老年人心脏瓣膜置换手术的临床特点及围手术期处理  

Clinical characteristics of elderly patients suffering from heart valve replacements and experiences of the perioperative management

作　　者：焦国庆[1,2] 肖明第[1] 叶一舟[1] 林雷[1] 袁忠祥[1] 卢成宝[1] 吕志前[1] 

机构地区：[1]上海交通大学附属上海市第一人民医院心血管外科,200080 [2]南京医科大学附属无锡市第二人民医院胸心外科,214002

出　　处：《中华老年医学杂志》2007年第8期593-596,共4页Chinese Journal of Geriatrics

摘　　要：目的总结60岁以上心脏瓣膜置换手术387例的临床特点及围手术期处理经验。方法1998年5月至2006年5月共实施心脏瓣膜置换术1116例,60～89岁患者387例（老年组）,其中男178例,女209例,按年龄60～64岁、65～69岁、70～89岁分为3组,手术在体外循环中度低温下行瓣膜置换术,并发严重冠心病者行冠状动脉旁路移植术,并发心血管畸形者行矫治术。分析老年人瓣膜置换手术的临床特点,并以同期13～59岁的729例（非老年组）作比较。结果老年组术后早期（30 d内）发生各种并发症55例,并发症发生率14.2%,高于非老年组的11.2%（P〈0.05）。主要并发症为心包积液、胸腔积液、恶性心律失常、循环衰竭,肾功能衰竭及多脏器功能衰竭。老年组术后早期死亡10例（2.6%）,60～64岁4例、65～69岁3例、70～89岁3例；非老年组死亡31例（4.2%）。早期死亡的主要原因是恶性心律失常、呼吸循环衰竭、肾功能衰竭及多脏器功能衰竭。结论老年人心脏瓣膜置换术并发症发生率高,加强围手术期处理,可降低术后病死率。Objective To summarize the elderly cases（≥60 years） who underwent heart valve replacement operations and to analyze the characteristics and experiences of the perioperative management. Methods A total of 387 elderly patients （178 males and 209 females） suffering from heart valve replacements between May 1998 and May 2006 were enrolled in the study, The mean age was （68.0±4.4）years （aged 60-89 years）, They were divided into three groups according to age（60- 64 years, 65-69 years and 70-89 years） . All of them underwent hypothermia, cardiopulmonary bypass （CPB） and heart valve replacements, and patients with coronary artery disease （CAD） received coronary artery bypass graft. The clinical characteristics of elderly patients were analyzed and compared with those of 729 patients aged less than 60 years. Results There were 55 cases with complications （14.2%）during the early 30 days after operation in elderly group which was higher than in non-elderly group（11. 2%）, including 10 deaths. The major causes of early death were ventricular arrhythmia,respiratory and circulatory failure, renal failure and multiple organ failure. Conclusions The complications incidence of heart valve replacement are high in patients aged more than 65 years.

关 键 词：心脏瓣膜 人工 心脏瓣膜假体植入 围手术期医护 

分 类 号：R686[医药卫生—骨科学]