高龄高危患者人工股骨头置换术围手术期并发症预防对策

目的：探讨高龄高危患者人工股骨头置换术围手术期并发症预防和处理对策。方法：2003年3月～2007年3月,80岁～99岁髋关节置换术共92例,平均年龄86.1岁,伴有重度骨质疏松（DorrⅢ期）34例;冠心病53例,症状性心率失常12例,糖尿病12例,脑中风史17例。采用骨水泥柄股骨头置换术24例,非骨水泥柄股骨头置换术68例。结果：术中无1例死亡,1例92岁女性患者术后第4天死亡,1例全麻术后昏迷1周苏醒,2例糖尿病患者术后出现酮症酸中毒,7例出现术后5天内认知障碍。其余术后功能康复良好,84例（91.3%）生活基本自理,患髋疼痛缓解。结论：此类病人围手术期必须经过多学科的紧密配合,以最大限度地减少或避免并发症的发生,提高手术成功率。

Perioperative Countermeasures for Complications in Aged and High-risk Patients with Artificial Femoral Head Arthroplasty

Objective： To analyze the perioperative management and preventive countermeasures for complications in aged and high-risk patients with artificial femoral head arthroplasty.Methods： From Mar.2003 to Mar.2007,a total of 92 patients who aged between 80 and 99 years,with 86.1 years on average,were treated by hip replacement.Among them,there were 34 cases with severe osteoporosis（Dorr Ⅲ）,53 with coronary disease,12 with symptom arrythmia,12 with diabetes,and 17 with cerebral apoplexy.Cemented and cementless artificial femoral head arthroplasty were applied respectively to 24 patients and 68 patients.Results： All patients survived the operation.One female patient of 92 years old died on the 4th day after the operation,one patient regained consciousness after general anesthesia on the 7th day,2 patients went through diabetic ketoacidosis,and 7 patients suffered from cognitive handicap within 5 days after the operation.The others recovered well,with 84 patients（91.3%） able to take care of themselves and their pain relieved.Conclusion： For such patients during perioperative period,it is critical to carry out close and multi-disciplinary cooperation in order to reduce or avoid complications and raise the surgery success ratio.