老年心血管病的外科治疗及围术期处理

Surgical treatment and perioperative management in elderly patients with cardiovascular disease

目的 :总结老年心血管病外科手术治疗及围术期处理的特点。方法 :回顾性研究分析 1996年 1月至2 0 0 2年 12月间 ,在我科手术的 60岁以上老年心血管病患者 97例 ,对其病变特征、手术方式、体外循环管理及术后并发症防治进行讨论。结果 :术后出现并发症 19例 ( 19 6% ) ,死亡 5例 ( 5 2 % ) ,3例死于严重术后低心排 ,2例死于多脏器功能衰竭。随访 68例 ( 70 1% ) ,术后心功能和生活质量明显改善。结论 :老龄是心血管外科治疗的高危因素之一 ,但并非手术禁忌 ,严格掌握手术适应证、选择适当手术方式。

Objective To summarize the clinic experience of surgical treatments and perioperative managements in elderly patients with cardiovascular disease. Methods A retrospective study was carried out at our hospital from Jan. 1996 to Dec. 2002. A total of 97 elderly patients with cardiovascular diseases submitted to surgical treatment were included. The clinical characters, surgical techniques, cardiopulmonary bypass managements, main complications, and therapeutic principles were reviewed. Results Postoperative complications occurred in 19 (19.6%) patients. 92 patients (94.8%) were successfully treated and their cardiac functions were improved significantly, especially in the patients with preoperative NYHA Ⅳ. Only 5 patients (5.2%) died, 3 from severe postoperative low output syndrome, the other 2 from multiple organ failure. Conclusion Cardiac surgery in elderly patients accounts more and more in our nowadays surgical activities. Advanced age is an independent risk factors but not a contraindication for the operative process. We believe that choosing the appropriate operative modalities, controlling the preoperative comobolites efficiently, and paying good attentions to the management of perioperative cardiac function and postoperative complications, can help to improve results.