老年及合并基础疾病的慢性化脓性中耳炎患者围手术期管理

发布时间：2018-06-20 20:37

本文选题：慢性化脓性中耳炎 + 老龄　；参考：《苏州大学》2016年硕士论文

【摘要】：目的:手术治疗老年及合并基础疾病的慢性化脓性中耳炎病例时,手术风险及手术相关并发症的发生率相对较高。本文分析了此类患者的基础疾病特点及管理原则,以期更好地维护围手术期安全,为存在相对手术禁忌的患者提供治愈机会。资料与方法:我科收治拟行手术治疗的老年或合并基础疾病的慢性化脓性中耳炎患者194例,根据基础疾病的类型、严重程度、治疗用药对手术的影响等等进行围手术期管理,排除手术禁忌并决定是否建议手术。根据手术实施率、基础疾病恶化率、干耳率等评估围手术期管理的合理性。结果:194例患者中,4例因无法控制基础疾病而放弃手术,余190例接受手术手术实施率为97.9%(190/194)。全部手术病例中,术前71例(71/190,37.4%)需要调整基础疾病治疗方案;术后14例出现基础疾病恶化(14/190,7.4%),包括7例血糖紊乱、1例诱发谵妄、4例血压紊乱、1例哮喘复发、1例再发脑梗,余176例(176/190,92.6%)术后平稳。所有手术病例均实现干耳,未出现面瘫、新发感音神经性聋等手术相关并发症。结论:针对各不同类型基础疾病,采用相应的干预措施,有望为存在相对手术禁忌的慢性化脓性中耳炎患者获得治愈机会,降低围手术期严重并发症的发生几率。
[Abstract]:Objective: the risk of operation and the incidence of complications associated with surgery are relatively high in the treatment of chronic suppurative otitis media in the elderly and patients with underlying diseases. This paper analyzes the basic disease characteristics and management principles of these patients in order to better maintain perioperative safety and provide cure opportunities for patients with relative contraindications. Materials and methods: 194 cases of chronic suppurative otitis media were treated by surgical treatment. According to the type and severity of the underlying diseases and the effect of medication on the operation, 194 patients with chronic suppurative otitis media underwent perioperative management. Remove surgical taboos and decide whether to recommend surgery. To evaluate the rationality of perioperative management according to the rate of operation, the rate of deterioration of basic diseases and the rate of dry ear. Results of 194 patients, 4 patients gave up the operation because they could not control the underlying diseases, and the other 190 patients received the operation at the rate of 97.9 / 190 / 194. Of the total surgical cases, 71 cases (71 / 190 37.4) needed to adjust the treatment plan for basic diseases, 14 cases had a deterioration of the underlying disease (14 / 190 / 7.4), including 7 cases of blood glucose disorder, 1 case induced delirium, 4 cases of blood pressure disorder, 1 case of recurrent asthma and 1 case of recurrent cerebral infarction, including 7 cases of blood glucose disorder and 1 case of induced delirium, 4 cases of blood pressure disorder and 1 case of recurrent cerebral infarction. The remaining 176 cases were smooth after operation. All cases had dry ear, no facial palsy, new sensorineural deafness and other surgical complications. Conclusion: according to the different types of basic diseases, the corresponding intervention measures can be used to treat chronic suppurative otitis media patients with relative contraindications and reduce the incidence of severe complications in perioperative period.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R764.9

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