75岁以上老年瓣膜手术临床特征及手术安全性评价

目的研究75岁以上老年瓣膜手术临床特征及手术效果。方法回顾性分析2014年1月至2019年1月我院75岁以上老年瓣膜手术患者资料,总共73例,占同期心脏瓣膜手术的5.3%(73/1372)。其中男46例,女27例;平均年龄77.35岁(75~88岁),诊断为二尖瓣关闭不全28例(38.3%),二尖瓣狭窄8例(11.0%),主动脉瓣关闭不全7例(9.6%),主动脉瓣狭窄合并主动脉瓣关闭不全7例(9.6%),主动脉瓣狭窄6例(8.2%)。行二尖瓣置换联合三尖瓣成术28例(38.4%),主动脉瓣置换术20例(27.4%),二尖瓣置换术11例(15.1%)。同期安装起搏器2例(2.7%),同期行冠状动脉旁路移植术14例(19.2%)。结果手术前后左心房舒张期末内径(LA)、左心室舒张期末内径(LV)、右心房舒张期末内径(RA)及左心室射血分数(EF)差异有统计学差异(P<0.05)。与随机抽取的150例60岁以下瓣膜手术相比,手术阻断时间、体外循环时间、术后呼吸机时间、ICU时间、手术并发症、术后肝肾功能不全及病死率两组间差异无统计学意义(P>0.05)。结论75岁以上老年瓣膜病以二尖瓣关闭不全发病率最高,手术后心脏结构改善明显,且手术风险与正常年龄组相同,因此常规瓣膜手术在75岁以上老年人群中是安全的。

Clinical characteristics and safety of valvular surgery in elderly patients aged over 75 years

Objective To study the clinical characteristics and surgical conditions of valve surgery in elderly patients over 75 years old.Methods Datas of patients over 75 years old with valve surgery in our hospital from January 2014 to January 2019 were retrospectively analyzed.73 cases were analyzed,accounting for 5.3%(73/1372)of the cardiac valve operations performed during the same period.There were 46 males and 27 females,with an average age of 77.35 years(75-88 years).The main diagnoses were MR 28 cases(38.3%),MS 8 cases(11.0%),AR 7 cases(9.6%),AS+AR 7 cases(9.6%)and AS 6 cases(8.2%).There were 28 cases(38.4%)of MVR+TVP,20 cases(27.4%)of AVR,and 11 cases(15.1%)of MVR.Pacemakers were installed in 2 patients(2.7%)and coronary artery bypass grafting was performed in 14 patients(19.2%).Results There were statistically significant differences in left atrial end-diastolic diameter(LA),left ventricular end-diastolic diameter(LV),right atrial end-diastolic diameter(RA)and ejection fraction(EF)before and after surgery(P<0.05).There were no statistically significant differences between the two groups(P>0.05)in surgical interception time,extracorporeal circulation time,postoperative ventilator time,ICU time,surgical complications,postoperative liver and kidney functioninsufficiencyand mortality,as compared with 150 cases of valve surgery under 60 years old(P>0.05).Conclusion Mitral regurgitation is the most common valvular disease in senile patients over 75 years old,the cardiac structure is improved significantly after surgery,and the risk of surgery is the same as that in normal age groups.Therefore,valvular surgery issafe in elderly patients over 75 years old.