合并肺心病老年患者行腹腔镜下乙状结肠癌根治+回肠造口术的围手术期管理1例

Perioperative management in an elderly patient undergoing radical colorectal surgery with pulmonary heart disease:A case report

老年患者合并多种基础疾病接受择期腹腔镜手术的数量不断增加。腹腔镜手术具有微创优势的同时,CO2气腹及患者体位亦明显影响呼吸和循环功能,要求麻醉医师合理调控并需要麻醉医师和外科医师良好的沟通协作。该例患者有明确的肺源性心脏病(肺心病)病史、术前筛选出冠状动脉粥样硬化性心脏病(冠心病)、血栓栓塞的高危因素,准确的手术时机和手术禁忌的判断、准确的风险干预、多学科协作保证了患者的围手术期安全。术前该患者不全性肠梗阻经保守治疗缓解,预后良好,为该病例的讨论提供了良好背景。

The tendency that elderly patients with multiple underlying diseases undergo elective laparoscopic surgeries is increasing.While laparoscopic surgery has the advantage of minimal invasiveness,CO2 pneumoperitoneum and the Trendelenburg positioning significantly affect respiratory function and hemodynamics,which require proper regulation and collaboration between anesthesiologist and surgeon.This patient underwent radical colorectal surgery with a definite history of pulmonary heart disease.His high‑risk factors of coronary heart disease and thromboembolism complications were screened out as well before surgery.Perioperative management ensured the patient's safety,which included accurate evaluation of operation timing and surgical contraindications,as well as reasonable multidisciplinary therapeutic interventions.The patient's ideal prognosis is also derived partly from the relieved ileus by effective conservative treatment before surgery.