Silvay George, Castillo Javier G, Chikwe Joanna, Flynn Brigid, Filsoufi Farzan
Department of Anesthesiology, Mount Sinai Medical Center, New York, NY 10029-6574, USA.
Semin Cardiothorac Vasc Anesth. 2008 Mar;12(1):18-28. doi: 10.1177/1089253208316446. Epub 2008 Apr 7.
The average age of US population is steadily increasing, with more than 15 million people aged 80 and older. Coronary artery disease and degenerative cardiovascular diseases are particularly prevalent in this population. Consequently, an increasing number of elderly patients are referred for surgical intervention. Advanced age is associated with decreased physiologic reserve and significant comorbidity. Thorough preoperative assessment, identification of the risk factors for perioperative morbidity and mortality, and optimal preparation are critical in these patients. Age-related changes in comorbidities and altered pharmacokinetics and pharmacodynamics impacts anesthetic management, perioperative monitoring, postoperative care, and outcome. This article updates the age-related changes in organ subsystems relevant to cardiac anesthesia, perioperative issues, and intraoperative management. Early and late operative outcome in octogenarians undergoing cardiac surgery are reviewed. The data clearly indicate that no patient group is "too old" for cardiac surgery and that excellent outcomes can be achieved in selected group of elderly patients.
美国人口的平均年龄在稳步上升，80岁及以上的人口超过1500万。冠状动脉疾病和退行性心血管疾病在这一人群中尤为普遍。因此，越来越多的老年患者被转诊接受手术干预。高龄与生理储备下降和显著的合并症相关。全面的术前评估、围手术期发病率和死亡率风险因素的识别以及最佳准备对这些患者至关重要。合并症的年龄相关变化以及药代动力学和药效学的改变会影响麻醉管理、围手术期监测、术后护理和结果。本文更新了与心脏麻醉、围手术期问题和术中管理相关的器官子系统的年龄相关变化。对接受心脏手术的八旬老人的早期和晚期手术结果进行了综述。数据清楚地表明，没有哪个患者群体“年龄太大”而不能进行心脏手术，并且在选定的老年患者群体中可以取得优异的结果。
