高龄患者心脏围手术期手术风险分析

Analysis of perioperative risks for elderly patients in cardiac surgery

目的探讨高龄心脏病患者围手术期特点及心脏手术的风险。方法选取2007年1月-2011年6月不同类型心脏手术病人255例,分为A组(≥70岁)55例,B组(<70岁)200例。分析两组间病人术前危险因素、手术策略及围术期监护的特点,对比两组间术后并发症及预后。结果术前危险因素中,原发性高血压、急性冠脉综合征、肾功能不全在A组占比例显著高于B组(P<0.05),EuroSCORE评分A组(5.56±2.26)高于B组(2.14±2.21,P<0.05)。术中体外循环时间A组(102.61±38.36min)显著短于B组(119.66±47.57min,P<0.05),主动脉阻断时间A组(63.57±27.08min)显著短于B组(79.46±35.29min,P<0.05)。术后A组肺部感染发生率,急性肾损伤发生率,呼吸机使用时间,ICU停留时间均高于B组(P<0.05);术后脑梗塞发生率,心律失常发生率,总引流量,血管活性药物使用情况及住院死亡率两组间无显著差异。结论准确识别高龄患者围术期危险因素,制定个性化策略,缩短体外循环时间,积极预防并正确处理围术期并发症,可有效降低高龄患者群体心脏手术的风险。

Objective To analyze the perioperative characteristics and risk of elderly patients underwent cardiac surgery. Methods From January 2007 to June 2011,255 patients underwent different cardiac surgery were included in this study. The patients were divided by age into two groups： 55 patients with age I〉70 years in group A and 200 patients with age〈70 years in group B. Preoperative risk factors, surgical strategy, perioperative management, postoperative complications and prognosis were compared between the two groups. Results Hypertension, acute coronary syndrome and renal insufficiency were found significantly higher in group A than in group B（P〈0.05）, and so was EuroSCORE （5.56±2.26 vs 2.14±2.21,P〈0.05）; Time of eardiopulmonary bypass in group A （102.61±38.36 min） was significantly shorter than in Group B （119.66±47.57 min,P〈0.05）, and so was time of aorta cross clamping （63.57±27.08 min vs 79.46±35.29 min,P〈0.05）.Frequency of postoperative lung infection and acute kidney injury in group A were significantly higher than in Group B （P〈0.05）. Ventilation time and length of ICU stay were significantly longer in group A than in group B. There was no significant difference in stroke, severe ventricular arrhythmia, total drainage, use of inotropic drugs between the two groups. No significantly difference in hospital mortality was shown between the two groups. Conclusion Careful discrimination of perioperative risks, individualized surgical strategy, shorter cardiopulmonary bypass time , active and correct management of postoperative complications may reduce operative risk and mortality for elderly patients in cardiac surgery.