老年急症胆道手术的麻醉处理

ANESTHESIA MANAGEMENT OF EMERGENCY BILIARY SYSTEM SURGERY IN THE AGED

目的探讨老年急症胆道手术的麻醉方法选择与术中的麻醉处理。方法选择老年急症胆道手术麻醉患者30例,分别合并有冠心病、高血压、心律失常、慢性心功能不全、慢性肺部疾病、糖尿病,以及伴有高热、轻度中毒性休克等。麻醉选择:连续硬膜外麻醉10例,全身麻醉20例。结果连续硬膜外麻醉:镇痛效果满意,但呼吸道管理麻烦,术中血液动力学变化大,术中难以完全抑制内脏牵拉痛所致迷走反射而出现胆心反应,影响呼吸与循环稳定。全身麻醉:术中呼吸道管理容易、氧合好,对心律失常、急性心功能不全等处理上相对方便有效。结论高龄胆道患者,呼吸、循环、内分泌等系统合并症多,常伴有高热、水电解质紊乱、酸碱失衡及中毒性休克,易导致多种严重并发症,术前须进行必要的检查与处理,术中应密切监测呼吸、循环功能。

Objective To discuss the anesthesia management of emergency biliary system surgery in the aged. Methods 30 patients were included, who had various kinds of complications,such as CAD, hypertension, cardiac arrhythmia, chronic heart failure, chronic lung disease, diabetes mellitus, fever, or mild infectious shock. 20 of them received epidural anesthesia, and others received general anesthesia. Results Continuous epidural anesthesia offered a satisfactory analgesia, but might induce a difficult respiratory management and unsteady circulation. Meanwhile,cholecysto-cardiac reflexion was ineluctable during such an anesthesia. General anesthesia could obtain a good respiratory control and an effective treatment of arrhythmia and acute heart failure. Conclusions Aged patient, who often suffered from certain kinds of complications, may lead to some serious prognoses. Active preanesthetic medication and careful intraoperative monitoring are necessary.