| 大于68岁高龄心脏瓣膜疾病手术患者近中期疗效分析 |
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| 引用本文： | 施超,刘学刚,刘以尧,刘戈,孟金金,刁文杰,叶枫林.大于68岁高龄心脏瓣膜疾病手术患者近中期疗效分析[J].中华全科医学,2018,16(7):1061. |
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| 作者姓名： | 施超 刘学刚 刘以尧 刘戈 孟金金 刁文杰 叶枫林 |
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| 作者单位： | 蚌埠医学院第一附属医院心脏外科, 安徽 蚌埠 233004 |
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| 基金项目： | 2016安徽省高校优秀青年人才支持计划重点项目(gxyqZD2016167)；安徽省学术和技术带头人及后备人选学术科研活动资助项目(2015H070) |
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| 摘 要： | 目的 回顾分析近年蚌埠医学院第一附属医院 ≥ 68岁高龄心脏瓣膜疾病手术患者,总结外科及围手术期临床经验。 方法 选择蚌埠医学院第一附属医院2016年3月-2017年9月间,单中心接受手术的 ≥ 68岁高龄心脏瓣膜患者为研究对象,其中男性16例,女性9例。其中,风湿性心脏瓣膜病18例,感染性心内膜炎2例,老年退行性瓣膜病变5例。行二尖瓣置换术(mitral valve replacement,MVR)14例,主动脉瓣置换术(aortic valve replacement,AVR)5例,双瓣膜置换术(double valve replacement,DVR)2例,二尖瓣置换术+冠状动脉旁路移植术(coronary artery bypass graft,CABG)2例,主动脉瓣置换术+升主动脉置换术+冠状动脉旁路移植术1例,主动脉瓣置换术+二尖瓣成形术1例。合并手术包括三尖瓣成形术11例,左房血栓清除+左心耳切除1例,左房黏液瘤切除术1例。 结果 全组体外循环时间(126.2±57.2)min,主动脉阻断(72.3±48.2)min,术后呼吸机辅助(15.24±6.91)h,术后监护(49.12±18.82)h,术后住院(9.5±4.2)d。手术死亡1例(4%),各类手术并发症11例(44%),其中心律失常7例,肺部感染2例,切口裂开1例,活动性出血1例。术后患者心功能显著改善,活动能力不同程度改善。术后随访时间1~18个月,死亡1人,二尖瓣置换患者术后7月死于严重肺部感染,其余23例患者均存活,生活质量均显著改善。 结论 充分的围手术期处理、良好的心肌保护及完善的术中操作,老年心脏瓣膜病外科治疗是安全和有效的。
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| 关 键 词： | 直视心脏手术 心脏瓣膜病 高龄 |
| 收稿时间： | 2018-03-02 |
Short and medium-term surgical treatment effects of cardiac valve disease for patients more than 68 years old |
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| Affiliation: | Department of cardiac surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China |
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| Abstract: | Objective To retrospectively evaluate the outcome of valvular surgery for the elder patients and to summarize the clinical experience of surgery and perioperative period. Methods From March, 2016 to September, 2017, 25 elderly patients (≥ 68) underwent valvular operations in our hospital, including 16 male and 9 females. There were 18 cases of rheumatic valvular heart disease, 2 cases of infective endocarditis and 5 cases of senile degenerative valvular disease. A total of 14 patients had Mitral valve replacement (MVR), 5 had aortic valve replacement (AVR), 2 had MVR plus AVR, 2 had MVR combined with coronary artery bypass grafting (CABG), 1 had AVR plus CABG combined with ascending aorta replacement, and 1 had AVR combined with mitral valve repair. The other concomitant operation included 11 cases of tricuspid valve repair, 1 atrial thrombus clearance plus resection of left atrial appendage, and 1 left atrial myxoma resection. Results The time of cardiopulmonary bypass time (CPB), aortic cross-clamp, postoperative ventilator, postoperative care, and postoperative hospital stay were (126.2±57.2) min, (72.3±48.2)min, (15.24±6.91)h, (49.12±18.82)h, and (9.5±4.2) days respectively. The operative mortality was 4%. Operation complications included 7 cases of arrhythmia, 2 pulmonary infections, 1 postoperative hemorrhage, and 1 wound dehiscence. After the operation, the cardiac function of the patients was improved significantly, and the activity ability was improved in different degrees. Follow-up time was 1-18 months, 1 patient died of pulmonary infection 7 months after MVR operation. The remaining patients survived with life quality being significantly improved. Conclusion Adequate perioperative management, good myocardial protection and improved operation are safe and effective for elderly patients with valvular heart disease. |
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