摘要
目的总结70岁以上老年患者心脏瓣膜病的特点及手术效果。方法2005年1月到2011年11月，115例70岁以上老年患者接受心脏瓣膜手术，占同期心脏瓣膜手术的8．4％（115／1366例），其中男65例，女50例；年龄（74．3±3．1）岁。风湿性心脏瓣膜病68例（59．1％），非风湿性瓣膜病47例（40．9％）。术前心功能Ⅲ～Ⅳ级75例（65．2％）。行二尖瓣置换术（MVR）55例（47．8％），主动脉瓣置换术（AVR）33例（28．7％），AVR＋MVR16例（13．9％），二尖瓣成形术（MVP）3例（2．6％），AVR＋MVP5例（4．3％），三尖瓣置换术3例（2．6％）。同期行左心房血栓清除术18例（15．7％），三尖瓣成形术71例（61．7％），Bentall手术6例（5．2％），冠状动脉旁路移植术15例（13．0％）。结果术后早期死亡1例（0．87％）。术后早期主要并发症包括重度低心排血量综合征6例，新发房颤17例，呼吸机延迟拔管12例，急性肾功能衰竭3例，脑部并发症3例。术后6个月复查，112例（97．4％）生存，心功Ⅲ一Ⅳ级8例（7．14％）。结论老年患者心脏瓣膜手术虽然手术风险较高的，但仍可以获得满意效果。
Objective To evaluate the outcomes for elderly （ 〉 70 years） patients undergoing valvular heart surgery and determine the early mortality and major morbidity associated with cardiac valve surgery in the elderly. Methods Between 2005 and 2011,1366 patients underwent cardiac valve surgery in our department. 115 patients （65 males, 50 females） were 70 or ol- der[ aged （74.3 ＋ 3.1 ）years 1. Rheumatic valvular disease presented in 68 （59.1% ） , degenerative valvular disease in 33 （28.7 % ） , congenital heart disease in 6 （5.2 % ） and the others in 8 （7.0%）. 20 cases（ 17.4% ） had hypertent^on, 17 ca- ses（15.8 % ） had diabetes mellitus, 18 （15.7%） had coronary hear disease . Chronic obstructive pulmonary disease was found in 25 cases（21.7 % ）, and renal insufficiency was found in 9（7.8 % ）. 6 patients（5.2% ） had the history of cerebro- vascular disease. 72 （62.6 % ） had atral fibrillation and 11 cases （9.6%） had the history of cardiac valve surgery previously. 75 （65.2 % ） cases were in New York Heart Association （NYHA） functional class m - IV. Left ventricular ejection fraction （LVEF） was 0.28 -0.72 （0.53 ＋ 0.01 ）. All the patients receieved coronary angiography preoperatively. All the operations were performed on cardiac-pulmonary bypass （CPB） with moderate hypothermia. During CPB, the perfusional pressure was maintained between 60 - 70 mm Hg and the oxygen saturation for mixed venous blood was kept above 0.70. Artificial uhrafili- tration was performed for all the patients during the time of CPB. 55 （47.8 % ） patients had mitral valve replacement（ MVR）, 3 （2.6%） had mitral valve repair（MVP） , 33 （ 28.7 % ） had aortic valve replacement （AVR） , 16 （ 13.9 % ） had AVR ＋ MVR, 5（4. 3% ） had AVR ＋ MVP, and 3 had tricuspid replacement . The concomitant procedures included left atrial thrombus scavenging in 18（ 15.7% ）, tricuspid valvularplasty in 71 （61.7 % ）, bental procedure in 6 （5.2 % ）, and coronary artery bypass grafting（CABG） in 15 （ 13.0 % ）. Results The early mortality was 0.87%. The major complications included sever low cardiac output syndrome in 6 patients, transient atrial fibrillation in 17 , acute renal failure requiring dialysis in 3, delayed ventilation assistance in 12, and stroke in 3. 112（97.4% ） patients survived during 6 months period of follow-up, in whom only 8 （ 7.14% ） were in NYHA functional class 111 - 1V which was lower significantly compared with that preoperatively. Conclusion Heart valve surgery for elderly patients can get satisfactory result and early mortality and major mortality is low for them. Concerns over the risk of cardiac valve surgery in the elderly should not prevent referral, and elderly patients ean do well.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2012年第3期146-148,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
