老年患者颈椎手术麻醉处理特点.docVIP

老年患者颈椎手术麻醉处理特点【摘要】 目的 老年的定义随时间变迁而出现不同的标准,20世纪末被认为65~70岁可算为老年期;实践证明,生理年龄比实际年龄为重要,患者本身是否有严重并发症更重要。老年人颈椎病患者由于常合并其他系统疾病及主要器官功能减退,手术及麻醉的耐受能力差,围麻醉期常出现特殊问题,需引起临床足够重视。近5年来,我院收治300余例颈椎手术患者,其中一些年龄高70岁以上。为研究该类患者的麻醉处理特点,我们进行了随机分组对照研究。? 【关键词】 老年患者;颈椎;气管插管静吸复合全身麻醉;麻醉处理?? 【Abstract】 The definition of the old age at any time a change but appear the different standard, the end of 20 centuries is think that 65~70 years old can reckon the old-age period;Practice the certificate, the physiology age compares the actual age as importance, whether patient has the more important serious complications or not.Old people cervical vertebra the patient?s because of often merging other system diseases and the main organfunction decrease, surgical operation and anaesthetize of bear the ability of be subjected to differ, round the anaesthesia to expect to often appear the special problem, need to cause the clinical enough value.Be close to 5 in the last yearses, my hospital accepts to cure more than 300 cervical vertebras surgical operation sufferer, among them, some ages are 70 years old in height above.In order to study the anaesthesia of that type of suffererprocessing characteristics, we carried on random cent the set checks against the research.? 【Key words】 Old-age patient;Cervical vertebra;The windpipe puts the tube to calm down to absorb the compound general anaesthesia;Anaesthesia processing ? DOI:10.3760/cma.j.issn 1673-8799.2010.11.52? 作者单位:831100昌吉州人民医院麻醉科 1 资料与方法? 1.1 一般资料 70岁以上组(A组)80例,其中男56例,女24例,体重55~68 kg,70岁以下组(B组)80例,其中男51例,女29例,体重52~74 kg,术前A组有67例,B组有71例出现不同程度肢体麻木、肌力和感觉减退。? 各组均有部分患者伴发其他系统疾病,包括慢性阻塞性肺疾患(A组15例、B组6例),高血压病(A组17例,B组9例,两组比较P 3.2 临床资料显示,颈椎患者术中血压波动主要出现在麻醉诱导时、术中去椎体减压和摘除肿瘤时切口持续渗血致血容量不足时,在A组尤为明显。前一种情况如上所述。对于后一种情况,主要是根据手术方式,充分估计失血量。对于颈后路减压或较大颈椎肿瘤摘除应常规行深静脉穿刺。对年龄较大患者,要严格计算出血量,失血时以输血和补充胶体为主,要减少晶体液入量,以免加重心肺负荷。? 3.3 心律失常的发生率随年龄增长而增加,以室上性和室性期前收缩为多见,老年人的心血管功能除变衰老进程的影响外,还常受到各种疾病的伤害,在老年人中50%~65%有心血管疾病。因此,在评估老年人心血管功能状态是应特别重视其储备功能[2]。两组均有部分患