Analysis of the effect of anesthesia in elderly patients with critical acute abdomen
老年人危重急腹症的麻醉处理效果分析

摘要

目的：分析老年人危重急腹症的麻醉处理方法及效果。方法：71例老年危重急腹症行外科手术患者作为研究对象，结合患者生理、病理特点选取有效的麻醉方式，分析术期患者手术麻醉效果、预后及相关问题。结果：71例患者中，18例行硬膜外阻滞麻醉，9例发生低血压（仅为术前血压的30%），5例发生氧饱和度持续<89%，2例发生呼吸心脏骤停;25例行气管插管全身麻醉，3例发生低血压，2例发生氧饱和度持续<89%，0例发生呼吸心脏骤停;28例行硬膜外麻醉联合全身麻醉，2例发生低血压，3例发生氧饱和度持续<89%，0例发生呼吸心脏骤停。2例呼吸心脏骤停患者紧急改为全身麻醉气管插管后顺利完成手术。71例患者均顺利完成麻醉治疗，经5d随访，有1例患者死亡（死于重症胰腺炎后休克所致多脏器功能衰竭），有3例患者出现严重心肺功能障碍并发症，经对症处理后均明显改善，70例患者均康复出院。结论：在予以老年危重急腹症患者手术治疗时，应结合老年患者的年龄、机体功能、病情等因素选取适宜麻醉方式，以确保手术顺利完成，利于患者预后。

Abstract

Objective: to analyze the anesthetic treatment and effect of critical acute abdomen in the elderly. 
Methods: 71 elderly patients with critical acute abdomen underwent surgery as the object of study. The effective anesthetic methods were selected according to the physiological and pathological characteristics of the patients, and the anesthetic effect, prognosis and related problems were analyzed. 
Results: among the 71 patients, 18 cases underwent epidural anesthesia, 9 cases had hypotension (only 30% of preoperative blood pressure), 5 cases had persistent oxygen saturation < 89%, 2 cases had respiratory and cardiac arrest, 25 cases underwent endotracheal intubation general anesthesia, 3 cases had hypotension, 2 cases had persistent oxygen saturation < 89%, 0 cases had respiratory and cardiac arrest. 28 cases underwent epidural anesthesia combined with general anesthesia, 2 cases had hypotension, 3 cases had persistent oxygen saturation < 89%, and 0 cases had respiratory and cardiac arrest.Two patients with respiratory and cardiac arrest were changed to general anesthesia after endotracheal intubation successfully completed the operation. All 71 patients completed anesthetic treatment successfully. After 5-day follow-up, 1 patient died (died of multiple organ failure caused by shock after severe pancreatitis), and 3 patients had severe cardiopulmonary dysfunction complications. after symptomatic treatment, all the patients were significantly improved, and 70 patients were recovered and discharged from hospital. 
Conclusion  : in the surgical treatment of elderly patients with critical acute abdomen, the appropriate mode of anesthesia should be selected according to the age, body function, condition and other factors of the elderly patients, so as to ensure the smooth completion of the operation and benefit the prognosis of the patients.