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노인 마취의 임상적 고찰

노인 마취의 임상적 고찰
Other Titles
(A) clinical study on anesthesia in geriatric patients
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연세대학교 대학원
[한글]본 조사연구는 1970년 1월부터 1979년 12월까지 10년간 연세대학교 의과대학 부속 세브란스 병원에 입원한 65세 이상의 노인환자에서 전신마취 또는 부위마취하에 수술을 받았던 1097예를 선정하여, 마취중 및 후에 발생한 합병증과 사망에 영향을 미친 여러 요인들과 함께, 통계학적인 검토를 하여 다음과 같은 결론을 얻었다. 1. 전신마취 및 부위마취하에 시행한 수술예 총 53,288예 중 65세 이상의 노인환자는 1097예(2.1%)로서 남자(57.2%)가 여자(42.8%)보다 많았다. 2. 총 1097예의 노인환자중 70예(6.4%)가 사망하였다. 3. 환자상태에 따른 사망율은 선택수술 881예중 24예(2.7%)이고, 응급수술 216예중 46예(21.3%)였다. 4. 수술부위별 사망율은 흉곽내 수술(11.1%), 두개강내 수술(11.0%), 그리고 상복부수술(9.4%)의 순으로 높았다. 5. 수술전 동반질환의 빈도는 고혈압이 277예(25.3%)로 제일 많았고, 다음은 만성폐쇄성폐질환 146예(13.3%), 폐결핵 133예(12.1%) 및 빈혈증 109예(9.9%)의 순으로 많았다. 6. 마취시간의 연장에 따라 사망율이 증가되는 경향을 보였는데 이는 통계적 의의가 있었다. 7. 마취방법은 전신마취예(81.0%)가 부위마취예(19.0%)보다 많았다. 마취제와 사망율과의 관계는 의의있는 차이가 없었다. 8. 마취중 합병증 발생빈도는 고혈압이 262예(23.9%) 및 저혈압이 213예(19.4%)로 많았다. 9. 사망원인은 호흡기 합병증이 총 70예중 17예(24.3%)로 제일 많았고, 그 다음은 심부전 및 신부전이 각각 12예(17.1%)로 많았다.
[영문]Today raped medical and socio-economic progress has increased life expectancy and this has also increased the number of aged in the population. It is well known that the geriatric patient Is generally considered to be a poor risk for anesthesia and surgery compared with the younger age group, because many have associated chronic systemic diseases in addition to the aging of physiological function. The purpose of this clinical study is to evaluate factors affecting complications and mortality in patients over 65 years of age during anesthesia and the postoperative period. Among 53,288 cases of total anesthesia performed from January 1970 to December 1979 at Severance Hospital, 1,097 cases over 65 years of age were reviewed. The results are as follows: 1. Anesthesia for geriatric patients over 65 years of age comprised 2.1% of total cases, of which the number of male patients (57.2%) was slightly greater than that of female patients(42.8%). 2. Overall mortality was 6.4%. 3. The mortality late was related to preoperative physical status of patients; 2.7% of cases were elective and 21.3% were for emergency surgery. 4. High mortality rate following surgery was, in order of frequency, intrathoracic (11.1%), intracranial (11%) and upper abdomen(9.4%) 5. Preoperative concomittant disease was, in order of frequency, hypertension (25.3%), chronic obstructive pulmonary disease (13.3%), pulmonary tuberculosis (12.1%) and anemia(9.9%). 6. The mortality rate was clearly proportional to anesthesia time. 7. General anesthesia (81.0%) was administered more often than regional anesthesia(19.0%). No direct relationship between the anesthetic agent and mortality rage was noted. 8. Common complications during anesthesia were hypertension (23.9%) and hypotension(19.4%). 9. The leading causes of mortality were respiratory complications (24.3%), cardiac failure(17.1%) and renal failure(17.1%).
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