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医学论文范文:急性化脓性胆管炎合并心血管疾病的循证麻醉
【摘要】 目的：借助循证医学的方法为一例急性化脓性胆管炎合并心血管疾病的老年患者确定麻醉方案。方法：充分评估患者情况后，提出临床问题，从Cochrane 图书馆(2009年第1期 )、Pubmed(1999年1月-2009年4月)检索。检索主题词为：hypertension， cardiovascular disease，acute suppurative cholangitis，elderly patient，epidural anesthesia，general anesthesia， RCT,human，meta-analysis，systmatic review。结果：共检索出与麻醉处理相关问题的随机对照试验24篇，系统评价12篇。分析文献后为患者制定合理的麻醉方案。结论：在临床工作中采用循证方法，结合最佳文献证据及医务人员的临床经验和患者的期望值，为急性化脓性胆管炎合并心血管疾病的患者制定理想的治疗方案，有效提高麻醉安全性。
【关键词】 心血管疾病;急性化脓性胆管炎;老年患者;麻醉
Evidence-Based Anesthesia for an Acute Suppurative Cholangitis Patient Complicated Cardiovascular DiseaseZENG Wen-jing,LIU Ju-ying (Renmin Hospital of Wuhan University,Wuhan,Hubei 430060;Department of Anesthesiology,Taihe Hospital,Yunyang Medical College,Shiyan,Hubei 442000,China)Abstract:Objective A clinical scheme of anesthesia for an an acute suppurative cholangitis elderly patient complicated cardiovascular disease was made with the evidence-based medicine approach.Methods The situation of patient was fully assessed,the clinical problems were proposea and the information about how to slove the problems was searched in the database of Cochrane library(the first period,2009),PubMed(from January 1999 to April 2009).The searched Medical Subject Headings(MeSH) were:hypertension,cardiovascular disease,acute suppurative cholangitis,elderly patient,epidural anesthesia,general anaesthesia,RCT,human,meta-analysis,systmatic review.Results There were total 24 randomized controlled trials(RCTs) and 12 systmatic reviews correlating with the anesthetic treatment,the clinical scheme was worked out through the analysis of those literatures.Conclusion The evidence-based medicine method,the effective information from literatures,the clinical practise of medical staff combined with the expected value of patients could provide an ideal scheme for acute suppurative cholangitis patients complicated cardiovascular disease,and effectively improve the safety of anesthesia医.学.全.在.线www.med126.com.
Key words: Cardiovascular disease;Acute suppurative cholangitis;Elderly patient;Anesthesia
1 一般资料
1.1 临床资料患者，女，84岁，因反复右上腹疼痛一周入院。既往有胆囊结石，脑血栓，高血压病史。入院前行头孢噻肟和替硝唑抗炎治疗一周，缓解后再发。查体：T 40 ℃，HR 125 bpm，R 20 bpm，BP 125/75 mmHg。神志清楚，精神差，皮肤巩膜黄染，右上腹压痛，剑突下和右上腹有明显压痛和肌紧张，墨菲征阳性。辅助检查：白细胞：14.5×109/L，血生化：GPT 539 mmol/L，GOT 1 013 mmol/L，总血胆红素明显升高;B超提示：胆囊肿大、胆囊多发性结石、胆总管扩张。
1.2 评估患者并提出问题
根据患者临床表现，结合实验室检查和体格检查，参照1983年全国肝胆管结石专题研讨会制定的诊断标准，患者急性化脓性胆管炎的诊断成立。术前访视患者，ASA为3级;根据Goldman非心脏手术病人心血管疾病危险因素评分方法，对此例病人进行分析，得分12分，术前请相关科室会诊;根据非心脏手术心血管危险度分层，心血管危险1%～5%(心血管危险度包括心源性死亡及非致命性心肌梗死总发病率)，属中危，施行麻醉有一定风险。患者呼吸储备功能明显下降，无困难气道体征。既往有高血压、脑血栓病史，规律服用降压药及抗凝药，发病前血压维持在150/90 mmHg水平。据此，提出问题：⑴此病人手术时机如何选择?⑵采取哪种麻醉方式相对安全?⑶用麻醉药时注意哪些方面?
