135例80岁以上急腹症患者围手术期处理回顾性分析

发布时间：2018-07-23 18:25

【摘要】：目的:80岁以上急腹症患者病情危重,围手术期病死率较高,本研究主要探讨提高80岁以上急腹症患者围手术期生存率的处理措施。方法:回顾性分析我院急诊外科2012年07月至2014年03月收治的135例接受急诊手术治疗的80岁以上急腹症患者的临床资料,分析并总结提高80岁以上急腹症患者围手术期生存率的处理方法,统计资料随访为期6个月。结果:135例80岁以上急腹症患者(年龄:80岁-101岁,平均85.3±2岁,其中男性73例,女性62例):发病至就诊时间于发病12小时以内者25例,12小时至24小时者58例,24小时至48小时者45例,大于48小时以上者7例。合并症:高血压45例次,冠心病38例次,心律失常16例次,脑梗塞8例次,糖尿病39例次,慢性支气管炎10例次,院外肺部感染21例次,尿毒症3例次,凝血功能障碍3例次,血友病1例次。135例高龄急腹症患者全部施行急诊开腹手术。治愈出院99例,随访期间2例死于交通意外及脑血管意外,失访4例;好转24例,经随访现生存22例,死亡2例;自动出院(或转院)5例,经随访现生存2例,死亡2例,失访1例;院内死亡7例,2例死于严重脓毒症导致的多器官功能障碍综合征(MODS),2例死于心肌梗死,2例死于急性肺栓塞,1例死于脑干出血,院内病死率为5.19%;共随访123例,随访率96.09%。6个月随访期内患者生存率为91.41%。术后并发症46例次:手术切口感染20例次,院内肺部感染10例次,术后认知障碍9例次,应激性溃疡出血5例次,下肢深静脉血栓2例次。结论:80岁以上急腹症患者病情复杂,手术风险高,应以抢救生命为最终目的,不应追求过多的术前检查。积极地术前准备,尽可能缩短术前准备时间;积极防治感染和休克、对失血性休克早期宜行限制性液体复苏;根据病情选择个体化的手术方案,必要时行损伤控制性手术;高龄患者并存病多、宜多学科协作合理处理;防治并发症的重点是呼吸道感染,加强营养支持、积极防治MODS,有利于提高高龄急腹症患者围手术期生存率。
[Abstract]:Objective to improve the perioperative survival rate of patients with acute abdomen over 80 years of age and to improve the perioperative survival rate. Methods: the clinical data of 135 emergency abdomen patients over 80 years old who received emergency surgical treatment from July 2012 to March 2014 were analyzed retrospectively. Methods of improving perioperative survival rate in patients with acute abdomen over 80 years old were analyzed and summarized. The statistical data were followed up for 6 months. Results of 135 patients with acute abdomen over 80 years old (age: 80 to 101, mean 85.3 卤2 years, male 73, female 62): 25 patients with acute abdomen over 80 years old were diagnosed within 12 hours, 58 patients with 24 hours to 48 hours, 45 patients with 24 hours or 48 hours. More than 48 hours in 7 cases. Complications: hypertension 45, coronary heart disease 38, arrhythmia 16, cerebral infarction 8, diabetes 39, chronic bronchitis 10, nosocomial pulmonary infection 21, uremia 3, coagulation dysfunction 3. One patient with hemophilia, 135 elderly patients with acute abdomen underwent emergency laparotomy. 99 cases were cured and discharged, 2 cases died of traffic accidents and cerebrovascular accidents during follow-up, 4 cases were lost, 24 cases improved, 22 cases survived and 2 cases died, 5 cases were discharged (or transferred to hospital), 2 cases survived and 2 cases died. One case was lost, two cases died of multiple organ dysfunction syndrome (MODS) caused by severe sepsis, 2 cases died of myocardial infarction, 2 cases died of acute pulmonary embolism, 1 case died of brain stem hemorrhage, the mortality in hospital was 5.19%, a total of 123 cases were followed up. The survival rate was 91.41 during the follow-up period of 96.09.6 months. Postoperative complications included surgical incision infection (n = 20), nosocomial pulmonary infection (n = 10), postoperative cognitive impairment (n = 9), stress ulcer bleeding (n = 5) and deep venous thrombosis (n = 2). Conclusion the patients with acute abdomen over 80 years old have complicated condition and high risk of operation. The ultimate aim should be to save lives, and too much preoperative examination should not be pursued. Actively preparing before operation, shortening the time of preoperative preparation, preventing and treating infection and shock actively, performing restrictive fluid resuscitation in the early stage of hemorrhagic shock, choosing individualized operation plan according to the condition, and performing injury control surgery when necessary. The emphasis of prevention and treatment of complications is respiratory tract infection, strengthening nutritional support, actively preventing and treating MODS, which is helpful to improve perioperative survival rate of elderly patients with acute abdomen.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656.1

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