Lauven P M, Stoeckel H, Ebeling B J
Institut für Anästhesiologie der Rheinischen Friedrich-Wilhelms-Universität Bonn.
Anasth Intensivther Notfallmed. 1990 Jan;25 Suppl 1:3-9.
3905 patients of more than 60 years of age who underwent surgical, urological, orthopaedic or opthalmologic interventions, were retrospectively investigated with respect to preoperative condition, intraoperative peculiarities and postoperative complications. Only 3.2% of the old patients (of more than 75 years of age), but 7.2% of elderly patients (between 60 and 74 years of age) had no coexisting disease. Preexisting diseases were myocardial (54.5%) and respiratory diseases (41.3%), hypertension (32.6%), dysrhythmia (30.8%) and diabetes mellitus (17.6%). From the old patients, 58.1% were classified into ASA physical status III to V but only 43.2% from the elderly patients. Peculiarities during anaesthesia and recovery period were (in total): dysrhythmia (8.3%), blood pressure decrease (5.9%) and increase (1.6%) that were significantly more often seen in old than in elderly patients whereas bleeding (4.5%) in the old was not different from the elderly. Independent of age, 11.6% of patients were monitored postoperatively on an intensive-care unit. 47.3% of all patients did not develop any postoperative complication. The incidence of postoperative cardiac, respiratory, central nervous, and lethal complications was not significantly higher in old than in elderly patients. However, the incidence of complications increased significantly with ASA physical status. Mortality of elderly and old patients after emergency interventions was 17.8% and 24.7% respectively and about 10 times that high as after elective surgery (2% in both groups.)
对3905例60岁以上接受外科、泌尿外科、骨科或眼科手术的患者进行了回顾性研究,调查其术前状况、术中特点和术后并发症。75岁以上的老年患者中只有3.2%无并存疾病,而60至74岁的老年患者中这一比例为7.2%。并存疾病包括心脏病(54.5%)、呼吸系统疾病(41.3%)、高血压(32.6%)、心律失常(30.8%)和糖尿病(17.6%)。老年患者中,58.1%被归类为ASA身体状况III至V级,而老年患者中这一比例仅为43.2%。麻醉和恢复期的特点(总计)为:心律失常(8.3%)、血压下降(5.9%)和血压升高(1.6%),老年患者中这些情况比老年患者更常见,而老年患者的出血情况(4.5%)与老年患者无差异。与年龄无关,11.6%的患者术后在重症监护病房接受监测。所有患者中有47.3%未发生任何术后并发症。老年患者术后心脏、呼吸、中枢神经和致命并发症的发生率并不显著高于老年患者。然而,并发症的发生率随ASA身体状况显著增加。急诊手术后老年和老年患者的死亡率分别为17.8%和24.7%,约为择期手术后死亡率(两组均为2%)的10倍。