60岁以上老年人心脏手术的围术期治疗及影响因素  

Peri-operative treatment and risk factors of cardiac surgery in old patients above 60 years

作　　者：崔少鹏[1] 高奇英[1] 

机构地区：[1]山西省人民医院心外科,太原030012

出　　处：《山西医科大学学报》2007年第9期828-830,共3页Journal of Shanxi Medical University

摘　　要：目的总结60岁以上老年人心脏手术的围术期治疗体会,提高老年人心脏手术治疗水平。方法老年心脏病患者52例,单纯冠状动脉病变35例,冠状动脉病变合并瓣膜病变3例,单纯瓣膜病变11例,左心房黏液瘤1例,升主动脉瘤2例。38例冠状动脉搭桥术(CABG)中,有2例同期行二尖瓣置换术,1例同期行二尖瓣、主动脉瓣置换术。单纯二尖瓣置换2例,二尖瓣合并主动脉瓣置换9例,黏液瘤切除术1例,Bentall术2例。27例体外循环时间平均为(120.00±33.47)min,主动脉阻断时间平均(82.26±38.17)min。结果在52例手术中,术后出现严重并发症8例(15.4%),其中低心排综合征3例;肺功能不全致低氧血症3例,其中格林-巴利综合征1例;肾功能衰竭1例;脑血栓1例。围术期死亡4例(7.7%)。结论60岁以上老年人心脏手术,围手术期出现低心排综合征,肺功能不全和肾功能衰竭是影响手术效果的主要因素。Objective To summarize the experiences of peri-operative treatment of cardiovascular surgery in old patients above 60 years, and to improve the successful rate of operation. Methods Fifty-two old patients were selected, including 35 with coronary artery disease （CAD）, 3 with CAD and accompanying valvular diseases, 11 with valvular diseases, 1 with myxoma, and 2 with ascending aortic aneurysms. Thirty-eight patients with CAD had coronary artery bypass graft （CABG）, of which, 2 with concomitant mitral valve replacement（MVR）, 1 with concomitant both mitral and aortic valve replacement（MVR ＋ AVR）. Among 11 patients with valvular diseases, 2 had MVR, 9 had MVR ＋ AVR. One patient underwent myxomatomy, and 2 Bentall operation. Mean cardiopulmonary bypass time of 27 patients was （ 120.00 ± 33.47） rain, and mean aorta clamping time was （82.26 ± 38.17） rain. Results Of 52 patients, 3 suffered from low cardiac output syndrome; 3 from pulmonary functional disorder, one of which suffered from Guillain-Barre syndrome; 1 from cerebral infarction; 1 from renal failure. The mortality rate was 7.7%. Conclusion Low cardiac output syndrome, pulmonary functional disorder and renal failure are the important risk factors in old patients receiving cardiovascular surgery.

关 键 词：心血管外科手术 围术期治疗 老年人 

分 类 号：R654.2[医药卫生—外科学]