老年人胆囊结石合并心脏病行腹腔镜与剖腹胆囊切除的临床研究(1)
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【摘要】目的:探讨腹腔镜胆囊切除术治疗老年人胆囊结石合并心脏病的优越性和可行性。方法:胆囊结石合并心脏病的老年人112例,随机分成LC组56例和OC组56例;分别观察两组患者的临床效果和手术并发症的发生情况。结果:LC组的平均出血量(术中)、手术时间、提前进食时间及住院天数均明显优于OC组(P<0.01);LC组和OC组的手术并发症发生率分别为7.4%(4例)和26.8%(15例)(P<0.01)。结论:胆囊结石合并心脏病的老年人用LC治疗安全可行,具有显著的临床应用价值。
【关键词】老年人;胆囊结石;胆囊切除,腹腔镜;心脏疾病
doi:10.3969/j.issn.1006-1959.2010.09.006文章编号:1006-1959(2010)-09-2302-02
The clinical study of open cholecystectomy of elderly people with heart disease and laparoscopic gallbladder ZHOU Jian-rongThe first People's Hospital of Neijiang,Sichuan Province,641000,China
【Abstract】Objective:To evaluate the advantages and availability of the operation of laparoscopic cholecystectomy for elderly people with laparoscopic gallbladder and heart disease.Methods:112 patients with heart disease and laparoscopic gallbladder stones were randomly divided into LC group and OC group of 56 cases respectively;the clinical effect and the incidence of surgical complications of the two groups' patients are to be observed.Results:In LC group shows advantages.The blood loss of patients in operation,operation time,time of consuming food and hospital stay were significantly better than the OC group (P<0.01);LC group and OC group complication rate was 7.4% (4 cases) and 26.8% (15 cases) (P<0.01)respectively.Conclusions:The availability of the operation of laparoscopic cholecystectomy for elderly people with laparoscopic gallbladder stones and heart disease has significant clinical value.
【Key words】Aged;Gallbladder stones;Cholecystectomy,laparoscopic;Heart disease
胆囊结石伴急、慢性胆囊炎等胆囊良性疾病是老年人的常见病和多发病。老年人的机体免疫力逐渐降低,各脏器功能衰退明显,常常合并多种心血管疾病,对手术的应激代偿能力和耐受性逐渐下降。选择创伤少、痛苦少、恢复快及并发症少的安全术式显得非常重要。现将我院112例老年人的临床护理研究报告如下:
1.资料与方法
1.1一般资料:2003年1月至2009年12月,我院收治胆囊结石合并心脏病的老年人112例,其中男53例,女59例,年龄65～82岁,平均64±5.69岁。反复发作85例,首次发作21例,无症状6例。合并冠心病47例,占42.0%;肺心病35例,占31.3%;高血压性心脏病19例,占17.0%;风心病11例,占9.8%。随机分为腹腔镜胆囊切除术(laparoscopic cholecytecystectomy,LC)56例,剖腹胆囊切除术(open cholecytecystectomy,OC)56例。
1.2术前准备:按NYHA分级(美国纽约心脏协会)心功能分为Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级,根据心功能分级制订不同护理方案,对每级的护理问题采取相应的护理措施[1]。对合并各种疾病的老年人积极进行围手术期检查;合并心血管疾病患者,常规心电图检查外还应行心脏B超检查,对有心律失常的患者行24h动态心电图检查。合并冠心病患者,术前适当应用扩冠及强心药物,维持心功能在Ⅱ级以内;合并肺心病患者,常规摄胸片检查、肺功能检查、血气分析、胸部CT,肺功能最大通气量宜>60%;高血压患者术前将血压控制并稳定在160/90mmHg以下;合并风心病患者,以药物控制病情 ......
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