337例骨科老年患者围手术期处理的回顾性分析
摘要
目的：
通过对2007年11月到2011年11月骨科老年患者住院期间围手术期治疗的回顾研究,病例分析总结,强调围手术期程序化处理的重要性。
方法：
调阅回顾4年来骨科老年患者的典型案例,复习相关文献,对治疗过程进行分析研究。复习337例典型病例,发现围手术期术前常见合并疾病有慢性支气管炎、慢性肺源性心脏病、阻塞性肺气肿、心律失常、原发性高血压、冠状动脉粥样硬化性心脏病、动脉粥样硬化、糖尿病、低蛋白血症、贫血、脑卒中后遗症、肺部感染、泌尿系感染、前列腺增生症、消化道溃疡、糜烂性药物性胃炎、银屑病、肝硬化、胆结石、甲状腺功能亢进、恶性肿瘤、抑郁症、焦虑症等；术后常见并发症有水电解质紊乱、腹胀、便秘、尿潴留、泌尿系感染、肺部感染、消化道应激性溃疡出血、澹妄、下肢深静脉血栓形成、褥疮、脑梗塞等。
结果：
经过完善术前检查,进行术前评估,术前伴发慢性疾病者219例,合并两种以上慢性病者89例,经过调养,控制病情,39例由于风险高,放弃了手术治疗,余均顺利的进行了手术。术后并发低钾血症87例,低钠血症77例,应激性溃疡消化道出血39例,术后恶心呕吐27例,尿潴留69例,谵妄29例,脑梗塞11例,其中大面积脑梗塞3例,下肢深静脉血栓形成19例,心肌梗塞5例,肺部感染36例。其中16例自动出院,其中10例好转,6例放弃治疗出院,余经积极处理或转科治疗,安全度过了围手术期。
结论：
充分的术前准备,积极的术后治疗,可明显提高手术的安全性和成功率,减少医疗纠纷。围手术期的管理在外科治疗中占有重要的地位。骨科医师必须加强相关知识的学习。同时也希望围手术期医学专科的成立或围手术期医疗保障小组的建立、普及,提高围手术期处理水平,保障医疗安全。
Objective:
To emphasize on the importance of treatment of the perioperative, We study the cases of operative treatment for geriatric patients of orthopedic during hospitalization in November2007to November2011.
Methods:
We study the cases of operative treatment for geriatric patients of orthopedic during hospitalization nearly four years. By way of a retrospective study of337cases of typical cases, We found the common complication before the operation of chronic bronchitis, chronic pulmonary heart disease, obstructive emphysema, cardiac arrhythmia, hypertension, coronary artery disease, atherosclerosis, diabetes, hypoalbuminemia, anemia, stroke sequelae, pulmonary infection, urinary tract infection, benign prostatic hyperplasia, peptic ulcer, erosive drug-induced gastritis, psoriasis, cirrhosis, gallstones, hyperthyroidism, malignancy, depression, anxiety disorder, and so on, and the common complication following the operation of water and electrolyte disorders, abdominal distention, constipation, uroschesis, urinary tract infection, pulmonary infection, stress ulcer and gastrointestinal bleeding, delirium, deep venous thrombosis, pressure ulcers, cerebral infarction, and so on.
Results:
By way of examination and assessment, we found219cases have the chronic diseases before the operation, and89cases merge of two or more chronic diseases. After controlling disease,39cases given up surgery because of high risk, and the others successfully took the surgery. Postoperative,87cases of hypokalemia,77cases of hyponatremia,39cases of stress ulcer and gastrointestinal bleeding,27cases of nausea and vomiting,69cases of uroschesis,29cases of delirium,11cases of cerebral infarction,3cases of a large area of the cerebral infarction,19cases of deep venous thrombosis,5cases of myocardial infarction,36cases of pulmonary infection.16cases of them left voluntarily the hospital, and the others lasted out the perioperative safety after actively treatment.
Conclusion:
Through adequate pre-operative preparation and positive post-operative treatment, We can improve significantly the safety and success rate of surgery, and reduce medical disputes. Perioperative management occupies an important position in the surgical treatment. Orthopaedic doctor must strengthen the relevant knowledge of learning. At the same time also hope perioperative medical college was established in the perioperative or medical security team building, popularization, improve the perioperative management level, ensure medical safety.
通过对2007年11月到2011年11月骨科老年患者住院期间围手术期治疗的回顾研究,病例分析总结,强调围手术期程序化处理的重要性。
方法：
调阅回顾4年来骨科老年患者的典型案例,复习相关文献,对治疗过程进行分析研究。复习337例典型病例,发现围手术期术前常见合并疾病有慢性支气管炎、慢性肺源性心脏病、阻塞性肺气肿、心律失常、原发性高血压、冠状动脉粥样硬化性心脏病、动脉粥样硬化、糖尿病、低蛋白血症、贫血、脑卒中后遗症、肺部感染、泌尿系感染、前列腺增生症、消化道溃疡、糜烂性药物性胃炎、银屑病、肝硬化、胆结石、甲状腺功能亢进、恶性肿瘤、抑郁症、焦虑症等；术后常见并发症有水电解质紊乱、腹胀、便秘、尿潴留、泌尿系感染、肺部感染、消化道应激性溃疡出血、澹妄、下肢深静脉血栓形成、褥疮、脑梗塞等。
结果：
经过完善术前检查,进行术前评估,术前伴发慢性疾病者219例,合并两种以上慢性病者89例,经过调养,控制病情,39例由于风险高,放弃了手术治疗,余均顺利的进行了手术。术后并发低钾血症87例,低钠血症77例,应激性溃疡消化道出血39例,术后恶心呕吐27例,尿潴留69例,谵妄29例,脑梗塞11例,其中大面积脑梗塞3例,下肢深静脉血栓形成19例,心肌梗塞5例,肺部感染36例。其中16例自动出院,其中10例好转,6例放弃治疗出院,余经积极处理或转科治疗,安全度过了围手术期。
结论：
充分的术前准备,积极的术后治疗,可明显提高手术的安全性和成功率,减少医疗纠纷。围手术期的管理在外科治疗中占有重要的地位。骨科医师必须加强相关知识的学习。同时也希望围手术期医学专科的成立或围手术期医疗保障小组的建立、普及,提高围手术期处理水平,保障医疗安全。
Objective:
To emphasize on the importance of treatment of the perioperative, We study the cases of operative treatment for geriatric patients of orthopedic during hospitalization in November2007to November2011.
Methods:
We study the cases of operative treatment for geriatric patients of orthopedic during hospitalization nearly four years. By way of a retrospective study of337cases of typical cases, We found the common complication before the operation of chronic bronchitis, chronic pulmonary heart disease, obstructive emphysema, cardiac arrhythmia, hypertension, coronary artery disease, atherosclerosis, diabetes, hypoalbuminemia, anemia, stroke sequelae, pulmonary infection, urinary tract infection, benign prostatic hyperplasia, peptic ulcer, erosive drug-induced gastritis, psoriasis, cirrhosis, gallstones, hyperthyroidism, malignancy, depression, anxiety disorder, and so on, and the common complication following the operation of water and electrolyte disorders, abdominal distention, constipation, uroschesis, urinary tract infection, pulmonary infection, stress ulcer and gastrointestinal bleeding, delirium, deep venous thrombosis, pressure ulcers, cerebral infarction, and so on.
Results:
By way of examination and assessment, we found219cases have the chronic diseases before the operation, and89cases merge of two or more chronic diseases. After controlling disease,39cases given up surgery because of high risk, and the others successfully took the surgery. Postoperative,87cases of hypokalemia,77cases of hyponatremia,39cases of stress ulcer and gastrointestinal bleeding,27cases of nausea and vomiting,69cases of uroschesis,29cases of delirium,11cases of cerebral infarction,3cases of a large area of the cerebral infarction,19cases of deep venous thrombosis,5cases of myocardial infarction,36cases of pulmonary infection.16cases of them left voluntarily the hospital, and the others lasted out the perioperative safety after actively treatment.
Conclusion:
Through adequate pre-operative preparation and positive post-operative treatment, We can improve significantly the safety and success rate of surgery, and reduce medical disputes. Perioperative management occupies an important position in the surgical treatment. Orthopaedic doctor must strengthen the relevant knowledge of learning. At the same time also hope perioperative medical college was established in the perioperative or medical security team building, popularization, improve the perioperative management level, ensure medical safety.
引文
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