Safety Assessment And Treatment Of Oral And Maxillofacial Surgery In Elderly Patients During Perioperative Period

Objective1.Discuss the possible effect of accompanying diseases and the time of operation in the safety of perioperative period on the elder who take the oral and maxillofacial surgery.2. Disscuss the methods to deal with the old patients who have accompanying diseases during perioperative period.MethodsTo collect the data of641old patients who have taken the operations of the oral and maxillofacial surgery (selected age≧60) from the Second Xiangya Hospital. And the analysis of the treatment of the patients with accompanying diseases or postoperative complications during the perioperative period, the management of the postoperative respiratory track and the relations among accompanying diseases, time of operation and postoperative complications.Results1. There are380patients suffering from the systemic disease in the total number641, taking up59.28%, among which145patients have two or more systemic diseases,22.62%. It is usually common to witness the patients afflicted with cardiovascular disease. 2. The occurrence of the pulmonary infection among641people happens to25patients; wound infection,61; necrosis of skin flap,3; death,1.3.There are197patients with hypertensive patients in the total number641,the occurrence of the transient hypertension among these197patients happens to82patients,resistant hypertension,25. Preoperative blood pressure control<160/90mmHg,and intently monitored the blood pressure during the perioperative period, timely treated the high blood pressure symptom,there were no severe cardio-cerebrovascular complications caused by hypertension happened.4.This group of patients has seen34people accompanying CHD,there are9people who had suffered from myocardial ischemia after the operation.The incidence rate of myocardial ischemia after the operation in people with cardiac function in Ⅰ and Ⅱ level is less than the people with cardiac function in Ⅲ level,Statistical significance between the two cases.(P=0.025);the incidence rate of myocardial ischemia after the operation in people had the operation more than5hours is higher than those had the operation less than5hours,no statistical significance between the two cases.(P=0.201)5.There are13cases found with the occurrence of arrhythmia after operation in people with cardiovascular disease,5.99%.ST-segment depression≥0.05mv,cardiac function and operation time are the important factors to affect the incidence of postoperative arrhythmia.6.There are75cases with diabetes mellitus in the total number641, the BS before operation of these patients was controlled within5.0-10.Ommol/L.The BS can be controlled in the reasonable scope during the perioperative period.No ketoacidosis and nonketotic hyperosmolar coma happened.Among75patients with diabetes mellitus there are22people with wound infections after the operation take up29.33%;566with no diabetes,39people have wound infections after the operation taking up6.89%; Statistical significance between the two cases(P=0.000);among the75patients with diabetes there were no pulmonary infection.7.Among75cases of diabetic patients,there are29cases with oral cancer,other46cases are not.The mean value of postoperative BS and one day after BS of oral cancer group is higher than that of non oral cancer group,no statistical significance between the two cases(P>0.05).The mean value of postoperative FPG of oral cancer group is higher than that of non oral cancer group,statistical significance between the two cases(P>0.021).8.There are55cases with respiratory diseases in the total number641,among which27cases occured PPCs,taking up49.09%.The major of PPCs are pulmonary infection, hypoxemia, pulmonary atelectasis, pleural effusion. 9.The incidence rate of pulmonary infection after operation in the patients who had the operation more than5hours is higher than those had the operation less than5hours,statistical significance between the two cases(P=0.000);there were30patients ever used the breathing machine,and there are4people who have pulmonary infections after the operation if they took the breathing machine earlier, taking up13.33%;611people who never take that machine and there are only21that has pulmonary infections, taking up3.44%; Statistical significance between the two cases.(P=0.000<0.05).Conclusions1.Cardiovascular disease, diabetes and diseases of the respiratory system are the major concomitant diseases of the elderly patients who take the oral and maxillofacial surgery.The proportion of older patients with diabetes and associated with more than one disease increased.2.Associated with serious cardiovascular and respiratory diseases are insecure factors in elderly patients with major maxillofacial surgery operation.3.Accurate pre-operative evaluation, actively dealing with the disease, strengthen the monitoring and timely symptomatic treatment can ensure the safety of elderly patients who take the maxillofacial surgery during the perioperative period.