Wellington J L, Lynn R B
Can Med Assoc J. 1966 Aug 6;95(6):252-6.
With careful attention to details of preoperative, operative and postoperative care, intrathoracic procedures can be carried out safely in the elderly patient. The authors describe such procedures in 111 patients over 60 years of age who presented with a wide variety of primary diseases. Bronchogenic carcinoma, present in 48 patients, was the commonest. One-third of the total group had significant associated disease, usually in the form of coronary artery or chronic respiratory disease. The overall mortality rate was 6.3%.Before surgery, all patients were prophylactically digitalized regardless of their cardiac status. Blood volume estimations were determined in those with excessive weight loss. At operation, measurement of central venous pressure was found to be the best guide to blood replacement.Retention of bronchial secretions was the commonest postoperative complication. This problem can be minimized with intensive chest physiotherapy, adequate hydration, minimal doses of analgesic agents and, when indicated, early tracheostomy.
通过对术前、术中和术后护理细节的密切关注，老年患者可以安全地进行胸腔内手术。作者描述了111例60岁以上患有多种原发性疾病患者的此类手术情况。48例患者患有支气管源性癌，是最常见的疾病。整个组中有三分之一的患者患有严重的相关疾病，通常表现为冠状动脉疾病或慢性呼吸道疾病。总体死亡率为6.3%。术前，所有患者无论心脏状况如何均进行预防性洋地黄化。对体重过度减轻的患者进行血容量评估。手术中，发现中心静脉压测量是输血的最佳指导。支气管分泌物潴留是最常见的术后并发症。通过强化胸部物理治疗、充足的补液、最小剂量的镇痛剂以及在必要时早期气管切开术，这个问题可以最小化。
