老年二尖瓣病变外科治疗

Research on the surgical treatment of mitral valve diseases in the elder patients

目的 回顾研究160例老年重症心脏瓣膜病的手术适应证、手术方法和治疗效果.方法 对2005年6月至2013年12月收治的160例老年重症二尖瓣心脏瓣膜病患者一般情况、手术方法、合并症和外科治疗效果等临床资料,完成系统随访,分析影响手术预后的高危因素.结果 术后长期生存153例,早期死亡7例,占全组病例的4.4％,主要死因为心力衰竭、心肌梗死.随访145例,随访率94.8％.与同期60岁以下的二尖瓣病变患者比较,术后5年生存率明显降低[（88.19±0.17）％比（97.68±0.20）％].晚期死亡7例（0.12％例/月）,主要的死因为心力衰竭、呼吸衰竭、心肌梗死、肾功能衰竭.影响手术预后的因素有术前心、肺、肾功能.结论 老年重症二尖瓣病变患者合并症多,手术死亡率、并发症发生率均较高.

Objective To research the effects of mitral valve replacement （MVR） in the elder patients with mitral valve diseases （MVD）.Methods The documents of 160 cases undergoing MVR were reviewed,who aged 60 years old or over between June 2005 and December 2013.Demographices,clinicd pre-operation conditions,indication to surgery,early postoperative course and longterm outcome collected via hospital documents and outpatient follow-up.Many risk factors were analyzed.Results Follow-up to amounte to 94.8％.The mortality was 4.4％（7/160） with in 30 days.Heart failure and respiratory failure were the main causes of death.Compared with younger patients （＜60 years old）,longterm survival rate was lower in the old [（88.19±0.17）％ vs （97.68±0.20）％].There were also 7 late death （0.12％ case/M）,most of whom died of heart failure,respiratory failure,myocardial infarction,and renal failure.Risk factors for MVR in the old included New York Heart Association class Ⅲ-Ⅳ,diabetes,and lung incompetence.Conclusion The patients with MVD over 60 years old tend to present high postoperatively mortality and morbidity.