老年退行性心瓣膜病的临床研究

Clinical Study on Senile Degenerative Cardiac Valvular Diseases

本文对256例60岁以上老年患者进行全面的临床检查,以研究老年性退行性心瓣膜病的状况及临床表现。通过病史、物理检查、胸部 X 光、超声心动图、多普勒超声图、动态心电图、血液流变学、眼底及微循环等检查确定诊断。检出退行性心瓣膜病人98人,检出率38.28%,发病随增龄上升。受累瓣膜以主动脉瓣为主,约为二尖瓣的3倍,亦有联合瓣膜受累。心脏杂音非本病特异体征,约半数患者无明显杂音。心律失常为主要合并症,期前收缩及心房纤颤较多,束支传导阻滞及房室传导阻滞亦不少见。患者心脏室壁及腔室均较对照组增厚增宽,心脏功能亦明显减退。文章对老年退行性心瓣膜病发病情况、诊断及鉴别诊断以及转归进行了详细讨论。

256 patients,aged over 60 years,were analysed to study the degenerative valvular heart disease in the elderly in terms of clinical history,physical examination,X-rayfilm,ECG,echocardiography,rheology,microcirculation,etc.In the series,the rateof degenetative valvular heart disease in the elderly was 38.28% or 198 cases,theincidence increased with age.It was shown that involvement of the aortic valve was3 times that of the mitral valve and frequently involvement of both valves mightappear.About a half of the patients had no heart murmurs.The main complicationsin the patients were premature beats,atrial fibrillation,atrioventricular block,intra-ventricular block,etc.It was found that the thickness of the ventricular wall andthe ventricle volume become greter in the elderly.The cardiac function decreasedwith age.With reference to relevent literature,a discussion on the pathogenesis,cli-nical manifestations,diagnosis,differential diagnosis and prognosis of the degene-rative valvular heart disease in the elderly was made.