高危胆囊结石患者的围手术期处理

Perioperative management for the high-risk patients with cholecystolithiasis

目的 :探讨提高对高危胆囊结石患者治疗水平的经验。方法 :回顾分析 82例高危胆囊结石患者的临床资料。结果 :高危胆囊结石患者并存心血管疾病 5 0例 (占 6 1% ) ,内分泌代谢性疾病 32例 (占 39% ) ,呼吸系统疾病 11例 (占 13% ) ,5例并存脑血管意外后遗症 (偏瘫、失语等 )。 80岁以上患者为 9例。 2 3例患者还同时并存多个系统多种疾病。按美国麻醉医师学会 (AmericanSocietyofAnesthesiologists,ASA)分级 ,其中ASAⅢ级、Ⅳ级患者并存疾病涉及 2个系统以上的病例数和并存 2种以上疾病的病例数均明显高于ASAⅡ级患者 ;ASAⅡ级患者住院时间明显短于ASAⅢ级和Ⅳ级患者 (P <0 .0 1) ,无术后并发症 ;ASAⅢ级和Ⅳ级患者中并发症发生率为 16 .7% ;全组无死亡 ,均痊愈出院。结论 :对合并多个系统多种疾病 ,储备功能差的胆囊结石患者 ,经过严格的术前准备 ,以及加强围手术期监护与治疗 ,可降低其术后并发症发生率和病死率 。

Objective:To explore the experience to raise the level of treatment of the high-risk patients with cholecystolithiasis.Methods:The clinical data of the high-risk patients with cholecystolithiasis were analyzed retrospectively in 82 cases.Results:In 82 cases of the high-risk patients with cholecystolithiasis,50 cases(61%) coexisted with cardiovascular diseases,32 cases(39%) with endocrinal and metabolic diseases,11 cases(13%) with the respiratory system diseases and 5 cases with the sequelae of the previous cerebrovascular accidents(hemiplegia and aphasia). Elderly patients(≥80 years) were 9 cases. Twenty-three patients coexisted concurrently with kinds of diseases in multiple systems. General anesthetic risk for patients with concurrent disease was determined by the classification of American Society of Anesthesiologists(ASA). The numbers of patients with multiple systems dysfunction and the average numbers with multiple system diseases in ASA class Ⅲ and Ⅳ were significantly higher than that in ASA class Ⅰ and Ⅱ. The hospitalization time in ASA class Ⅱ was obviously shorter than that in ASA class Ⅲ and Ⅳ(P<0.01). No postoperative complication occurred. The rates of postoperative incidence of complication and mortality were 16.7% and 0%,respectively in ASA class Ⅲ and Ⅳ. No patient died in all groups,and all patients were recovered and discharged.Conclusion:The patients of chronic calculous cholecystitis with kinds of diseases in multiple systems and bad reserving function can decrease the postoperative complication and mortality,improve its prognosis as long as strictly preoperative preparation and the monitoring and treatment during operation.