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目的探讨老年急腹症手术的麻醉方法及其安全性。方法对112例65岁以上老年患者,根据不同的ASA评级采用不同的麻醉方法,其中ASA为Ⅰ～Ⅱ级的患者选择硬膜外麻醉42例(A组);ASA为Ⅱ～Ⅲ级的患者选择气管内全麻复合硬膜外麻醉44例(B组);ASA为Ⅲ～Ⅳ级的患者选择气管内全麻26例(C组)。结果三组患者无一例因麻醉死亡者,但术中均有不同程度的循环功能紊乱,其中A组及C组血压波动较大,而B组血压无明显波动,并且意识恢复快,未发生严重麻醉并发症,麻醉有效率100%。A组因麻醉效果欠佳,术中改行气管内全麻的有8例(19%)。三组患者无一例术中死亡,但术后48h死亡1例,72h死亡1例。结论急腹症的老年患者,常伴有重要器官的合并症,病情复杂多变,需做好术前评估和术前准备,选择对老年患者呼吸及循环功能影响小的麻醉方法,其中气管内全麻复合硬膜外麻醉具有镇痛充分、肌松完全、应激反应小、患者苏醒快、拔管早等优点,是老年急腹症手术安全、有效的麻醉方法之一。
Objective To investigate the anesthesia and safety of elderly acute abdomen surgery. Methods A total of 112 elderly patients over the age of 65 were enrolled in this study. According to different ASA ratings, different anesthesia methods were used. Among them, 42 patients with ASA grade Ⅰ ~ Ⅱ received epidural anesthesia (group A), and patients with ASA grade Ⅱ ~ Ⅲ Forty-four patients underwent general anesthesia with tracheal anesthesia (group B) and 26 patients with ASA (grade Ⅲ-Ⅳ) underwent general anesthesia (group C). Results None of the three patients died of anesthesia, but there were varying degrees of circulatory dysfunction during the operation. Among them, the blood pressure in Group A and C fluctuated greatly, while the blood pressure in Group B did not fluctuate significantly, and the consciousness recovered quickly without serious occurrence Anesthesia complications, anesthesia effective rate of 100%. A group due to poor anesthesia, intraoperative tracheal intubation general anesthesia in 8 cases (19%). No case of three patients died of surgery, but after 48h died in 1 case, 72h died in 1 case. Conclusion The elderly patients with acute abdomen are often accompanied by the complication of vital organs. The condition is complex and changeable. Preoperative evaluation and preoperative preparation are required. Anesthetic methods that have little effect on respiration and circulatory function in elderly patients are selected. Among them, General anesthesia combined with epidural anesthesia with full analgesic, complete muscle relaxation, small stress response, rapid recovery of patients, early extubation, etc., is an elderly acute abdomen surgery is safe and effective anesthesia method.