60岁以上瓣膜病患者的瓣膜置换术65例临床分析  

Analysis of surgical treatment in the elderly patients above 60 years old with heart valvular disease

作　　者：丁凯[1] 周华富[1] 覃家锦[1] 郑宝石[1] 李世康[1] 冼磊[1] 郭建极[1] 陈铭武[1] 何巍[1] 

机构地区：[1]广西医科大学第一附属医院心胸外科,南宁530021

出　　处：《重庆医学》2010年第13期1687-1688,1690,共3页Chongqing medicine

摘　　要：目的总结60岁以上瓣膜病患者的手术治疗经验及死亡原因。方法回顾性分析2003年1月至2008年12月60岁以上65例瓣膜病患者的临床资料。男32例,女33例,年龄60-78（63.1±4.1）岁。均在全麻体外循环下行瓣膜置换术,停跳手术19例,不停跳手术46例。其中MVR 29例,AVR 18例,DVR 18例,同期TVP 23例,左房血栓清除8例,共置入瓣膜83枚,机械瓣50枚,生物瓣33枚,转机时间51-305（105.2±48.7）min,阻断24-160（72.3±29.6）min,住院时间7-109（33.5±17.7）d。结果术中死亡2例,术后住院期间死亡5例,早期死亡率10.77%。放弃治疗6例（未随访）,术后并发症13例,呼吸功能不全5例,切口愈合不良3例,肺部感染2例,胸腔积液2例,精神症状1例。随访6-77个月,随访50例,院外死亡3例。结论选择恰当手术时机,充分术前准备,改善心功能,术中谨慎操作,良好心肌保护,术后加强监护,对60岁以上瓣膜病患者行瓣膜置换术是安全可行的。Objective To summarize the experience of surgical treatment and causes of death in patients above 60 years with val- vular disease. Methods Clinical datas of 65 cases （32 men,33 women, 60 78 years old） above 60 years with valvular disease from January 2003 to December 2008 were retrospectively reviewed, valve replacement procedures were performed in general anesthesia and cardiopulmonary bypass（CPB）, with on-pump performed in 19 cases and off pump in 46 cases. There were 29 cases received mi- tral valve replacement （MVR）. 18 received aortic valve replacement（AVR）. 18 received double valve replacement （DVR）. all of 23 cases of tricuspid valvuloplasty （TVP） and 8 cases removal of left atrial thrombus in the same period. 83 valves replacements（me- chanical valve 50 and biovalve 33） were performed, the CPB time and aortic block time and hospitalization time were 51-305（105. 2±48.7）minand 24-160（72.3±29.6）min and 7-109（33.5±17.7）d respectively. Results 6 cases gave up treating（not follow up）. 7 cases died in the early stage of operation and the mortality rate was 10.77%. In this group, 13 postoperative complications occurred,in which 5 of respiratory dysfunction, 3 of bad wound healing, 2 of pneumonic infection, 2 of thoracic cavity effusion and 1 of psychiatric symptom. 50 patients were followed up for 6-77 months with a follow-up rate of 96.2%（50/52）. 3 cases died out of hospital. Conclusion Select the appropriate timing of operation, correct preoperative heart function, perfect surgical technique, con- summate myocardial preservation and enhance the nursing in postoperative, valve replacement is considerably safe and available therapy in patients with valvular disease above 60 years.

关 键 词：老年 瓣膜病 瓣膜置换术 

分 类 号：R654.2[医药卫生—外科学] R592[医药卫生—临床医学]