60岁以上瓣膜病患者的瓣膜置换术65例临床分析

目的 总结60岁以上瓣膜病患者的手术治疗经验及死亡原因.方法 回顾性分析2003年1月至2008年12月60岁以上65例瓣膜病患者的临床资料.男32例,女33例,年龄60～78 (63.1±4.1)岁.均在全麻体外循环下行瓣膜置换术,停跳手术19例,不停跳手术46例.其中MVR 29例,AVR 18例,DVR 18例,同期TVP 23例,左房血栓清除8例,共置入瓣膜83枚,机械瓣50枚,生物瓣33 枚,转机时间51～305(105.2±48.7)min,阻断24～160(72.3±29.6)min,住院时间7～109(33.5±17.7)d.结果 术中死亡2例,术后住院期间死亡5例,早期死亡率10.77%.放弃治疗6例(未随访),术后并发症13例,呼吸功能不全5例,切口愈合不良3例,肺部感染2例,胸腔积液2例,精神症状1例.随访6 ～77 个月,随访50例,院外死亡3例.结论 选择恰当手术时机,充分术前准备,改善心功能,术中谨慎操作,良好心肌保护,术后加强监护,对60岁以上瓣膜病患者行瓣膜置换术是安全可行的.

Analysis of surgical treatment in the elderly patients above 60 years old with heart valvular disease

Objective To summarize the experience of surgical treatment and causes of death in patients above 60 years with valvular disease.Methods Clinical datas of 65 cases(32 men,33 women,60-78 years old) above 60 years with valvular disease from January 2003 to December 2008 were retrospectively reviewed.valve replacement procedures were performed in general anesthesia and cardiopulmonary bypass(CPB).with on-pump performed in 19 cases and off-pump in 46 cases.There were 29 cases received mitral valve replacement(M...