老年患者心脏手术围手术期处理及风险分析

Perioperative treatment and surgery risk for cardiac surgery of elderly patients

目的探讨分析老年患者心脏手术围手术期处理及手术风险。方法选取2002年8月—2011年10月于该院行心脏手术患者共260例,其中65岁以下患者200例(I组),65岁以上患者60例(Ⅱ组),分析两组患者术前一般状况、合并症及手术策略,并对比两组间术后并发症及预后情况。结果两组患者性别分布、NYHA分级、择期手术率及手术种类无明显差异,Ⅱ组患者术前患高血压、糖尿病、COPD及脑血管疾病数目显著多于I组(P<0.05)。Ⅱ组术后治疗时间、慢性肾功能衰竭及肺部感染发生率要显著高于I组,同时某些术后并发症的发生与术前合并症有关。两组患者死亡率无显著差异(P>0.05)。结论应重视老年患者心脏手术围术期危险因素,并制定个性化策略,缩短体外循环时间,积极预防并正确处理围术期并发症,以减低手术风险。

Objective To analyze the perioperative treatment and surgery risk of elderly patients under going cardiac surgery.Methods The 260 patients who underwent cardiac surgery from Aug.2002 to Oct.2011 were selected.All the patients were divided into 2 groups：group I（65y） and group Ⅱ（65y）.The preoperative general condition,complication and operational manner were analyzed.The postoperative complication and prognosis were compared between 2 groups.Results There were not significant differences in general condition such as sex distribution,NYHA level,rate of selective operation and kind of surgery.The preoperative complication rates of hypertension,diabetes,COPD and cerebrovascular disease in group Ⅱ were higher than those in group I（P0.05）.Meanwhile the postoperative treat-time and rate of some complication of group Ⅱ were higher than group Ⅰ,and the occurrence of some postoperative complication（renal failure and pulmonary infection）was related to the preoperative complication.Besides,there was no difference in mortality rate between 2 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.