老年普胸病人手术治疗及围手术期处理.DOCVIP

临床医学论文-老年普胸病人手术治疗及围手术期处理 ??????????????????? 作者：王秀兰 俞耀辉 陈世发 马陆军? 【摘要】? 目的:总结70岁以上老年普胸病人的手术指征,手术治疗及围手术期处理体会。方法：1996.6～2005.6月我院共施行普胸手术578例，其中70岁以上的老年患者118例，占20.4%（118/578）。现对118例70岁以上老年患者手术治疗及围术期处理进行回顾性分析。结果：术中术后出现或加重的循环系统并发症34例占28.8%（34/118）；呼吸系统并发症29例占24.6%（29/118）；消化系统并发症19例占16.1%（19/118）；精神神经系统并发症10例占8.5%（10/118）；经综合治疗均治愈出院。术后1、3、5年生存率分别为90.0%、77.6%、42.8%。结论：对70岁以上老年普胸病人围术期处理十分关键，因老年人全身各系统器官的衰退及疾病本身的并发症相互叠加，风险较大；但只要手术指征选择合适，手术中间处理严密，围术期处理恰当，70岁以上老年患者施行普胸手术效果理想。 【关键词】? 普胸病人；手术治疗；围术期处理 ??? 【ABSTRACT】? Objective:To study surgical data,surgical approaches and perioperative management on geriatric patients over 70 years with thoraces.Methods:From June 1996 to June 2005,578 cases with thorace were performed general thoracic operations in our hospital.Among them the geriatric sufferers over 70 years were 118 cases,occupying 20.4%(118/578).At present,we will amlce a retrospective analysis concerning surgical therapeutics and perioperative management in the 118 geriatric patients.Results:34 sufferers,constituting 28.8%(24/118),had the complications of circulatory system in and after the surgical operation;29 sufferers,taking up 24.6%(29/118),had the complications of respiratory system;19 sufferers,constituting 16.1%(19/118),had the complications of digestive system and 10 sufferers,constituting 8.5%(10/118),had the complications of nervous system.The cases mentioned above were all cured when they were discharged from the hospital.The 1year,3year and 5year survival rate is 90.0%,77.6% and 42.8%,respectively.Conclusion:The perioperative management on geriatric patients over 70 years with thoraces is quite significant,because the organic deterioration in each system and the complications of the disease can mutually facilitate the aggravation of the pathogenetic condition.Therefore the surgical risk is much more high.But,if only the surgical approaches are selected suitably,the processes of surgical operations are managed exactly and the perioperative courses are handled