75岁以上高龄患者的外科决策——附133例病例报告

目的探讨预测高龄患者术后转归的方法,提高高龄患者手术安全性。方法回顾性分析该院2004年1月～2006年12月133例年龄在75岁以上(不含75岁)的高龄普外科手术患者的临床资料。结果POSSUM评分系统预测的术后并发症和死亡分别为51例(38.3%)和9例(7.1%),P-POSSUM评分系统计算的术后死亡为3例(2.3%),实际发生并发症和死亡分别为27例(21.5%)和2例(1.2%)。手术后发生并发症的患者的POSSUM预测值、手术评分、住院时间、住院费用、手术时间、术中输血量均明显增加。手术时间越长,并发症的发生率越高。急诊手术的术后并发症较高。结论POSSUM和P-POSSUM评分系统可以预测术后并发症率和死亡率;对于高龄患者,应该尽量缩短手术时间,避免急诊手术,减少术后并发症。     

75岁及以上高龄结直肠癌患者手术治疗安全性、远期疗效及腹腔镜手术可行性评估

目的 评估≥75岁高龄结直肠癌患者手术安全性、远期疗效及腹腔镜手术的可行性.方法 回顾性分析2007年9月-2010年10月在复旦大学附属华山医院普通外科接受手术治疗的≥60岁的301例结直肠癌患者,分为高龄组(≥75岁,132例)及低龄组(≥60且＜75岁,169例),评估高龄结直肠患者的手术危险因素,高龄患者接受根治手术的风险因素、安全性及远期疗效.回顾性分析2009年1月-2010年10月共27例年龄≥75岁并接受一期腹腔镜下根治性手术的结直肠癌患者(腔镜组)及同期56例年龄≥75岁并接受一期开放根治术的患者(开放组)的临床资料,比较两组近期疗效,探讨腹腔镜手术在高龄结直肠癌患者中的安全性和适用性.结果 高龄组内科合并症发生率为75.8％(100/132),显著高于低龄组的50.9％(86/169,P=0.000).高龄组术后并发症发生率为48.5％(64/132),显著高于低龄组的32.0％(54/169,P=0.004);两组手术相关死亡率分别为2.3％(3/132)、1.8％(3/169),差异无统计学意义;两组术后镇痛要求、术后排气时间、进食半流质时间、保留导尿管时间的差异均无统计学意义(P值均＞0.05),高龄组术后住院时间显著长于低龄组(P＜0.05).患者随访于2011年4月30日完成,平均随访时间为(34.5±0.8)个月,其中213例健在,18例带瘤生存,59例死亡,失访11例.高龄组术后平均生存时间为(32.1±1.0)个月,术后3年总生存率为62.1％,无进展生存率为56.9％.低龄组平均生存时间为(36.6±1.2)个月,术后3年生存率为79.0％,无进展生存率为74.5％.COX多因素回归分析显示,手术根治性及肿瘤分期、分化程度是影响预后的主要因素(P值均＜0.05).结论 在≥75岁高龄结直肠癌患者中,通过进行术前综合病情评估,选择合适的病例进行根治性手术治疗,加强监护,积极治疗合并症,不仅可使患者安全耐受手术,而且可获得满意的远期效果.腹腔镜手术安全可靠,近期疗效满意,应成为治疗高龄结直肠癌患者的首选.     

高龄肺癌患者围手术期临床特点分析

目的：分析高龄（年龄≥70岁）肺癌患者围手术期的临床特征、手术方式、术后主要并发症等情况,探讨高龄肺癌患者围手术期的安全性。方法回顾分析54例（A组）高龄肺癌手术患者与同期住院70岁以下肺癌手术患者78例（B组）的临床特征、手术方式、术后主要并发症等情况,比较2组上述围手术期临床特点的差异。结果 A组患者术后并发症发生率（40.74%）显著高于对照组（20.51%）（P<0.05）。A组患者术后拔管时间5～31 d及住院时间7～20 d多于对照组,但2组比较差异无统计学意义。结论高龄肺癌患者心、肺合并症相对较多,肺功能减退或功能不全,术后拔管时间及住院时间长,但高龄不是手术治疗主要的禁忌证,把握好手术适应症,认真做好围手术期管理,选择恰当的手术方式,其术后并发症发生率及死亡率并无增加。     

不同手术时机对高龄股骨粗隆间骨折术后结局的观察

目的:探讨不同手时机对高龄股骨粗隆间骨折术后结局的影响.方法:对经髋动力锁定钢板治疗的129例75岁以上高龄股骨粗隆间骨折患者进行回顾性研究,按照手术时间分为A组≤24小时、1天＜B组≤4天和C组＞4天,观察各组术后30天并发症发生率及术后30天与1年死亡率.结果:A、B、C三组术后30天死亡率差异比较无统计学意义(P＞0.05);术后30天并发症发生率B组与A组和C组及术后1年死亡率B组与C组间有显著差异(P＜0.05).结论:高龄股骨粗隆间骨折后1～4天内手术,可明显降低术后30天并发症发生率及术后1年死亡率,为高龄股骨粗隆间骨折的最佳手术时机.     

高龄老年人髋部骨折的临床治疗分析

目的:分析高龄患者髋部骨折的治疗方法。方法:回顾总结132例75岁以上髋部骨折患者,获得随访住院患者手术治疗95例,非手术治疗37例。对照分析手术治疗与非手术治疗患者功能恢复、并发症的发生和死亡情况。结果:采用手术治疗高龄髋部骨折患者术后死亡率及并发症发生率明显低于非手术组。结论:做好术前评估,有效控制并发症,高龄患者髋部骨折应早期手术治疗。     

老年胃癌患者行微创根治术的临床研究

［摘要］ 目的　观察老年胃癌患者行微创根治术的安全性和临床疗效．方法　回顾性分析在上海市松江区中心医院行微创根治术的282例胃癌患者,根据年龄分为2组:高龄组78例,年龄大于等于70岁;非高龄组204例,年龄低于70岁．比较2组患者临床病理特征、手术情况和术后并发症发生率． 结果　高龄组患者ASA评分差于非高龄组（P＜0.001）,且合并糖尿病（P＝0.024）、高血压（P＜0.001）患病率明显高于非高龄组．各组患者平均手术时间、术后输血率、术中失血量、中转开腹率、术后排气时间以及术后住院时间等指标均无显著差异（P＞0.05）．高龄组和对照组相比,术后总并发症和手术相关并发症发生率无明显差别（P＞0.05）,但高龄组术后内科系统并发症发生率为11.54%,显著高于对照组的1.96%（χ2＝11.771,P＝0.001）．高龄组和非高龄组术后30 d内死亡率分别为2.56%和1.47%,差异无统计学意义（P＞0.05）．结论　微创根治术并未增加老年患者的手术相关风险,但由于其合并多种内科疾病,术后内科并发症发生率明显提高．     

人工髋关节置换治疗高龄股骨颈骨折

目的: 探讨人工髋关节置换治疗高龄股骨颈骨折的可行性、安全性,提出围手术期处理方法和关节置换方式。方法: 回顾分析2000年3月~2006年9月人工关节置换治疗70岁以上的股骨颈骨折26例的疗效及并发症情况,比较两组人工股骨头置换组20例和全髋置换组6例的平均住院时间、手术时间、术中和术后出血量、输血量、Harris评分、下地时间等的差异。结果: 两组术中、术后均无病死,Harris评分平均改善38.2分,优良率为88.46%,并发症发生5例,发生率19.23%;人工股骨头置换组在手术时间、术中、术后出血量、输血量均明显低于全髋置换组(P<0.01~P<0.001),而Harris评分、下床时间和住院时间两组差异均有统计学意义(P<0.001和P<0.01)。结论: 对高龄股骨颈骨折患者,人工关节置换为有效的治疗方式,能显著改善患者的生存质量,只要经过正确的围手术期处理,该类患者能度过围手术期,取得良好的治疗效果;两种手术方式中人工股骨头置换更适合80岁以上高龄股骨颈骨折患者。     

70岁以上高龄患者的外科决策-附246例病例报告

目的 探讨POSSUM评分系统对高龄患者手术风险的评定意义.方法 回顾性分析某普外病房2004年1月～2006年12月246例年龄在70岁以上(不合70岁)的高龄手术患者的临床资料.结果 POSSUM评分系统预测的术后并发症和死亡分别为87例(35.5%)和16例(6.5%),P-POSSUM评分系统计算的术后死亡为5例(2.0%),实际发生并发症和死亡分别为56例(22.8%)和4例(1.6%).手术后发生并发症患者的POSSUM预测值、手术评分、住院时间、住院费用、手术时间、术中输血量均显著高于未发生并发症的患者.呼吸系统评分越高,术后并发症的发生率越高.急诊手术的术后并发症发生率较高.结论 POSSUM评分系统可以协助评估高龄患者的手术风险;对于高龄患者,应该尽量缩短手术时间,减少术中出血,避免急诊手术,并注意患者呼吸系统情况.     

腹腔镜联合纤维胆管镜对高龄胆总管结石合并胆囊结石的疗效分析

目的 分析腹腔镜联合纤维胆管镜治疗胆总管结石合并胆囊结石高龄患者的临床效果.方法 抽取2014年12月—2016年3月我院收治的92例胆总管结石合并胆囊结石患者,根据手术方式的不同分为2组各46例,对照组行开腹手术,观察组行腹腔镜联合纤维胆管镜手术.对比观察2组患者的手术情况及术后并发症发生率.结果 观察组手术时间、术中出血量、术后排气时间和住院时间均少于对照组,差异有统计学意义(P<0.05);观察组术后并发症发生率为2.17%,明显低于对照组的17.39%,差异有统计学意义(P<0.05).结论 腹腔镜联合纤维胆管镜治疗高龄胆总管结石合并胆囊结石,可缩短手术时间、术后排气时间及住院时间,减少术中出血量,且术后并发症发生率低,临床效果显著.     

解剖性分离方法在肝切除术中的临床应用

目的探讨降低肝癌肝切除术后并发症和死亡率的有效途径。方法回顾性分析398例肝脏恶性肿瘤患者的临床资料,其中243例采用解剖性分离方法(A组)进行肝切除;155例采用传统钳夹法(B组)进行肝切除。围手术期常规保肝治疗。比较2组术中出血及输血情况、术后肝功能、并发症发生率、手术死亡率以及住院时间。结果A组肿瘤直径(6.02±3.24)cm,术中出血量(445±240)ml,输血52例(24.3%),输血量(520±280)ml。无手术死亡及腹腔出血、肝功能衰竭等严重并发症,轻度并发症12例(4.9%),术后住院时间为(13.4±4.9)d。B组肿瘤直径(5.84±2.93)cm,术中出血量(1 200±320)ml,输血53(34.2%)例,输血量(1 400±623)ml。手术后30d内死亡5例(3.23%),发生并发症25例(16.1%),其中术后腹腔或肝创面出血5例、肝功能衰竭5例。术后住院时间(18.9±10.3)d。A组术中出血量、输血量、手术死亡率、术后严重并发症发生率、总并发症发生率、术后住院时间均显著低于B组(P<0.05,P<0.01)。结论在积极的围手术期处理同时,采用解剖性分离方法进行肝切除,可以显著降低肝癌肝切除手术并发症和死亡率。     

高尿酸血症与风湿性主动脉瓣置换后不良事件的关系:>40岁患者分析

目的 探讨高尿酸血症对中老年风湿性主动脉瓣置换后患者的院内及1年不良事件的预测价值.方法 连续性入选2009年3月~2013年7月间在我院诊断为风湿性主动脉瓣疾病并接受外科主动脉瓣瓣膜置换手术中老年患者(>40岁),根据血清尿酸水平,分为高尿酸血症组和血尿酸正常组两组.比较两组临床资料的差异,多因素分析评估高尿酸血症与不良事件发生的关系.结果共有632名患者入选,分为高尿酸血症组(n=381)和血尿酸正常组(n=251).高尿酸血症组院内死亡率显著高于血尿酸正常组(7.6%vs 2.0%,P=0.002).血尿酸与肾小球滤过率呈负相关(r=-0.421,P<0.001),与C反应蛋白呈正相关(r=0.093,P=0.025).多因素分析显示,经校正影响预后的混杂因素,包括年龄、NYHA心功能III-IV级和术后急性肾损伤后,高尿酸血症与院内死亡率(OR=3.07,95%CI:1.13,8.37,P=0.028)和1年死亡率(HR=3.14,95%CI:1.30,7.62,P=0.011)独立相关.Kaplan-Meier分析显示,高尿酸血症组患者手术后1年死亡率累积率较高(Log-rank=11.73,P=0.001).结论 高尿酸血症是中老年风湿性主动脉瓣置换后患者院内死亡及1年死亡的独立预测因子.     

Analysis of risk factors for valve replacements in 5128 cases from a single heart center in China

Background Numerous studies have developed a ＂severity score＂ or ＂risk index＂ for short-term mortality associated with coronary artery bypass grafting （CABG）. Due to the different distribution of disease types, the number of valve surgeries in the US and Europe is relatively small. Thus, a risk-scoring system for valve surgeries was developed later and used less than that for the CABG surgery. We retrospectively reviewed 5128 cases of heart valve replacement, to quantitatively assess the risk factors for hospital mortality, and establish risk models for the hospital mortality of cardiac valve replacement patients.Methods A total of 1549 cases of aortic valve replacement, 2460 cases of mitral valve replacement, and 1119 cases of combined aortic valve and mitral valve replacement that were recorded from January 2005 to December 2009 in the cardiac surgery database at Beijing Anzhen Hospital were selected for this study. The cases were randomly assigned to a indicators were selected as possible influencing factors for hospital mortality. Single-factor analysis was performed to screen these factors, and then multi-factor analysis was used to determine the risk factors for hospital mortality in the three surgeries and to establish risk models.Results In the multi-factor analysis, age, body surface area, etiology, cardiopulmonary bypass time, preoperative cardiothoracic ratio, cardiac functional classification, and preoperative creatinine were risk factors for aortic valve replacement. Etiology, preoperative history of heart failure, cardiopulmonary bypass time, preoperative cardiothoracic ratio, and preoperative left ventricular end systolic diameter were risk factors for mitral valve replacement. Age, body mass index, cardiopulmonary bypass time, and cardiac function classification were risk factors for combined aortic valve and mitral valve replacement. The risk models showed good predictive ability （Hosmer-Lemeshow test： P=0.981 in the model for aortic valve replacement, P=0.503 in the model for mitral valve replacement, and P=0.154 in the model for combined aortic valve and mitral valve replacement）. The area under the ROC curve of the validation group was 0.958 （95% CI： 0.936-0.975） for the aortic valve replacement model, 0.876 （95% CI： 0.805-0.948） for the mitral valve replacement model, and 0.845 （95% CI： 0.753-0.939） for the combined aortic valve and mitral valve replacement,indicating that the risk models were good in predicting hospital mortality for surgeries.Conclusion The three risk models can quantitatively assess the hospital mortality risk in the patients treated with cardiac valve replacement.     

成人主动脉瓣置换 927 例回顾性分析

目的 探讨近20年来中国大陆主动脉瓣病变的病因构成、变迁及成人主动脉瓣置换手术的早期预后。 方法 回顾性分析1990年1月至2009年12月第二军医大学长海医院927例成人主动脉瓣置换术患者的临床资料。 结果 先天性和退行性病变是近年来成人主动脉瓣置换术的主要病因。风湿性和感染性病变比例逐渐下降,而退行性和先天性病变比例不断上升。后10年内患者的术后呼吸机辅助时间、术后ICU停留时间及术后住院时间均较前10年明显缩短（P<0.05）。927例患者中44例发生在院死亡,总在院病死率4.7%;男女性病死率差异无统计学意义;近15年内患者手术病死率下降,明显低于最初5年（P<0.05）。 结论 国人主动脉瓣疾病的病因近20年来发生明显变化;成人主动脉瓣置换术后在院病死率较前下降。     

瓣膜替换或成形术同期行冠状动脉旁路移植术的临床分析

目的 分析７６例瓣膜替换或成形术同时行冠状动脉旁路移植术的危险因素,并介绍此类手术的成功经验。方法 行瓣膜替换或成形术同时行冠状动脉旁路移植术７６例。男６１例,女１５例,平均年龄５６岁,共移植旁血管１１７支,同时行主动脉瓣转换（ＡＶＲ）（１～３支桥）２５例,二尖瓣转换（ＭＶＲ）（１～４支桥）３１例（ＭＶＲ＋ＴＶＰ３例,ＭＶＲ＋ＡＶＰ２例）,双瓣转换（ＢＶＲ）（１～３支桥）１８例（ＢＶＲ＋ＴＲＰ２例     

Surgical intervention for advanced valvular heart disease in 227 cases

Background Although the results of surgical treatment in cardiac valve disease continue to improve, the postoperative mortality rate and the rate of complications in patients with advanced valvular heart disease (AVHD) are still very high. We did this retrospective study to summarize the surgical experience of heart valve replacement for patients with AVHD and discuss effective ways to improve the surgical outcome.Methods From January 1994 to October 2003, surgical procedures of heart valve replacement were performed on 227 (136 men and 91 women) patients with AVHD in our Department of Cardiothoracic Surgery. The clinical data of all patients were collected and analysed. Patients’ age ranged from 10 years to 77 years. In preoperative cardiac function grading, 157 cases were NYHA III and 70 cases NYHA IV. Fifty-one patients had had cardiac operations. The ultrasonic cardiac graphs showed that 145 patients suffered from moderate or severe pulmonary hypertension and 73 had combined giant left ventricle. Mitral valve replacement was performed in 32 cases, aortic valve replacement in 90, tricuspid valve replacement in 1, combined mitral and aortic replacement in 103 and combined mitral and tricuspid replacement in 1. Nineteen patients also received surgical corrections for other minor abnormalities during the operations. A logistic model was established to evaluate the influence of perioperative factors on the mortality rate. Results The operative mortality rate was 13.2% (30/227). The main causes of death included multiple organ dysfunction syndrome (MODS), low cardiac output syndrome and ventricular fibrillation. From the results of the binary noncounterpart multivariate logistic regression, the following statistically significant factors were found to influence the operative mortality rate: redo operation, age ≥55 years, preoperative NYHA cardiac function grading, extracorporeal circulation time ≥120 minutes and postoperative usage of GIK (glucose, insulin and potassium) solution. All factors were risk ones except postoperative application of GIK. The Hosmer-Lemeshow goodness of fit coefficient of this model was 0.976. Conclusions The risk factors associated with postoperative mortality rate in the patients with AVHD were redo operation, age ≥55 years, preoperative NYHA cardiac function grading and extracorporeal circulation time ≥120 minutes. Postoperative usage of GIK acted as a kind of metabolic therapy and will improve the recovery for patients with AVHD. Active perioperative management and care will play a very important role in reducing the operative risk and improving the short term outcome of surgical treatment for the patients with AVHD.     

CABG联合MVR治疗老年冠心病合并中重度功能性二尖瓣反流效果分析

目的 比较分析老年冠状动脉粥样硬化性心脏病（以下简称冠心病）合并中重度功能性二尖瓣反流患者行单纯冠状动脉旁路移植术（CABG）和CABG联合二尖瓣置换术（MVR）的临床疗效。方法 选取2009年6月—2018年4月徐州医科大学附属淮安医院诊治的老年冠心病合并中重度功能性二尖瓣反流患者106例作为研究对象。根据手术方式将其分为CABG组和CABG+MVR组,分别于术前及术后1年检查患者左室射血分数、左心室舒张末期内径和二尖瓣反流面积,评估纽约心脏病协会（NYHA）心功能分级改善情况,并记录患者住院时间、ICU时间、体外循环时间等手术指标。结果 CABG+MVR组术中体外循环时间、升主动脉阻断时间及术后ICU时间与CABG组比较,差异有统计学意义（P?<0.05）,CABG+MVR组时间较长;IABP使用比例、住院时间和围手术期病死率比较,差异无统计学意义（P?>0.05）;两组患者术后1年较术前：左室舒张末期内径和二尖瓣反流面积减小,左室射血分数增加,NYHA心功能分级明显改善（P?<0.05）。结论 老年冠心病合并中重度功能性二尖瓣反流患者行CABG+MVR手术可改善患者心功能,提高生活质量,具有临床疗效佳、安全性好等优点。     

24-hour in-hospital mortality predictions in coronary artery bypass grafting patients

BACKGROUND: The purpose of this study was to determine the factors that can help predict risk of mortality in the first 24 h of coronary artery bypass grafting (CABG), because mortality within a few hours of surgery is a disastrous event for surgeons and the patient's family. METHODS: The study population consisted of 120 in-hospital mortality cases (1.07%) from 11,183 patients who underwent CABG from February 2002 to February 2006 by the same group of surgeons in a referral center. One group consisted of 40/120 (about 33.3%) patients who died during the first 24 h after surgery. The second group consisted of 80/120 patients (66.7%) who died between the 2(nd) and 30(th) day postoperatively. A set of data was gathered from the surgery database of the hospital and analyzed in a univariate model. RESULTS: Among the studied variables, only the following factors proved to be significant: previous percutaneous transluminal coronary angioplasty (PTCA), previous cerebrovascular accident (CVA), cardiopulmonary bypass (CBP) time, and postoperative atrial fibrillation (AF) (p 相似文献   

Isolated aortic valve replacement in patients older than 65 years.

The results of 196 isolated aortic valve replacements in patients older than 65 years were analyzed. Eighty-four percent of patients were in New York Heart Association (NYHA) functional class III or IV preoperatively. The operative mortality was 12% for all cases and 9% for elective cases. Actuarial probability of five-year survival was 55% for the entire group and 61% for discharged patients. Myocardial failure and congestive heart failure were the most common causes of early and late postoperative death, respectively. Embolic strokes occurred in 16% of discharged patients and caused substantial disability in 9%. At the termination of the study, 94% of surviving patients were in NYHA class I or II, and none were in class IV. Aortic valve replacement in elderly patients entails reasonable operative risk, and results in satisfactory postoperative rehabilitation.     

冠状动脉搭桥同期行瓣膜置换术近期疗效

目的探讨冠状动脉粥样硬化性心脏病(冠心病)合并心脏瓣膜病,风湿性心脏病合并冠心病同期行冠状动脉搭桥术(CABG)及瓣膜置换术的安全性及适应证。方法首都医科大学宣武医院心血管外科自2001年5月至2004年12月间,在中低温体外循环下完成12例冠心病合并瓣膜病变、风湿性心脏病合并冠心病同期施行冠状动脉搭桥和瓣膜替换手术。12例中男8例,女4例,年龄52~78岁,平均64.5岁。3例以多年风湿性心脏病、心功能不全为主诉,近年出现胸痛,手术前冠状动脉造影发现冠状动脉病变;9例以心肌缺血症状为主诉,同时合并瓣膜病变。冠状动脉造影提示单支病变1例,双支病变3例,3支病变8例。合并原发性高血压8例,糖尿病6例,心力衰竭病史5例,心房颤动7例。手术前左心室舒张末期内径(LVED)45~87 mm[(56.7±77)mm],左心室射血分数(LVEF)24%~67%(50.3%±11.7%)。心功能NYHAⅠ级1例,Ⅱ、Ⅲ和Ⅳ级分别为8、2和1例。12例患者中MVR(二尖瓣置换)+CABG 9例,AVR(主动脉瓣置换)+CABG 2例,DVR(双瓣置换)+CABG 1例。结果全组术后恢复顺利,随访3个月至2年无1例死亡。结论年龄超过50岁风湿性心脏病患者,无论有无心绞痛症状均需行冠状动脉造影检查,决定是否同期行CABG;冠心病合并二尖瓣中到重度反流及主动脉瓣严重钙化者,应同期行瓣膜置换术。对于冠状动脉病变与瓣膜病变同时存在的病例,2种手术同期进行可降低病死率,改善预后。     

经皮自膨胀式肺动脉瓣植入术的长期随访

 目的   评估经皮肺动脉瓣植入术(percutaneous pulmonary valve implantation,PPVI)的长期疗效及国产自膨胀式瓣膜(Venus-P)的耐久性。方法  选取2013年5月至2015年11月于复旦大学附属中山医院接受PPVI并完成1年以上随访的14名患者,其中男3例,女11例,平均年龄(35.8±7.8)岁,均为法洛四联症外科根治术重度肺动脉瓣反流患者。对14名患者的生存率、术后围手术期及远期并发症发生率、PPVI的远期疗效及Venus-P的远期功能进行评估。结果   14名患者平均随访(2.3±0.8)年(1.0～3.5年),术后死亡患者1例(6.7%)。无心衰恶化、感染性心内膜炎、恶性心律失常等并发症,无患者再次手术。所有瓣膜位置固定,无瓣膜脱落、移位、支架断裂,无轻度及以上瓣周漏和瓣膜反流。术后6个月心脏磁共振测得右心室舒张末容积相比术前明显下降［(40.711±19.58)mL/m2 vs. (83.03±20.0) mL/m2,P<0.05］;术后1年随访超声心动图测得跨瓣压差为(20.85±4.45) mmHg (1 mmHg=0.133 kPa);术后1年时NYHA心功能较术前提升1~2个等级(Ⅰ~Ⅲ级4人,Ⅰ~Ⅱ级10人),6分钟步行实验距离显著提高［(475.00±55.06) m vs. (594.23±194.51) m,P<0.05］;术后QRS波宽度有缩短趋势,术后1个月及3个月有显著差异［(169.93±21.34) ms vs.(159.87±24.4) ms及(160.00±27.07) ms,P均<0.05］。结论   使用国产自膨胀式瓣膜(Venus-P)介入治疗慢性肺动脉瓣反流具有较好的长期疗效和较低的并发症发生率,该瓣膜耐久性良好。