Perioperative management of 58 hypertensive patients suffering from surgical disease is reported. We emphasize that before operation the blood pressure should be adequately controlled, and heart function promoted. It is safer that the diastolic pressure is controlled under 14 kPa before operation. During operation we strictly observe the change of the blood pressure and manage it in time. Analgesic and antihypertensive agents are used after operation.
摘要:目的:探讨老年人梗阻性大肠癌的围手术期处理。方法:回顾性分析2003年至2008年间71例60岁以上老年人梗阻性大肠癌的围手术期处理情况。 结果:术前发现并存病者43例,术中出现并发症19例,术后发生并发症37例得,除5例死亡外,均得到有效控制,死亡原因与并存疾病有关。结论:加强围手术期处理,积极治疗并存疾病,老年人梗阻性大肠癌的治疗同样能取得满意的效果。Abstract: Objective:To study the perioperative measures for the aged patients with Obstructive Colorectal Cancer. Methods: Seventyone cases above 60 years with Obstructive Colorectal Cancer were analysed retrospectively on their individual accompanied diseases and perioperative treatments, from 2003 to 2008.Results: Fortythree cases of them had suffered from other diseases. Midoperative complications occurred in 19 cases. Postoperative complications occurred in 37 cases. Except 5 cases of death, complications occurring in others cases were well controlled. The death causes mainly were correlated with accompanied chronic diseases. Conclusion: Strengthen care, active management of other chronic diseases are important significantly for senile patients with colorectal carcinoma to get satisfied outcome.
ObjectiveTo summarize the individualized selection of surgical treatment strategies and the key points of perioperative management for patients with heart valve disease complicated with severe chronic heart failure.MethodsThe clinical characteristics of 5 male patients with valvular heart disease complicated with severe chronic heart failure (CHF) were analyzed retrospectively from June 2017 to October 2018 in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, with an average age of 60.21 years.ResultsFive patients were given angiotensin receptor and neprilysin inhibitor (ARNI)-based anti-heart failure treatment after admission. The operation mode of these patients was decided to be valve replacement under cardiopulmonary bypass after individualized evaluation of patients’ improving symptoms. Three patients were treated with intra-aortic balloon pump (IABP) and continuous renal replacement therapy (CRRT) early after operation to assist patients in improving cardiac function. Five patients recovered oral anti-heart failure after awakening. All patients were discharged smoothly 2 weeks after operation.ConclusionIndividualized evaluation is needed for the choice of operation timing and mode, standardized preoperative treatment for heart failure, shortening the aortic blocking time during cardiopulmonary bypass, and early application of left ventricular adjuvant drugs or instruments are all important measures to help patients recover smoothly.
目的:探讨脊柱结核一期内固定手术的围手术期处理方法。方法:一期手术治疗脊柱结核患者68例。围手术期处理主要包括正规化疗、围手术期营养支持、选择正确的手术时机、术后支具保护下逐步功能锻炼、定期随访、监测药物副作用等。结果:68例患者切口均一期愈合,无窦道形成。平均2.2 年随访,结核治愈、后凸畸形纠正,10 例患者出现化疗相关的并发症对症或调整药物后症状控制。结论:正确的围手术期处理是脊柱结核手术成功的重要保证。.
【Abstract】ObjectiveTo investigate the perioperative management in hepatectomy using hepatic energy metabolisom for enhancing safety of and improving the survival in patients with primary liver cancer (PLC).MethodsTwo thousands and one hundred fortythree patients with PLC were treated in this hospital from January 1990 to January 2004. The perioperative data, operative approach, postoperative treatment, postoperative clinical course and follow up data were retrospectively analyzed. All patients were divided into two groups: the early period group and the late period group(from January 1997 to January 2004) and comparison was taken between two groups. The preoperative redox tolerance index (RTI), intraoperative hepatopetal blood occlusion of half liver, and postoperative arterial ketone body ratio (AKBR) were investigated and evaluated.Results①The proportion of small PLC and resection rate increased, the morbidity of complications and mortality after hepatectomy decreased, also the survival rate prolonged in the late period group. ②When using RTI as an indicator for selection of hepatectomy, the morbidity of complications decreased from 21.1% to 11.0%, the mortality form 1.6% to 0.3%. ③Comparising hepatopetal blood occlusion of total liver (n=476) with half liver (n=523),the postoperative morbidity of complications and mortality were 25.8% to 11.9% and 2.3% to 0.6% respectively. ④Postoperative AKBR measurements was a reliable indicator to assess the energy status of the liver and liver failure.ConclusionRTI is of potential value in predicting preoperative hepatic functional reserve, hepatopetal blood occlusion of half liver could protect the residual liver function, and postoperative AKBR measuremeant is a simple and accurate means of determining the immediate state of metabolic dysfunctioning in liver resection. The authors propose that perioperative treatment is an important factor in decreasing operative complications and mortality rate after liver resection.
Abstract: Due to complicated procedures and severe trauma, esophagectomy still remains an operation with high mortality and morbidity. With the advancement of anesthetic and surgical technique, as well as perioperative management, the mortality and morbidity after esophagectomy decreased significantly in recent years. The optimal perioperative management, normalized and individualized treatment was of importance in preventing postoperative complications and decreasing mortality after esophagectomy. This review summarizes the current state of perioperative management for esophagectomy.