老年钙化性心瓣膜病的临床特点及其对心功能的影响  

Clinical features of calcified valvular disease in elderly and its influence on cardiac function

作　　者：张新超[1] 全锦花[1] 温伟[1] 陈燕启[1] 王旭涛[1] 

机构地区：[1]卫生部北京医院急诊科,北京市100730

出　　处：《中华老年多器官疾病杂志》2008年第1期19-22,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的分析老年钙化性心瓣膜病的临床特征,并观察其对心功能的影响。方法经超声心动图检查证实的132例老年钙化性心瓣膜病患者,分为钙化性瓣膜病组和钙化性瓣膜病+冠心病组,并与同期不伴钙化性瓣膜病的冠心病43例作对照。结果钙化性心瓣膜病以单纯主动脉瓣病变(40.2%)最多见,其次主动脉瓣+二尖瓣病变(34.8%),功能异常主要为主动脉瓣狭窄、关闭不全、或(和)二尖瓣关闭不全;76.7%病例无明显呼吸困难、晕厥、心绞痛等症状,起病隐匿,55.0%患者缺乏瓣膜病变相关病理性杂音,轻度的钙化性心瓣膜病本身对心脏血液动力学影响较小;钙化性瓣膜病+冠心病组患者的左心扩大明显,心功能不全发生率高,且左心收缩功能不全的程度较重;老年钙化性瓣膜病心律失常(室性早搏、房颤与病态窦房结综合征、房室传导阻滞)的发生率也较高。结论老年钙化性心瓣膜病早期缺乏特征性的症状和体征,对心功能与血液动力学影响不大,随着瓣膜狭窄和(或)关闭不全的加重,逐渐成为心脏重构和心功能不全的影响因素,若合并冠心病等心肌病变,则会起到加速或加重心力衰竭的作用。Objective To analyze the clinical features of calcified valvular disease in the elderly,and to observe its influence on the cardiac function. Methods One hundred and thirty-two cases, aged over 60 years, with calcified valvular disease identified by Doppler echocardiography were divided into two groups： calcified valvular disease group and calcified valvular disease complicated by coronary artery disease group. Forty three cases with coronary artery disease served as control. Results Most valvular lesions of calcified valvular disease were at the aortic valve （40.20%） followed by aortic valvular combined with mitral valvular lesions （34.8%）. The main functional abnormalities were aortic stenosis, aortic insufficiency, or/and mitral insufficiency. The development of calcified valvular disease was insidious, and most cases （76.7%） had no significant cardiovascular disease-related symptoms such as dyspnea, syncope, angina pectoris, etc. Approximately half of cases lacked valvular lesion-related murmurs. Mild calcified valvular lesion had little influence on the hemodynamics. Significant enlargement of left-heart and high incidence of cardiac dysfunction were found in cases with calcified valvular disease complicated by coronary artery disease. There was also a high incidence of arrhythmia （premature ventricular beats, atrial fibrillation, sick sinus syndrome and atrial-ventricular block） in elderly cases with calcified valvular disease. Conclusion Calcified valvular disease in the elderly lacks characteristic symptoms and signs in the early stage, and mild calcified valvular lesions has a little influence on the hemodynamics and cardiac function. With the aggravation of valvular stenosis and/or insufficiency, it becomes an important factor for cardiac re-modeling and cardiac dysfunction. If combined with coronary artery disease, calcified valvular abnormalities may play important role in heart failure.

关 键 词：心脏瓣膜病 老年人 心脏功能试验 

分 类 号：R542.5[医药卫生—心血管疾病] R541[医药卫生—内科学]