中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2011年
4期
275-278
,共4页
高夏%刘占峰%朱汝军%张瑞成%梁志强%徐宏耀%王平凡%白希玲%王建伟
高夏%劉佔峰%硃汝軍%張瑞成%樑誌彊%徐宏耀%王平凡%白希玲%王建偉
고하%류점봉%주여군%장서성%량지강%서굉요%왕평범%백희령%왕건위
主动脉瓣狭窄%心脏瓣膜,人工
主動脈瓣狹窄%心髒瓣膜,人工
주동맥판협착%심장판막,인공
Aortic valve stenosis%Aortic valve replacement
目的 对年龄≥70岁的主动脉瓣狭窄患者主动脉瓣置换术后的病死率进行分析.方法 回顾性分析246例年龄≥70岁、并接受主动脉瓣置换的主动脉瓣狭窄患者的临床资料.其中高血压144例(58.5%),心房颤动42例(17.1%),肥胖27例(11.0%),有心脏手术史18例(7.3%).结果 手术30 d内死亡29例,病死率为11.8%.其中单纯主动脉瓣置换死亡15例,病死率为8.8%;复合手术死亡14例,病死率为18.7%.两种手术方式比较,差异有统计学意义(P＜0.05).手术并发症发生率为24.4%.常见的并发症为低心排出量综合征48例(19.5%),肾衰竭24例(9.8%),呼吸机辅助时间延长52例(21.1%),败血症12例(4.9%).Possion回归分析结果显示,死亡的预后因素是低心排、肾衰竭、败血症及复合手术.并发症发生的主要危险因素为体外循环时间＞120 min、心房颤动与慢性阻塞性肺疾病.结论 主动脉瓣狭窄的老年患者在决定主动脉瓣置换手术前需慎重评估手术获益与手术风险.
目的 對年齡≥70歲的主動脈瓣狹窄患者主動脈瓣置換術後的病死率進行分析.方法 迴顧性分析246例年齡≥70歲、併接受主動脈瓣置換的主動脈瓣狹窄患者的臨床資料.其中高血壓144例(58.5%),心房顫動42例(17.1%),肥胖27例(11.0%),有心髒手術史18例(7.3%).結果 手術30 d內死亡29例,病死率為11.8%.其中單純主動脈瓣置換死亡15例,病死率為8.8%;複閤手術死亡14例,病死率為18.7%.兩種手術方式比較,差異有統計學意義(P＜0.05).手術併髮癥髮生率為24.4%.常見的併髮癥為低心排齣量綜閤徵48例(19.5%),腎衰竭24例(9.8%),呼吸機輔助時間延長52例(21.1%),敗血癥12例(4.9%).Possion迴歸分析結果顯示,死亡的預後因素是低心排、腎衰竭、敗血癥及複閤手術.併髮癥髮生的主要危險因素為體外循環時間＞120 min、心房顫動與慢性阻塞性肺疾病.結論 主動脈瓣狹窄的老年患者在決定主動脈瓣置換手術前需慎重評估手術穫益與手術風險.
목적 대년령≥70세적주동맥판협착환자주동맥판치환술후적병사솔진행분석.방법 회고성분석246례년령≥70세、병접수주동맥판치환적주동맥판협착환자적림상자료.기중고혈압144례(58.5%),심방전동42례(17.1%),비반27례(11.0%),유심장수술사18례(7.3%).결과 수술30 d내사망29례,병사솔위11.8%.기중단순주동맥판치환사망15례,병사솔위8.8%;복합수술사망14례,병사솔위18.7%.량충수술방식비교,차이유통계학의의(P＜0.05).수술병발증발생솔위24.4%.상견적병발증위저심배출량종합정48례(19.5%),신쇠갈24례(9.8%),호흡궤보조시간연장52례(21.1%),패혈증12례(4.9%).Possion회귀분석결과현시,사망적예후인소시저심배、신쇠갈、패혈증급복합수술.병발증발생적주요위험인소위체외순배시간＞120 min、심방전동여만성조새성폐질병.결론 주동맥판협착적노년환자재결정주동맥판치환수술전수신중평고수술획익여수술풍험.
Objective To analyze the mortality in people aged 70 years and over who had undergone aortic valve replacement (AVR) for aortic stenosis.Methods The clinical data of 246consecutive cases aged 70 years and over,who had received AVR,were retrospectively analyzed.The 144 cases (58.5 % ) had hypertension,42 cases ( 17.1 %) had atrial fibrillation,27 cases ( 11.0 % )were obeses,and 18 cases (7.3%) had undergone previous heart surgery.Results The 29 cases (11.8%) were dead within 30 days after operation.Among them,15 cases (8.8%) were with isolated AVR and the other 14 cases (18.7%) were with an associate procedure,the difference was significant (P ＜ 0.05).The rate of postoperative complication was 24 .4%.The commoncomplications were:48 cases (19.5%) with low cardiac output,24 cases (9.8%) with renal dysfunction,52 cases (21.1% ) with prolonged ventilatory support and 12 cases (4.9%) with sepsis.In the Poisson regression analysis,the main predictors of mortality were low cardiac output,renal failure,sepsis and associate procedure.The main predictors of morbidity were CBP time ＞ 120 min,atrial fibrillation and chronic obstructive pulmonary disease.Conclusions The balance between the benefits and risks of the surgery should be well evaluated before deciding to perform AVR.
