摘要
目的总结老年人瓣膜病的手术效果。方法 1993年至2004年252例≥65岁老年瓣膜病病人接受瓣膜手术,占同期瓣膜手术5．5％(252／4546例),其中男147例,女105例;平均年龄(67．9± 2．9)岁。风湿性瓣膜病201例(79.8％),非风湿性瓣膜病51例(20．2％)。术前心功能Ⅲ-Ⅳ级141例 (56．0％)。主动脉瓣置换63例,二尖瓣置换93例,二尖瓣成形42例,主动脉瓣置换+二尖瓣置换或成形47例,三尖瓣置换或成形7例。同期行冠状动脉旁路移植术34例。结果手术死亡23例(9．1％), 逐年病死率有下降趋势。与同期瓣膜手术16-64岁组相比,术后ICU时间显著延长[(60．1±101．2)h对 (43．0±70．6)h,P=0．00],术后带气管插管时间明显延长[(30．6±42.8)h对(24．1±45．0)h,P=0．02], 术后并发症发生率明显高(10．6％对6．4％,P=0．01),住院时间明显延长[(25．7±41．3)d和(19．6± 14．4)d,P=0．00]。手术死亡病人术前心功能级别明显高于生存者[(2．8±1．0)级对(2.4±1．0)级,P< 0．05];术前射血分数差异无统计学意义(55．8％对59．5％)。结论老年人瓣膜病手术总体手术病死率可以接受,近2年手术病死率已接近5％。多元回归分析显示,并行冠状动脉旁路移植术、主动脉瓣和二尖瓣双瓣手术、术后急性肾衰需要透析、体外循环时间长、主动脉阻断时间长是住院病死率的独立预测因子。
Objective To evaluate the outcome of valvular surgexy in the elderly. Methods Between 1993 and 2004, 4546 patients underwent cardiac valve operation at our hospital. 252 patients （5.5%）（ 147 males, 105 females） were 65 or older [ mean age （67.9±2.9） years]. Rheumatic valvular disease presented in 201（79.8%） patients and non-rheumatic valvular disease in 51 （20.2%）. 56.0% of patients were in New York Heart Association （NYHA） functional class Ⅲ～Ⅳ. 63 （25%） patients had aortic valve replacement （AVR）, 93 （36.9%） had mitral valve replacement （MVR）, 42 （16.7%） had mitral valve repair （MVP）, 47 （ 18.7 % ） had AVR ＋ MVR/MVP, and 7 （ 2.8 % ） had isolated tricuspid repair or replacement. 34 （ 13.5 % ） had concomitant coronary artery bypass grafting （CABG）. Results Results The operative mortality was 9.1%, and the tendency of decline was observed in recent 3 years. As compared with the patients aged 16 to 64 years, the duration of mechanical ventilation, stay in ICU and in hospital postoperatively was longer [（30.6±42.8）h vs. （24.1 ± 45.0） h, P = 0.02, （60.1 ± 101.2） h vs. （43.0 ± 70.6） h, P = 0.00, （25.7 ± 41.3） days vs. （19.6 ± 14.4） days, P = 0.00]. In this group, the morbidity of postoperative complications was significant higher than that of the patients aged 16 to 64 years （ 10.6% vs. 6.4%, P = 0.01 ）. Preoperative NYH function class was an important factor for postoperative mortality. Multivariate logistic regression showed that concomitant coronary artery bypass grafting （CABG）, AVR ＋ MVR/MVP, and prolonged cardiopulmonary bypass time, prolonged aortic cress-clamping time, postoperative acute renal failure demanding dialysis were significant independent predictors of operative mortality. Conclusion The mortality of cardiac valvular surgery in the elderly is acceptable. It is characterized by higher morbidity of postoperative complications and prolonged duration of stay in hospital. Concomitant CABG, AVR
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2005年第6期325-327,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
