Surgical procedures in patients aged 90 years and older.
Surgical procedures in patients aged 90 years and older.
复制标题
90 岁及以上患者的外科手术。
DOI：
10.1097/00007611-198411000-00003
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发表时间：
1984
影响因子：
1.1
通讯作者：
Scott Hw
中科院分区：
文献类型：
--
作者：
Adkins Rb;Scott Hw
在过去的五年中，有75名90岁以上的患者在纳什维尔大都会综合医院和范德比尔特大学医院接受了85次大手术。最常见的手术是剖腹探查。第二种是下肢截肢，原因是周围血管疾病和/或坏疽。57%的患者接受了气管内麻醉。相关医疗问题很常见，包括充血性心力衰竭（24%）、高血压（21%）、糖尿病（13%）、慢性心律失常（9%）、心肌梗死史（8%）和脑血管意外史（5%）。手术后死亡11例（13.4%），其中全身麻醉6例。其中，2人患术后肺炎，2人未从肠穿孔和腹膜炎中恢复，1人患术后心肌梗死，1人患脑血管意外，1人患败血症。1例患者猝死可能是由于心肌梗死或肺栓塞。其他3例死亡发生在广泛癌患者中（1例胆囊癌，2例来源不明的广泛转移癌）。这三名病人死于他们接受手术的疾病，因为手术未能改变病情。当需要外科手术来延长和/或改善老年患者的生活质量时，这些手术在大多数情况下可以获得可接受的结果。
: During the past five years 75 patients aged 90 years or more had 85 major surgical procedures at the Metropolitan Nashville General and Vanderbilt University hospitals. The most common operation was exploratory laparotomy. The second was lower extremity amputation for peripheral vascular disease and/or gangrene. Fifty-seven percent had general endotracheal anesthesia. Associated medical problems were common, and included congestive heart failure (24%), hypertension (21%), diabetes mellitus (13%), chronic arrhythmias (9%), history of myocardial infarction (8%), and history of cerebrovascular accident (5%). Eleven patients (13.4%), six of whom had general anesthesia, died after operation. Of these, two had postoperative pneumonia, two did not recover from bowel perforation and peritonitis, one had a postoperative myocardial infarction, another had a cerebrovascular accident, and one had sepsis. One patient's sudden death was likely due to myocardial infarction or pulmonary embolus. The other three deaths occurred in patients with extensive carcinomas (gallbladder carcinoma in one and widely metastatic carcinoma of unknown origin in two). These three patients died of the disease for which they were operated upon when the operation failed to alter its course. When surgical procedures are necessary to prolong and/or improve the quality of life in elderly patients, these procedures may be done in most cases with acceptable results.