97 -year -old elderly femoral fragmented fracture, the trauma orthopedics department of the city of the city with the anesthesia department for 20 minutes of surgery repair

The 97 -year -old femoral fragmented fracture needs surgery urgently, but the fragile cardiopulmonary function and coagulation disorders of ultra -old -age patients have greatly increased the risk of surgery.

In the face of this problem, the team of trauma and anesthesiology in Shanghai First People's Hospital, with precise anesthesia management and surgical skills, under the "precise anesthesia", a patient with a super -aged femoral crushing fracture successfully implemented the "closed reset PFNA Internal fixed surgery. The surgery team completed a series of operations such as reset, nail planting, and fixing in less than 20 minutes, and protecting the fragile cardiopulmonary and coagulation function of patients to the greatest extent. After surgery, the treatment team implemented refined pain management for patients under the concept of "Painless Hospital", and closely monitored their various signs and indicators to help them pass the perioperative surgery during the surgery. Essence

At the beginning of September this year, Ms. Huang, 97, was sent to the emergency department of Hongkou District, Shanghai First People's Hospital for falling. After investigation, Ms. Huang had a crushing fracture in the left femur, and Fu Dehao, the director of trauma (north) of the municipal hospital, was treated and admitted to the hospital.

The threat of femoral fractures to the health of the elderly is great. If conservative treatment is adopted, patients need to bed for a long time, which is prone to complications such as bedsores, pneumonia, urinary system infections, deep venous thrombosis, etc., and the risk of death is high; if surgery is undergoing, then the fragile cardiopulmonary function and coagulation function of ultra -aged elderly people will be accepted. Disorders are a huge challenge that the surgery team must face.

"After admission, we conducted a comprehensive inspection and evaluation of patients. Her cardiopulmonary system was very fragile, and the possibility of myocardial infarction and cerebral infarction during surgery and perioperative surgery was very high." Fu Dehao told reporters. In order to ensure the safety of surgery, trauma orthopedics invited anesthesia and vascular surgery to conduct further examination and consultation.

Under the suggestion of Director Li Jinbao of the Department of Anesthesiology, the expert team of the experts also performed coagulation function tests such as CTA, lower limb dynamic vein ultrasound, lower limb CTV, and thrombosis. The results showed that Ms. Huang's D-DRES indicators severely increased (more than 60 times the normal value), and the detection of thrombosis stretch diagram showed that the patient was in a serious high-coeaic state, which means that the patient may occur at any time. Waiting for intravenous embolism.

"In theory, if the elderly patients with femoral fractures decide the operation, they should be performed as soon as possible. Patients will be in bed for one day, and the success rate of the surgery will decrease by one point." Li Jinbao said, "But the patient's coagulation indicator is too high, the patient's coagulation indicator is too high, the patient's coagulation indicator is too high, the patient's coagulation indicator is too high, and the patient's coagulation indicator is too high. Anticoagulating therapy must be performed first, which requires us to accurately grasp the best balance between preoperative anticoagulant therapy and reduce bedtime time. "

After 3 days of anticoagulanting, Ms. Huang's coagulation function and other indicators barely met the standards that can be surgery, and the expert team also agreed that surgery should be performed as soon as possible. However, the risk of carrying out systemic anesthesia for such ultra -aged patients is still very large. After careful discussion and judgment, the anesthesia team decided to perform neurological blockage+sub -absorbent anesthesia for Ms.

The advantage of the "semi -hemp" surgery is that it has less impact on cardiopulmonary function and blood pressure. The patient is awake throughout the process, and it is also helpful for postoperative rehabilitation, but this also puts forward higher requirements for surgical skills. In order to ensure that the surgery is everything, the trauma orthopedic team has fully discussed, planned, and deduced the surgical plan before surgery, developed emergency plans for possible emergencies, and prepared medical equipment and equipment that could be required during the operation.

On the day of the operation, Li Jinbao, the director of the anesthesiology department, led the team member Zhang Yibo to attend physicians and Dr. Yang Qing under the ultrasound guidance for the patient's surrounding neural blockage of the hip joint. Anesthesia planes are accurately controlled below the 10th thoracic vertebra, reducing the impact of patients' breathing and circulating systems, and ensuring the irrigation of important organs. In order to further reduce tension, the anesthesia team also assisted the use of venous sedatives to help patients enter a normal sleep state.

After the anesthesia was completed, Fu Dehao, the director of the trauma orthopedic (north), led Dr. Yang Yuehua and Dr. Ren Haijiang and other members of the team to immediately start the operation. Because the duration of the half-body anesthesia is shorter than the general anesthesia, the surgery time that usually needs 1-2 hours must be greatly compressed. With rich experience, Fu Dehao quickly completed the traction and reset of the fracture area, and then cut about 3 cm in the left hip for about 3 cm. Insert the pins, expand the marrow, implant the main nails, and entered the "spiral blade" to inside the inside inside. Fixed operation. The surgery was completed smoothly in less than 20 minutes. Patients with blood pressure and respiration during surgery are stable, and normal dialogue can be performed after anesthesia.

After surgery, the trauma orthopedic medical team was closely monitored and cared for the patient's heart failure indicators and blood indicators. The anesthesia team conducts pain management of it. Due to the age of the patient, there is a mild cognitive disorder before surgery, and the anesthesia team replaces the analgesic pump in a single nerve block complex before surgery. Light pain) below. On the third day after the operation, the patient's pain disappeared basically and was discharged from the hospital on September 16.

According to Li Jinbao, as early as 2020, Shanghai First People's Hospital launched the construction of "Painless Hospital".System of painless diagnosis and treatment.After entering the ward, the anesthesia team in charge of this ward will use international standard "Pain Digital Rating Assessment Meter" (NRS) to evaluate the pain for the patient.The analgesic scheme is implemented by the anesthesia team on time and continuously conducts pain assessment and management.Author: Li Chenzhen Populus Populus

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Edit: Li Chenzhen

Editor in charge: Jiang Peng

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