老年心脏外科手术患者诊疗策略

Treatment strategy of the elderly patients with cardiac surgery

目的：分析老年患者心脏外科手术围术期处理,探讨老年心脏外科手术患者的诊疗策略。方法：回顾性分析本院2010年9月至2013年9月接受心脏外科手术的215例患者,分为青年组（≤44岁）59例、中年组（45~59岁）96例、老年组（≥60岁）60例共3组。对比各组的术后住院时间、术后机械通气时间、重症监护时间、引流管留置时间、并发症发生率。结果：214例患者手术后痊愈出院,治愈率为99.5%。老年组死亡1例,病死率为1.7%,中青年组无死亡病例。老年组术后住院时间为（13.5±2.8）d,与中青年组比差异无统计学意义（P〉0.05）;重症监护时间为（3.3±1.1）d,术后机械通气时间（14.8±3.5）h,引流管留置时间（3.7±1.1）d,与中青年组差异有统计学意义（P〈0.05）。并发症发生率分别为青年组28.5%,中年组37.5%,老年组45.0%。结论：老年患者心脏外科手术风险高,但只要掌握手术适应证,充分作好术前准备、术中及术后处理,手术治疗是安全、有效的。

Objective： To summarize the treatment strategy of the elderly patients with cardiac surgery by analyzing the perioperative care.Methods： From September 1 2010 to September 30 2013, 215 patients were undergone cardiac operations in our hospital. They were divided into young group （age≤44 y, 59 cases）, middle-aged group （age between 45~59 y, 96 cases） and elderly group （age≥60 y, 60 cases）. The postoperative hospital stay, postoperative mechanical ventilation time and intensive care time, drainage tube indwelling time and com-plication rate of elderly group were compared with the young group and middle-aged group.Results： Two hun-dred and fourteen cases were cured after operations and the cure rate was 99.5%. One case of elderly group died. The operative mortality in group was 1.7%. The postoperative mechanical ventilation time and intensive care time and drainage tube indwelling time of elderly group, except the postoperative hospital stay, were signiifcantly longer then the young group and middle-aged group. Complication rate of elderly group was 45.0%.Conclusion：The surgical treatment is safe and effective to the elderly patients if the surgical indications, intraoperative and postoperative management are mastered well.