老年心脏瓣膜病患者外科手术的临床分析

Cardiac valve surgery in elderly patients

目的探讨老年心脏瓣膜病患者施行心脏瓣膜手术的临床效果。方法连续选择90例年龄≥60岁的心脏瓣膜手术患者的临床资料进行回顾性分析。建立logistic回归模型,分析围手术期各个相关因素对治疗效果的影响。结果早期死亡8例,病死率为8.89%。术后发生并发症34例,包括低心排出量综合征、心室颤动、多脏器功能不全综合征、肺部感染、急性肾功能衰竭。再次手术、心功能(NYHA)分级、体外循环时间是患者术后死亡的危险因素(P<0.05)。结论对症状严重而合并症少的老年心脏瓣膜病患者进行心脏瓣膜手术是安全、有效的。

Objectives To evaluate the short-term outcome of elderly patients undergoing heart valve surgery, and to explore perioperative management and effective ways to improve surgical outcomes. Methods From Jan 1994 to March 2008,heart valve surgery was performed on 90 consecutive elderly patients（38 men and 52 women） in our Department. The clinical data of all patients were collected and analyzed. A Logistic model was established to evaluate the perioperative factors influencing the fatalily rate and mobidity rate. Results The operative fatality was 8. 89% （8/90） in this group. The incidence of postoperative complications was 37.78% （34/90） ,including severe low cardiac output syndrome, ventricular fibrillation, multiple organ dysfunction syndrome, pulmonary infection and acute renal failure. Conclusions This study further confirms that cardiac valve surgery can achieve satisfactory results in elderly patients. Active and efficient management and care for every perioperative procedure will play a very important role in reducing the operative risks as well as improving the short-term outcome of the surgery for elderly patients.