上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

80岁及以上高龄患者行心脏瓣膜置换手术临床分析

毛建强1,2，庄 瑜2，樊永亮2，袁忠祥2，吕志前1   

  1. 1.上海交通大学附属第六人民医院心胸外科， 上海 200233； 2.上海交通大学附属第一人民医院心血管外科， 上海 200080
  • 出版日期:2013-10-28 发布日期:2013-10-31
  • 通讯作者: 吕志前, 电子信箱: luzhiqian@gmail.com。
  • 作者简介:毛建强（1974—），男，副主任医师，博士生；电子信箱: jianqiang.mao@gmail.com。

Clinical outcomes of cardiac valve replacement in octogenarians

MAO Jian-qiang1,2, ZHUANG Yu2, FAN Yong-liang2, YUAN Zhong-xiang2, LÜ Zhi-qian1   

  1. 1.Department of Cardiothoracic Surgery, the Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China; 2.Department of Cardiovascular Surgery, the First People's Hospital, Shanghai Jiaotong University, Shanghai 200080, China
  • Online:2013-10-28 Published:2013-10-31

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摘要：

目的 总结≥80岁高龄患者心脏瓣膜置换手术的临床效果及围手术期治疗经验。方法 56例≥80岁高龄患者于体外循环中度低温下行心脏瓣膜置换手术，分析其手术情况、并发症情况和随访情况。结果 56例患者中，4例术后早期死亡，52例（92.9%）康复出院。术后发生并发症23例，主要为呼吸功能不全、肾功能不全、恶性心律失常、胸腔积液及心包积液等。42例患者随访时间超过2年。术后2年，患者心功能分级Ⅱ级31例，Ⅲ级11例；左心房内径和肺动脉压均显著小于术前（P<0.05）。结论 选择合适的手术时机、加强围手术期处理可使≥80岁高龄患者行心脏瓣膜置换手术具有可行性。

关键词: 高龄, 心脏瓣膜病, 瓣膜置换, 临床效果

Abstract:

Objective To summarize the clinical outcomes and experience in perioperative management in octogenarians undergoing cardiac valve replacement. Methods Fifty-six octogenarians underwent heart valve replacement with hypothermia and cardiopulmonary bypass, and the surgical outcomes, complications and followup findings were analyzed. Results Among the 56 patients, 4 died early after operation, and 52 (92.9%) discharged. There were 23 cases of complications, including respiratory failure, renal failure, ventricular arrhythmia, pleural effusion and pericardial effusion. Forty-two patients were followed up for more than 2 years, there were 31 patients with gradeⅡ of cardiac function and 11 patients with grade Ⅲ of cardiac function 2 years after operation, and the left atrial diameter was significantly smaller and the pulmonary arterial pressure was significantly lower 2 years after operation than those before operation (P<0.05). Conclusion With appropriate timing of operation and proper perioperative management, cardiac valve replacement may be feasible for octogenarians with cardiac valvular
disease.

Key words: octogenarians, cardiac valvular disease, valve replacement, clinical outcomes