老年患者开胸术后体液平衡管理与术后心肺并发症关系的观察分析朱峰，郝宝泉，裴少华【摘要】目的：探讨老年患者开胸术后体液平衡管理对预防术后并发症的意义。方法：对135例老年开胸手术病人根据术后1〜3天液体出入量进行分纟H.,曾出现过液体岀入明显正平衡（$800nd）者为I组，保持每口为负平衡者为II组，其他为III组，比较不同组的术后心肺并发症发生率。结果：I组中9例术后出现不同程度心肺并发症，其中循环并发症5例，呼吸并发症8例，导致病死2例；II组中共5例术后出现不同稈度心肺并发症，其中循环并发症2例，呼吸并发症4例，无病死病例；组术后出现不同程度心肺并发症者15例，其中循环并发症5例，呼吸并发症13例，导致病死1例。3组患者在循环系统并发症总发生率、严重心律失常、心力衰竭、呼吸系统并发症总发生率、肺部感染、哮喘、低氧血症、肺水肿、呼吸衰竭差异均有统计学意义（PV0.05〜PV0.05=；II组低氧血症发生率明显减少，且未岀现肺水肿及呼吸衰竭病例。结论：老年患者开胸术后早期应避免出现过量正平衡，通过限制性液体管理使正平衡尽早转入负平衡期，有助于减少术后心肺并发症的发生率和病死率。【关键词】老年病学；外科；呼吸；循环；手术后并发症；体液管理[中图分类法分类号]Therel且tionshipandanalysisbetweenthenegativebodyfluidbalancemanagementandthecardio-pulmonaxycomplicationsinelderlypatientsafterthoracotomyZHUFeng,HAOBao-quan,PEIShao-hua,WANGPeisheng（DepartmentofCardio-ChestSurgery,BengbuFirstHosipital,Bengbu,Anhui,233000,China）[Abstract]Objective：toexploretheassociationbetweenthenegativebodyfluidbalaneemanagementandthecardio-pu1monarycomplicationsinelderlypatientsafterthoracotomy.Methods：135casesofthoracotomyinelderlypatientswereselected.Theyweregroupedaccordingtothevolumeofliquidin1-3claysafterthoracicsurgery,thosepositivebalanceforgroupIthattherewereover800mlvolumeoutofbalaneeanyday,Toinaintainthosedai1ynegativebalanceforgroupII,theothersforgroupIILAretrospectiveanalysisandcomparisonabouttheinciclenceofcardio-pu1monarycomplicationsweremadeamongdifferentgroups.ResuIts：Therewereninecaseswithpostoperativecardio-pulmonarycomplicationsingroupI,inc1uclingfivecasesofcardiovascularcomplications,eightcasesofrespiratorycomplications,andtwocasesofdeath.Therewerefivecaseswithpostoperativecardio-pu1monarycomplicationsingroupII,includingtwocasesofcardiovascularcomplications,fourcasesofrespiratorycomplications,nodeaths.Therewerefifteencaseswithpostoperativecardio-pu1monarycomplicationsingroupIII,includingfivecasesofcardiovascularcomplications,thirteencasesofrespiratorycomplications,andonecaseofdeath.Theincidenceofpostoperativecardio-pu1monarycomplicationsandmortalityingroupTwassignifiedntlyhigherthantheothertwogroups,theincideneeofrespiratorycomplicationswaslowerthangroup3.Conclusions：Tnearlypostoperativeelderlypatientsthenegativefluidbalancecontributedtoreducetherelativelyexcessvolumeloadthatinducedrespiratoryandcirculatorydysfunction,andadministertopreventandreducetheoccurreneeofpostoperativecardiopu1monarycomplications.[Keywords1Oldage；Thoracotomy；Circulatory；Respiratory；Post-operativecomplications；Fluidresuscitation老年患者全身脏器功能减退，备系统Z间平衡脆弱，使得在应对手术创伤时出现与年轻患者不同的变化，开胸术后并发症尤其是心肺并发症发生率高,甚至导致死亡笔者通过对老年开胸手术患者术后早期体液平衡管理与心肺并发症关系的观察,探讨术品液体治疗管理对预防老年患者开胸术后心肺并发症的临床价值。1资料和方法选取2005年1月至2008年12月60岁以上老年开胸手术患者135例，术后曾出现直接与手术操作有关的技术性并发症者未列入研究对象。根据术后1〜3天每II液体岀...