中医临床研究
中醫臨床研究
중의림상연구
CLINICAL JOURNAL OF CHINESE MEDICINE
2014年
33期
117-119
,共3页
高龄患者%髋关节置换%围手术期%风险规避管理
高齡患者%髖關節置換%圍手術期%風險規避管理
고령환자%관관절치환%위수술기%풍험규피관리
Elderly patients%Hip replacement%Perioperative period%Risk avoidance management
目的：讨论高龄患者人工髋关节置换围手术期风险及预防处理。方法：对我院538例高龄患者人工关节置换病历进行系统性回顾，其中75～79岁293例，80岁以上245例，平均82.7岁。其中男性125例，女性413例。全髋置换240例，股骨头置换298例。新鲜股骨颈骨折383例，陈旧性股骨颈骨折23例，股骨粗隆粉碎性骨折58例，股骨头无菌性坏死、髋关节发育不良及髋关节骨性关节炎共74例。其中347例患有一种以上的内科疾病。术前患有高血压病者294例，糖尿病121例，冠心病156例，呼吸系统疾病96例，贫血84例，低蛋白血症33例，脑卒中后遗症66例，帕金森氏病18例。术前均进行围手术期风险评估及相关科室会诊治疗，患者经调治后整体达到一个相对较好的状态。结果：术中及术后48 h 以内发生高血压96例，低血压24例，心律失常54例，血糖明显异常需调整用药45例，术后贫血86例，低蛋白血症50例，嗜睡12例（3～5天），一过性认知精神障碍6例，肺部感染7例，泌尿系感染6例，下肢深静脉栓塞3例，并发肺栓塞1例，应激性溃疡3例，术区感染2例。在相关科室协助治疗下，及时调整治疗方案，所有均安全度过围手术期。结论：通过对高龄患者风险评估及合并症处理，选择合适手术方式，重视并发症处理，能提高患者围手术期的安全性。
目的：討論高齡患者人工髖關節置換圍手術期風險及預防處理。方法：對我院538例高齡患者人工關節置換病歷進行繫統性迴顧，其中75～79歲293例，80歲以上245例，平均82.7歲。其中男性125例，女性413例。全髖置換240例，股骨頭置換298例。新鮮股骨頸骨摺383例，陳舊性股骨頸骨摺23例，股骨粗隆粉碎性骨摺58例，股骨頭無菌性壞死、髖關節髮育不良及髖關節骨性關節炎共74例。其中347例患有一種以上的內科疾病。術前患有高血壓病者294例，糖尿病121例，冠心病156例，呼吸繫統疾病96例，貧血84例，低蛋白血癥33例，腦卒中後遺癥66例，帕金森氏病18例。術前均進行圍手術期風險評估及相關科室會診治療，患者經調治後整體達到一箇相對較好的狀態。結果：術中及術後48 h 以內髮生高血壓96例，低血壓24例，心律失常54例，血糖明顯異常需調整用藥45例，術後貧血86例，低蛋白血癥50例，嗜睡12例（3～5天），一過性認知精神障礙6例，肺部感染7例，泌尿繫感染6例，下肢深靜脈栓塞3例，併髮肺栓塞1例，應激性潰瘍3例，術區感染2例。在相關科室協助治療下，及時調整治療方案，所有均安全度過圍手術期。結論：通過對高齡患者風險評估及閤併癥處理，選擇閤適手術方式，重視併髮癥處理，能提高患者圍手術期的安全性。
목적：토론고령환자인공관관절치환위수술기풍험급예방처리。방법：대아원538례고령환자인공관절치환병력진행계통성회고，기중75～79세293례，80세이상245례，평균82.7세。기중남성125례，녀성413례。전관치환240례，고골두치환298례。신선고골경골절383례，진구성고골경골절23례，고골조륭분쇄성골절58례，고골두무균성배사、관관절발육불량급관관절골성관절염공74례。기중347례환유일충이상적내과질병。술전환유고혈압병자294례，당뇨병121례，관심병156례，호흡계통질병96례，빈혈84례，저단백혈증33례，뇌졸중후유증66례，파금삼씨병18례。술전균진행위수술기풍험평고급상관과실회진치료，환자경조치후정체체도일개상대교호적상태。결과：술중급술후48 h 이내발생고혈압96례，저혈압24례，심률실상54례，혈당명현이상수조정용약45례，술후빈혈86례，저단백혈증50례，기수12례（3～5천），일과성인지정신장애6례，폐부감염7례，비뇨계감염6례，하지심정맥전새3례，병발폐전새1례，응격성궤양3례，술구감염2례。재상관과실협조치료하，급시조정치료방안，소유균안전도과위수술기。결론：통과대고령환자풍험평고급합병증처리，선택합괄수술방식，중시병발증처리，능제고환자위수술기적안전성。
Objective: To discuss perioperative risk prevention treatment of Hip Arthroplasty in elderly patients. Methods: We systematically reviewed 538 cases of elderly patients with Hip Arthroplasty, among whom 293 cases were 75-79 years old and 245 cases were more than 80 years old; 125 were male and 413 were female; 240 were operated total hip arthroplasty and 298 femoral head replacement; 383 cases of fresh femoral neck fracture, 23 cases of old femoral neck fracture, 58 cases of intertrochanteric comminuted fracture, 74 cases of aseptic necrosis of the femoral head, hip dysplasia and hip osteoarthritis. In addition, 347 among them suffered one or more medical diseases, including 294 cases of hypertension, 121 cases of diabetes, 156 cases of coronary heart disease, 96 cases of respiratory disease, 84 cases of anemia, 33 cases of hypoproteinemia, 66 cases of sequelae of stroke and 18 cases of Parkinson’s disease. Before the operation, we assessed perioperative risk and consulted relative departments for all patients so that all patients reached a favorable condition. Results: During and within 48h after the surgery, 96 cases developed hypertension, 24 hypotension, 54 arrhythmia, 45 dysglycemia that required medication; while after the surgery, 86 cases developed anemia, 50 hypoproteinemia, 12 drowsiness (3-5d), 6 transient cognitive disorder, 7 lung infection, 6 urinary tract infection, 3 deep venous thrombosis, 1 pulmonary embolism as complication, 3 stress ulcer and 2 surgical site infection. And with the help of relative departments, we adjusted our therapies timely and all patients safely spent their perioperative period. Conclusion: Through risk assessment of elderly patients, choosing appropriate surgical method and serious complications treatment, the perioperative safety of patients can be raised.
