Outcome of Surgery and Anesthesia in Patients 80 Years of Age and Older

80歲或以上老人手術麻醉結果之探討

鄭國偉(Kwok-Wai Cheng) ； 王致嫻(Chih-Hsien Wang) ； 何仁村(Ren-Tsuen Ho) ； 姚文聲(B. Jawan) ； 李汝浩(J. H. Lee)

《Acta Anaesthesiologica Sinica》 32卷1期 (1994/03) Pp. 37-44

摘要

We studied retrospectively the outcome of surgery and anesthesia in 294 patients aged 80 and older who underwent 362 surgical procedures. Of these, 52 cases (14.4%) were admitted to intensive care unit (lCU) post-operatively. The 48-hour, 48-hour-to-30-day and overall mortality rates were 0.8%, 3.8% and 5.2% respectively. ICU. admission and mortality rate were closely associated with the ASA physical status classification. The overall mortality rates were 1.3%, 5.7% and 27% in class II, III and IV respectively. The respective ICU admission rates were 3%, 20% and 56%. ICU admission rate and mortality rate were 42.5% and 13.8% in emergency surgery vs. 5.8% and 2.5% in elective surgery. Patients with 3 or more co-existing diseases had the mortality rate of 23% and the rates of ICU admission and mortality for those with 3 or more peri-operative complications were 22% and 16% respectively vs. 11% and 4% for those with 2 or less peri-operative complications. General surgery was associated with the highest mortality rate (15%) than other type of procedures. 22 of 74 cases who underwent intra-abdominal surgery required controlled ventilation for more than 24 hours post-operatively. 59% (13 cases) of such cases could not weaned successfully from ventilators and died subsequently. Only 2.5% (7 cases) of cases who underwent extra-pleural and extra-peritoneal procedures required controlled ventilation for more than 24 hours post-operatively. Of these, 2 died subsequently. For comparison, the study were artificially divided into two phases, each of three years long: they were the period from 1986-1988 and the period from 1989-1992. The rate of co-existing disease, incidence of emergency surgery, peri-operative complications, and, mortality rate and ICU admission rate were compared. Except for the increased incidence of emergency surgery with 20% v.s. 30% in the second period, there was no statistically significant difference in all other incidence of events. Our mortality rate (5.2%) was lower than those previously reported. Emergency surgery, abdominal surgery, ASA physical status classification and incidence of peri-operative complications are useful predictors of peri-operative morbidity and mortality. The most common co-existing disease was hypertension and the most frequent peri-operative complication was fluctuation of the blood pressure.

關鍵字

Anesthesia ； elderly patients ； morbidity ； mortality

並列摘要

本篇是以294位年齡80歲及80歲以上接受362次手術及麻醉之病患爲例，探討有關老人麻醉之安全性。根據我們統計362個病例中，有52個病例（14.4%）在手術後住進加護病房。而手術後48小時內，48小時至30天內以及總死亡率分別爲0.8%、3.8%及5.2%。手術後需住進加護病房之比率及總死亡率與美國麻醉學會體位分級有密切關係。第二級、第三級、第四級分類其死亡率分別爲1.3%、5.7%及27%，而住進加護病房之機率爲3%、20%及56%。急診手術亦比非急診手術有較高之機率住進加護病房，其機率分別爲42.5%及5.8%；至於急診手術之死亡率爲13.8%，非急診手術則爲2.5%。若是在手術前有3種或以上之併存疾病，病例之死亡率亦會增加至23%。至於手術中發生3種或以上之併發症時，住進加護病房及死亡之機率分別爲22%及16%。若手術中發生2種或以下之併發症時，則住進加護病房及死亡之機率分別爲11%及4%。手術科別分類則以一般外科佔最高之死亡率（15%）。在74個接受腹腔內手術之病例中，有22個病例於手術後需要依賴呼吸器輔助呼吸，而且時間皆超過24小時。在這些病例中有高達59%（13例）至死亡時仍未能脱離呼吸器。但在接受胸腔外及腹腔外手術後，需要使用呼吸器且超過24小時者，則只佔2.5%（7例），其中2例死亡。因爲以上數據乃代表本院開院6年以來之老人麻醉經驗，因此進一步又將6年中362個病例分爲前3年及後3年兩組群，比較了這兩組之手術前併存之疾病，美國麻醉學會體位分級，手術中之併發症，急診刀數，死亡率以及住進加護病房之機率。其中唯有急診刀數自20%增加至31%外，其它部份在統計上並無差異。總括而言，我們得到之總死亡率較過去報告低。至於影響住進加護病房及死亡率之因素包括急診手術，腹部手術，美國麻醉學會體位升級，手術前併存之疾病及手術中所發生之併發症。其中併存疾病以高血壓佔最高比例，而手術麻醉中最常出現之併發症爲血壓之波動。

並列關鍵字

麻醉 ； 老人 ； 併發症 ； 死亡率