高龄老年患者心脏直视（外科）手术的临床分析

Clinical analysis on octogenarian patients undergoing open heart（cardiac） surgery

目的 回顾性分析≥80岁接受心脏手术的高龄患者的临床特点,评价手术方式、围术期管理和治疗结果.方法 选取我院2012年6月至2014年5月接受心脏手术的25例高龄患者,男性19例,女性6例,年龄80～91（82.6±3.0）岁,其中冠心病17例、瓣膜病6例、瓣膜病合并冠心病2例.结果 高龄患者合并症多,冠心病患者绝大多数为不稳定型心绞痛,多数有心肌梗死病史,瓣膜病变多为老年退行性变.本组围手术期死亡1例.术后最常见的并发症为房颤和心功能不全,急性肾损伤（AKI）、慢性贫血、低蛋白血症等发生率较高.结论 接受心脏外科手术治疗的高龄患者具有其自身特点,高龄不是手术禁忌证,但需进行细致评估,根据个体特点选择个体化手术策略,围手术期尤其需要精细的管理,出院后适当增加随诊频率.

Objective To describe the chnical characteristic of octogenarians who underwent cardiac surgery.To evaluate the operative procedure and perioperative management and to analysis the clinical results.Methods The retrospective analysis included the medical data on 25 patients aged 80 years or greater undergoing cardiac surgery at our department from June 2012 to May 2014.There were 19 male and 6 female patients,aging from 80 to 91 years with a mean of （82.6±3.0）years.Seventeen patients underwent coronary artery bypass grafting （CABG）.Six patients underwent valvuloplasty or valve replacement.Two patients underwent valve replacement combined with CABG.Results There were more coexisting diseases in octogenarians underwent cardiac surgery.The majority of patients with coronary heart disease were unstable angina pectoris and had a history of myocardial infarction.The pathology examination revealed most of patients with valvular disease were senile degenerative disease.One patient died in postoperative period.It was lower than that predicted by EuroSCORE Ⅰ scale（logistic）-17.44% and EuroSCORE Ⅱ-4.24.The most frequent complication was atrial fibrillation and cardiac insufficiency.Acute kidney injury （AKI）,chronic anemia,hypoproteinemia were observed at a higher incidence.Condusion Octogenarian patients have their own characteristics and the advanced age does not constitute a contraindication for cardiac surgery.Surgical strategy must be based on individual factors.Careful preoperative evaluation and intensive perioperative treatment must be enhanced in octogenarians who underwent cardiac surgery.Frequency of postoperative follow-up can be properly increased.