老年心脏瓣膜手术早期死亡原因及相关因素分析

Early death reasons and related risk factors of cardiac valve replacement in the elderly

目的探讨≥60岁老年瓣膜疾病患者临床特点及手术早期死亡危险因素。方法回顾性总结1999年8月至2010年6月95例≥60岁瓣膜疾病并行瓣膜手术患者的临床资料,统计分析住院病死率,死亡原因及影响手术早期死亡危险因素。结果术后早期病死率为11·6%(11/95)。死亡原因有:低心排血量综合征,多器官功能衰竭、呼吸功能衰竭、脑血管意外。术后并发症发生率为37·9%;年龄>65岁、体外循环时间>3h、主动脉阻断时间>2h,术后出现并发症、呼吸机辅助时间>48h,输血量>2000ml是老年瓣膜手术后早期死亡潜在危险因素(P<0·05)。多元回归分析显示:年龄>65岁、体外循环时间>3h是老年瓣膜手术后早期死亡的独立预测因素。结论老年瓣膜疾病总体手术病死率可接受,根据老年瓣膜疾病患者临床特点进行术前评估,缩短手术时间,加强围手术期处理,减少并发症,可降低病死率。

Objective To evaluate the clinical characteristics and risk factors of early death in elderly patients with valvular surgery. Methods From August 1999 to June 2010, clinical data of 95 patients aged 60 years and older with valvular operation were investigated retrospectively. Hospital mortality, death reasons and risk factors of early death were analyzed. Results The operative mortality was 11.6% （11/95）. The main reasons of death were low output syndrome （ LOS）, muhiple organ failure（ MOF）, respiratory failure and cerebral vascular stoke. In this group, the morbidity of postoperative complications was 37.9%. Age 〉 65, eardiopulmonary bypass time 〉 3 h, aortic cross-clamping time 〉 2 h, postoperative complications, mechanical ventilation 〉 48 h and blood transfusion 〉 2000 ml were important risk factors for early death （ P 〈 0. 05 ）. Multivariate logistic regression showed that age 〉 65 and cardiopulmonary bypass time 〉 3 h were significantly independent predictors of operative mortality. Conclusions The mortality of cardiac valvular surgery in the elderly is acceptable. Evaluating the clinical pre-operative characteristics, shortening operative time, improving peri-operative management will be beneficial to reduce the operative mortality and the incidence rate of post-operative complications in eld- erly patients with vavular disease.