老年患者主动脉瓣置换术临床研究

Clinical study of cardiac aortic valve surgery in elderly patients

目的探讨老年心脏瓣膜病患者施行主动脉瓣手术的临床效果。方法连续选择81例,年龄>60岁的主动脉瓣手术患者的临床资料进行回顾性分析。建立logistic回归模型,分析围术期各个相关因素对于治疗效果的影响。结果早期死亡8例,病死率为9.88%。再次手术、心功能NYHA分级、体外循环时间长是影响患者术后死亡的危险因素。术后发生并发症31例,主要包括:低心排出量综合征、多脏器功能不全综合征、肺部感染、急性肾衰竭、术后呼吸功能不全。结论对症状严重而并发症少的老年心脏瓣膜病患者进行主动脉瓣手术是安全、有效的。

Objective Cardiac valve surgery is currently reserved for selected elderly patients with severe symptoms and low preoperative morbidity. This study is intended to evaluate the short - term outcome of elderly patients undergoing aortic valve surgery, discuss perioperative management and efective ways to improve surgical outcomes. Methods From January 2001 to December 2010. aortic valve surgeries were per- formed on 81 consecutive elderly patients （49 men and 32 women） in our Department of Cardiothoracic Surgery. The clinical data of all patients were collected and analyzed. A Logistic model was established to evaluate the perioperative factors＇ influence on the mortality rate. Results The operative mortality was 9.88% （ 8/81 ） in our group. The prevalence of postoperative complications is 38.27% （31/81）, including severe low cardiac output syndrome（ LCOS）, multiple organ dysfunction syndrome （MODS）, pulmonary infection, acute renal failure and pulmonary dysfunctiony. Conclusion This study further confirms that cardiac aortic valve surgery can achieve satisfactory results in elderly patients. Active and eficient management and care for every single perioperative procedure will play a very important role in significantly reducing the operative risks as well as improve the short - term outcome of the surgery for elderly patients.