合并NSTEMI的高龄心衰患者行髋部骨折闭合复位内固定术的麻醉处理1例  

Anesthesia treatment of closed reduction and internal fixation for hip fracture in an elderly heart failure patient with non‑ST segment elevated myocardial infarction

作　　者：王智鑫 傅洪 Wang Zhixin;Fu Hong(Department of Anesthesiology,Chongqing Emergency Medical Center,the Fourth People's Hospital of Chongqing,Chongqing 400014,China)

机构地区：[1]重庆市急救医疗中心,重庆市第四人民医院麻醉科,重庆400014

出　　处：《国际麻醉学与复苏杂志》2022年第10期1063-1067,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：髋部骨折是老年患者常见的外伤性疾病。该类患者常伴发多种并存疾病和并发症,麻醉评估及管理不当会导致术后并发症和病死率显著增加。该病例因车祸致伤,合并糖尿病、脑梗死后遗症,术前发生非ST段抬高心肌梗死(non⁃ST seg⁃ment elevation myocardial infarction,NSTEMI),反复心衰,经过细致评估与前期治疗,术中采用预防心肌缺血、肺保护通气策略、深麻醉下喉罩替代拔管、多模式镇痛等措施,很好地控制了手术麻醉应激,最终较为平稳地完成了手术麻醉及术后管理,患者顺利出院。总结该病例处置经验,以期为该类型老年髋部骨折麻醉评估与管理提供参考。Hip fracture is a common traumatic disease in elderly patients.These patients are more likely to develop a variety of comorbidities and complications.Improper anesthesia evaluation and management may lead to significant decreases in postoperative complications and mortality.In the current case,the patient was injured in a traffic accident,while developing preoperative non‑ST seg⁃ment elevated myocardial infarction(NSTEMI)and recurrent heart failure,in addition to diabetes and sequelae of cerebral infarction.After preoperative assessment and treatment,a series of measures were taken,such as prevention of myocardial ischemia,lung protec⁃tive ventilation strategy,replacement of extubation by laryngeal mask under deep anesthesia,and multi⁃mode anesthesia,and surgical anesthesia stress was well controlled and the patient was discharged.The experience of this case was summarized,so as to provide refer⁃ence for evaluation and management of anesthesia for elderly hip fractures.

关 键 词：髋部骨折 非ST段抬高心肌梗死 老年人 麻醉 评估 管理 

分 类 号：R614[医药卫生—麻醉学]