed retrospectively.Results 20 cases in high level,70 cases in intermediate level and 216 cases in low level.Postoperative complications included:stage 3 hypertension(22cases),congestive heart failure(10 cases),angina pectoris(3 cases),acute myocardial infarction(1 case),cardiac arrhythmia(102 cases),wound dehiscence(3 cases),pneumonia(34 cases),anastomotic leakage(6 cases),stress ulcer(8 cases),4 cases died in post-operative period.Conclusion The cardiovascular disease increase the risk of surgical procedures of advanced age patients with colorectal cancer,but complete assessment of the patient's general health and intensive perioperative management of the cardiovascular diseases can increase the success rate of operation and decrease the operative mortality and incidence of complication.