周全性老年評估個案報告：一位主動脈瘤合併多重慢性病及缺血性腦中風的個案

Comprehensive Geriatric Assessment: A Case Report of an Aortic Aneurysm Patient with Multi-Comorbidities and Stroke after Surgery

林玟玓(Wen-Ti Lin) ； 顏啟華(Chi-Hua Yen)

《台灣老年醫學暨老年學雜誌》 11卷3期 (2016/08) Pp. 196-211

https://doi.org/10.29461/TGG.201608_11(3).0005

摘要

主動脈瘤在65歲以上老年人之盛行率，胸主動脈瘤約為0.16-0.34%[5,6]，腹主動脈瘤約為4-8%[10]，但由於症狀多為非特異性，不易早期診斷，且併發症死亡率高，可說是老年人的沉默殺手。根據內政部統計，我國於1993年邁入高齡化社會(aging society) 後， 預估將於2018 年正式進入高齡社會(aged society)，隨著高齡人口逐年攀升，預估主動脈瘤於老年人之盛行率亦將逐漸上升，故如何預防及篩檢是值得重視的議題。患有主動脈瘤的老年人，因老化而同時合併多種心血管慢性疾病之狀況並不少見，如合併高血壓、糖尿病、高血脂、冠狀動脈疾病、心律不整等，不僅加深了疾病之複雜度，也提高了腦中風等併發症的發生率。研究顯示，腦中風是造成失能的第三大原因[1]，除了造成家庭社會之衝擊外，亦造成醫療資源的龐大支出，不可不慎。本個案為一位罹患高血壓、糖尿病、高血脂、心房顫動且有吸菸史之七十四歲男性病患，因健康檢查意外診斷出患有胸、腹多處主動脈瘤，在接受手術治療術後併發缺血性腦中風之復健個案。本文嘗試以周全性老年評估的方式介入，經過詳細的整體評估及文獻回顧，探討主動脈瘤合併多重慢性疾病在老年病患的表現，並透過跨領域的醫療團隊討論，針對主動脈瘤的篩檢及併發症的預防、心房顫動抗凝血藥物之選擇、中風後的復健及長期照護資源的介入、戒菸等項目等提供個人化的建議，以期幫助病人建立後續治療及追蹤的方向。

關鍵字

周全性老年評估 ； 腦血管疾病 ； 主動脈瘤

並列摘要

The prevalence of thoracic aortic aneurysms (TAA) and that of abdominal aortic aneurysms (AAA) in the elderly (≧65 years) population are respectively 0.16-0.34% [5,6] and 4-8%[10]. However, early diagnosis and complication prevention are difficult as the symptoms of aortic aneurysm are often non-specific. Due to the high mortality rate of ruptured aneurysm and difficulty in early diagnosis, aortic aneurysm is often referred to as a ＂silent killer.＂ According to the MOI (the Ministry of the Interior) statistics, Taiwan has been an aging society since 1993 and is projected to become an ＂aged society＂ by 2018. The prevalence of aortic aneurysms in the elderly is expected to grow with the rise in elderly population, thus rendering the screening and prevention of the disease an increasingly important issue. Also to be noted is that, as is often the case with aging, elderly patients with aortic aneurysm are very likely to be comorbid with multiple chronic cardiovascular diseases, such as hypertension, diabetes, dyslipidemia, coronary artery disease, and arrhythmia, a situation that may aggravate the complexity of the disease itself, increase the rates of complications, and cause enormous health care expenditures. In this paper, we presented a 74-year-old man with a medical history significant for hypertension, diabetes, dyslipidemia, atrial fibrillation. During a health examination, multiple thoracic and abdominal aortic aneurysms were discovered. During the aneurysm repair surgery, perioperative cerebral vascular accident occurred and resulted in dysphagia and weakness of four limbs. We conducted a comprehensive geriatric assessment and discussed the clinical presentation and management of elderly patients with aortic aneurysm comorbid with multiple chronic diseases. Through offering personalized recommendations concerning better screening of aortic aneurysm, future complication prevention, proper selection of anticoagulants in patients with atrial fibrillation, post-stroke rehabilitation, smoking cessation interventions, and effective utilization of currently available long-term care resources, we aim to help patients develop individual follow-up plans for subsequent treatment and health management.

並列關鍵字

comprehensive geriatric assessment ； cerebral vascular accident ； aortic aneurysm