189例老年肝脏手术的围手术期处理经验

Perioperative management measures of hepatic surgery in elders

目的：探讨老年肝脏手术的围手术期处理经验。方法对2005年1月至2015年1月189例60岁以上的老年肝脏手术的围手术期病人与同期胃肠外科60岁左右胃癌根治术161例病人进行对比做回顾性分析。结果老年肝脏手术病人术后出血、肝功能障碍、黄疸、肺部感染、切口感染、肝脓肿的并发症要高于老年胃癌根治病人。结论老年人肝脏手术围手术期术后渗血明显增多，凝血机制障碍更明显，术后应输血浆和白蛋白，密切观察凝血功能变化，以及少尿，肾功能不全的发生，纠正电解质紊乱，维持酸碱平衡，合理使用抗生素，选择合理的营养支持是手术成功的关键。

Objective To explore the perioperative management measures of hepatic surgery in elders.Methods A total of 189 hepatic surgical patients aged over 60 years from January 2005 to January 201 5 and 161 gastric cancer surgical patients aged around 60 years from January 2005 to January 201 5 were compared and retrospectively analyzed.Results There were postoperative hemorrhage （n=43）,hepatic dysfunction with elevated levels of alanine aminotransferase （ALT）＆ aspartate amin-otransferase （AST）（n=101）,jaundice （n=30）,pulmonary infection （n=19）,wound infection （n=10）and liver abscess （n =5 ）.Conclusions During hepatic surgery,perioperative and postoperative hemorrhage and coagulation disorders are evident.Transfusion of plasma and albumin and close moni-toring of blood coagulation are necessary.For oliguria and renal dysfunction,electrolyte disturbance should be corrected and acid-base balance maintained.Rational use of antibiotics and proper nutritional supports are vital for successful surgery.