【摘要】：目的:80歲以上急腹癥患者病情危重,圍手術(shù)期病死率較高,本研究主要探討提高80歲以上急腹癥患者圍手術(shù)期生存率的處理措施。方法:回顧性分析我院急診外科2012年07月至2014年03月收治的135例接受急診手術(shù)治療的80歲以上急腹癥患者的臨床資料,分析并總結(jié)提高80歲以上急腹癥患者圍手術(shù)期生存率的處理方法,統(tǒng)計(jì)資料隨訪為期6個(gè)月。結(jié)果:135例80歲以上急腹癥患者(年齡:80歲-101歲,平均85.3±2歲,其中男性73例,女性62例):發(fā)病至就診時(shí)間于發(fā)病12小時(shí)以內(nèi)者25例,12小時(shí)至24小時(shí)者58例,24小時(shí)至48小時(shí)者45例,大于48小時(shí)以上者7例。合并癥:高血壓45例次,冠心病38例次,心律失常16例次,腦梗塞8例次,糖尿病39例次,慢性支氣管炎10例次,院外肺部感染21例次,尿毒癥3例次,凝血功能障礙3例次,血友病1例次。135例高齡急腹癥患者全部施行急診開腹手術(shù)。治愈出院99例,隨訪期間2例死于交通意外及腦血管意外,失訪4例;好轉(zhuǎn)24例,經(jīng)隨訪現(xiàn)生存22例,死亡2例;自動出院(或轉(zhuǎn)院)5例,經(jīng)隨訪現(xiàn)生存2例,死亡2例,失訪1例;院內(nèi)死亡7例,2例死于嚴(yán)重膿毒癥導(dǎo)致的多器官功能障礙綜合征(MODS),2例死于心肌梗死,2例死于急性肺栓塞,1例死于腦干出血,院內(nèi)病死率為5.19%;共隨訪123例,隨訪率96.09%。6個(gè)月隨訪期內(nèi)患者生存率為91.41%。術(shù)后并發(fā)癥46例次:手術(shù)切口感染20例次,院內(nèi)肺部感染10例次,術(shù)后認(rèn)知障礙9例次,應(yīng)激性潰瘍出血5例次,下肢深靜脈血栓2例次。結(jié)論:80歲以上急腹癥患者病情復(fù)雜,手術(shù)風(fēng)險(xiǎn)高,應(yīng)以搶救生命為最終目的,不應(yīng)追求過多的術(shù)前檢查。積極地術(shù)前準(zhǔn)備,盡可能縮短術(shù)前準(zhǔn)備時(shí)間;積極防治感染和休克、對失血性休克早期宜行限制性液體復(fù)蘇;根據(jù)病情選擇個(gè)體化的手術(shù)方案,必要時(shí)行損傷控制性手術(shù);高齡患者并存病多、宜多學(xué)科協(xié)作合理處理;防治并發(fā)癥的重點(diǎn)是呼吸道感染,加強(qiáng)營養(yǎng)支持、積極防治MODS,有利于提高高齡急腹癥患者圍手術(shù)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 鹵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.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R656.1

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