合并冠心病老年患者行机器人辅助腹腔镜直肠癌根治术围手术期管理1例

Perioperative management in elderly patients with coronary heart disease undergoing robot-assisted laparoscopic surgery ofrectal cancer

随着无痛胃肠镜检查和外科手术技术的发展,越来越多合并冠心病的老年患者接受了胃肠道手术。患者的术前准备和评估、手术方式和术中麻醉管理对患者围手术期安全及快速康复有着至关重要的意义。此例患者术前合并严重的冠心病(三支病变)、不全肠梗阻、陈旧性脑梗死、轻度贫血和低钾血症,围手术期遵循肠道患者加速康复策略,术者选择了目前微创的机器人辅助腹腔镜手术,麻醉以优化心肌氧供需平衡为目标,患者预后良好,顺利出院。

With the development of painless gastrointestinal endoscopy and surgical techniques,more and more elderly pa⁃tients with coronary heart disease can undergo gastrointestinal surgery.Preoperative preparation and evaluation,surgical methods,and intraoperative anesthesia management are important to perioperative safety and rapid recovery.This patient had severe coronary heart disease(three⁃vessel disease),incomplete intestinal obstruction,old cerebral infarction,mild anemia,and hypokalemia before opera⁃tion.This patient followed the enhanced recovery after surgery strategy in the perioperative period,the surgeon chose the minimal inva⁃sive robot⁃assisted laparoscopic surgery,anesthesia was conducted to optimize the balance of myocardial oxygen supply and demand.The patient completed the surgery and successfully discharged.