老年人心脏瓣膜置换围术期处理(附123例分析)

目的总结老年人心脏瓣膜置换围术期处理经验。方法对本院123例接受心脏瓣膜置换60岁以上老年患者围术期处理的特点进行回顾性分析。结果二尖瓣置换66例,主动脉瓣置换39例,二尖瓣＋主动脉瓣置换15例,三尖瓣置换2例,同期进行其他手术共105例,早期死亡率8.9%（11/123）,并发症出现率41.5%（50/123）,晚期死亡3例,其中与心脏有关死亡1例,死于反复心力衰竭。随访6个月～14年,96例存活,失访13例,随访率88.4%（96/112）。结论重视老年人心脏瓣膜置换围术期的处理措施,合理的手术方法和心肌保护,可以减少围术期并发症,降低手术围术期的死亡率。

Perioperative management in 123 patients over 60 years of cardiac valve replacement

Objective To summarize the perioperative management experience of elderly cardiac valve replacement in old patients. Methods We retrospectively analyzed the characteristics of the perioperative management of 123 patients over 60 year old undergoing cardiac valve replacement. Results 66 cases of mitral valve replacement,39 cases of aortic valve replacement,15 cases of mitral valve replacement and aortic valve replacement,2 cases of tricuspid valve replacement. Over the same period a total of 105 cases of other operations performed. The early mortality rate was 8.9% （11/123）. The complication rate was 41.5% （50/123）,3 cases of late death,in these death cases one heart-related and died of recurrent heart failure. Follow-up study on these cases from 6 months to 14 years,96 cases survived and 13 patients lost to follow-up,the follow-up rate was 88.4% （96/112）. Conclusion Attention to the management of perioperative period,adequate preoperative preparation,a reasonable surgical techniques and myocardial protection can reduce the perioperative complications and decreased mortality of perioperative on elderly cardiac valve replacement surgery.