80岁以上老年人冠状动脉旁路移植术合并瓣膜置换手术的临床分析

摘要

Objective: To summarize the characteristic and experiences of coronary artery bypass and valve replacement surgeries in old people.Methods: From November 2001 to March 2010, 60 patients above 80 years old underwent coronary artery bypass valve replacement in department of cardiothoracic surgery, Shanghai First People'S Hospital, Jiaotong University.There were 33 males and 27 females with an average age of 83.77± 2.45 years.We did CABG+MVR surgeries in 36 patients,CABG+AVR surgeries in 15 ones,CABG+BVR surgeries in 9 ones and TVP in 8 patients, radiofiequency ablation procedure in 3 patients, ascending aorta plasty at the same time.51 patients were operated with biological valve and 9 ones with mechanical valve.The average of bridge vasculars we made in CABG was 2.13± 0.75.Materials in bypass were LIMA and saphenous vein.Results: Early death in the hole group was 9(mortality was 15％),1 died ofbleeding, 1 case died of multiple organ failure,7 cases died of postoperative heart-failure.51 survived early after operation (85％),10 survived patients suffered postoperative complication.2 suffered hydrothorax,l suffered pericardial tamponade, 3 suffered pulmonary infection, Ventricular fibrillation after atrial flutter occurred in one case and 3 cases suffered second open-chest.All recovered completel after corresponding symptomatic treatment.The outpatient service makes a follow-up visit 49 examples.Revisit time was 1-60 months, 2 examples result in heart function Ⅰ, 29 result infunction Ⅱ ,18 result in functionⅢ and 0 results in function Ⅳ(NYHA).Conclusion: As to the elders of coronary artery bypass and cardiac valvular surgery ,if we grasp the operative indications together with the pre, peri and postoperative care, the surgical treatment can achieve good results.%目的:总结老年患者行冠状动脉旁路移植术(CABG)合并瓣膜置换(VR)手术的特点及经验.方法:上海交通大学附属第一人民医院心血管外科2001年11月至2010年3月对60例年龄大于80的患者施行冠状动脉搭桥+瓣膜置换手术,男33例,女27例.年龄80-87岁,平均年龄(83.77±2.45)岁.均为冠心病合并瓣膜病变患者.其中36例患者行冠状动脉旁路移植+二尖瓣置换手术,15例患者行冠状动脉旁路移植+主动脉瓣置换手术,9例患者行冠状动脉旁路移植+双瓣置换手术,同时8例患者行三尖瓣成形手术,3例患者行射频消融手术,1例升主动开成形术.置换生物瓣膜者51例,置换机械瓣膜者9例.CABG平均搭桥(2.13±0.75)根,搭桥材料为左乳内动脉与大隐静脉.结果:全组早期死亡9例(15%),1例死于术后出血,1例死于多器官功能衰竭,7例死于术后心衰.早期生存51例(85%),出现术后并发症10例,其中2例发生胸腔积液,1例心包填塞,3例肺部感染,1例心房扑动后发生室颤,3例二次开胸止血.给予相应对症治疗后痊愈出院.门诊随访49例,随访时间1～60个月,心功能Ⅰ级2例、Ⅱ级29例、Ⅲ级18例、Ⅳ级0例(NYHA分级).结论:对老年患者行冠脉搭桥+瓣膜置换手术,只要掌握手术适应证,充分作好术前准备、术中及术后处理,手术治疗可以取得良好效果.