Pargger H, Scheidegger D
Departement Anästhesie, Kantonsspital, Basel.
Orthopade. 1994 Feb;23(1):16-20.
The percentage of elderly people in our population is increasing, and anaesthesiologists and surgeons need to find ways of decreasing perioperative complications in these patients. The chronological age is of lesser importance than biological age as far as the risks of perioperative complications are concerned. Indicators for biological age are the number and type of previous diseases, nutritional status and the doctor's clinical impression of the patient. Preoperative evaluation of the perioperative risks in elderly patients is now mandatory. The physical status classification of the American Society of Anesthesiologists and the Goldmann Index are very useful for patient evaluation. Optimal preparation of the patient is helpful in decreasing risks, and the avoidance of emergency operations will also decrease risks. It is not yet clear whether regional anaesthesia, as opposed to general anaesthesia, decreases mortality in geriatric patients. It seems, however, that regional anaesthesia may have some advantages in terms of postoperative consciousness, blood loss, thrombotic complications and mean length of stay in hospital. The surgeon can help reduce the operative risk by a rapid and atraumatic operation technique. The most frequent perioperative complications are alterations to the cardiopulmonary system and postoperative bleeding. Even minor perioperative complications can have a predictive value for later fatal events. Thus, careful preoperative preparation, a suitable anaesthetic procedure and a fast and atraumatic mode of operation will help to decrease perioperative complications in elderly patients.
我国老年人口的比例正在上升，麻醉医生和外科医生需要找到降低这些患者围手术期并发症的方法。就围手术期并发症的风险而言，实际年龄的重要性低于生物学年龄。生物学年龄的指标包括既往疾病的数量和类型、营养状况以及医生对患者的临床印象。目前，对老年患者围手术期风险进行术前评估是必不可少的。美国麻醉医师协会的身体状况分类和戈德曼指数对患者评估非常有用。对患者进行最佳准备有助于降低风险，避免急诊手术也会降低风险。与全身麻醉相比，区域麻醉是否能降低老年患者的死亡率尚不清楚。然而，区域麻醉在术后意识、失血、血栓形成并发症和平均住院时间方面似乎可能具有一些优势。外科医生可以通过快速且无创的手术技术来帮助降低手术风险。最常见的围手术期并发症是心肺系统改变和术后出血。即使是轻微的围手术期并发症也可能对后期的致命事件具有预测价值。因此，仔细的术前准备、合适的麻醉程序以及快速且无创的手术方式将有助于降低老年患者的围手术期并发症。
