我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

 ≥70岁与<70岁瓣膜病合并冠心病患者的外科治疗()

《中国胸心血管外科临床杂志》[ISSN:1007-4848/CN:51-1492/R]

期数:
2010年第17卷第3期
页码:
192-197
栏目:
临床研究论著
出版日期:
2010-06-25

文章信息/Info

Title:
 Surgical Therapy for Valve Diseases Combined with Coronary Heart Diseases in Patients Over or Below 70 Years Old
文章编号:
1007-4848（2010）03-0192-06
作者:
 喻磊 谷天祥 师恩祎 等
 中国医科大学附属第一医院 心脏外科， 沈阳 110001
Author(s):
 YU Lei;  GU Tian-xiang;  SHI En-yi;  et al .
 Department of Cardiac Surgery, The No. 1 Hospital of China Medical University, Shenyang 110001, P.R. China
关键词:
 ; 心脏瓣膜病;  冠心病;  心瓣膜置换术;  冠状动脉旁路移植术
Keywords:
 ; Heart valve diseases;  Coronary heart diseases;  Valve replacement;  Coronary artery bypass grafting
分类号:
R654.1
DOI:
-
文献标识码:
A
摘要:
 目的 比较70岁以上（≥70岁）和 70岁以下（＜70岁）心瓣膜病合并冠心病患者的临床结果，总结老年患者行心瓣膜手术加冠状动脉旁路移植术（CABG）的临床经验。 方法 回顾性分析我院1999年5月至2007年12月行心瓣膜手术同期行CABG 49例患者的临床资料，根据年龄分为≥70岁组（17例）和＜70岁组（32例）。≥70岁组患者术前合并慢性阻塞性肺疾病（COPD）的比例大于＜70岁组(P<0.05)，其余相关因素差异无统计学意义；分析比较两组患者的临床指标。 结果 ≥70岁组患者与＜70岁组比较，应用生物瓣膜比率（82.4% vs. 12.5%，χ2=23.311, P=0.000），呼吸机辅助时间(34.5±29.3 h vs. 18.0±16.1 h, t=-2.542, P=0.014)，住ICU时间(4.4±1.5 d vs. 3.3±0.7 d，t=-3.522, P=0.001)，住院时间(21.4±7.7 d vs. 18.1±1.8 d, t=-2.319, P=0.025)，主动脉内球囊反搏（IABP）应用率(29.4% vs. 6.3%, χ2=4.862, P=0.037）, 肺功能不全(35.3% vs. 6.3%, χ2=6.859,P=0.009），急性肾功能衰竭(23.5% vs. 3.1%, χ2=5.051, P=0.025）和脑血管意外发生率（11.8% vs. 0.0%, χ2=3.933, P=0.048）等差异有统计学意义；而移植血管远端吻合口数（2.5±3.1个 vs. 2.4±1.4个，t=0.301，P=0.758），主动脉阻断时间（89.3±25.4 min vs. 88.5±31.0 min，t=0.108，P=0.913），体外循环时间（144.6±44.8 min vs. 138.3±52.9 min，t=0.164，P=0.871），病死率（5.9% vs. 6.3%，χ2=0.002，P=0.959）等差异无统计学意义 (P>0.05)，围术期心肌梗死发生率均为0%。随访2个月～9年，≥70岁组患者失访1例；1例机械瓣置换术后1.5年死于脑出血，2例分别于术后3个月、6年死于心力衰竭和肺癌；其余生活质量明显改善，心功能Ⅰ～Ⅱ级。＜70岁组患者随访1个月～6年，失访5例；4例死于与抗凝有关的并发症（均为置换机械瓣患者），1例死于严重低心排血量，1例死于交通伤。 结论 术中操作及积极、正确的围手术期处理是提高瓣膜病合并冠心病患者手术成功率、降低病死率的关键，心瓣膜手术加CABG对≥70岁患者同样是安全可靠的。
Abstract:
 Surgical Therapy for Valve Diseases Combined with Coronary Heart Diseases in Patients Over or Below 70 Years Old YU Lei, GU Tianxiang, SHI Enyi, XIU Zongyi, FANG Qin, ZHANG Yuhai. (Department of Cardiac Surgery, The No. 1 Hospital of China Medical University, Shenyang 110001, P.R. China)Corresponding author: GU Tianxiang, Email: cmugtx@sina.com
Abstract： Objective To summarize the experiences of valve replacement combined with coronary artery bypass grafting (CABG) in senile patients by comparing clinical outcomes of valve diseases combined with coronary heart diseases in patients over or below 70 years old. Methods We retrospectively analyzed the clinical data of 49 patients who received valve replacement combined with CABG in our department from May 1999 to December 2007. Based on the age, the patients were divided into ≥70 years group (17 cases) with its patients at or above 70 years old and <70 years group (32 cases) with its patients younger than 70. The percentage of chronic obstructive pulmonary diseases (COPD) before surgery in ≥70 years group was higher than that in <70 years group(P<0.05). No significant difference was found in the other relevant factors between the two groups. The clinical index of patients in the two groups were compared and analyzed. Results There were significant differences between the two groups in such factors as the percentage of biovalve use (82.4% vs. 12.5%, χ2=23.311, P=0.000), the time of mechanic ventilation (34.5±29.3 h vs. 18.0±16.1 h, t=-2.542,P=0.014), the time of ICU stay (4.4±1.5 d vs. 3.3±0.7 d, t=-3.522, P=0.001), the time of hospital stay (21.4±7.7 d vs. 18.1±1.8 d, t=-2.319, P=0.025), the percentage of IABP use (29.4% vs. 6.3%, χ2=4.862, P=0.037), the percentage of pulmonary function failure (35.3% vs. 6.3%, χ2=6.859, P=0.009), the percentage of acute renal failure (23.5% vs. 3.1%, χ2=5.051, P=0.025), and the percentage of cerebrovascular accident (11.8% vs. 0.0%, χ2=3.933, P=0.048). There was no significant difference between the two groups in factors like the anastomosis of distal graft (2.5±3.1 vs. 2.4±14, t=0.301, P=0.758), the time of aortic occlusion (89.3±25.4 min vs. 88.5±31.0 min, t=0.108,P=0.913), the time of cardiopulmonary bypass (144.6±44.8 min vs. 138.3±52.9 min, t=0.164, P=0.871) and the mortality (5.9% vs. 6.3%, χ2=0.002,P=0.959). The perioperative myocardial infarction rate was zero in both groups. ≥70 years
group patients were followed up for 2 months to 9 years with only 1 case missing. One patient who had undergone mechanic valve replacement died of cerebral hemorrhage 1.5 years after operation. Two died of heart failure and lung cancer 3 months and 6 years after operation respectively. For all the others, the cardiac function was at class Ⅰ to Ⅱ and their life quality was significantly improved. The follow up time of <70 years group was 1 month to 6 years and 5 cases wer
e missing. Four patients who had undergone mechanic valve replacement died of complications in relation to anticoagulation treatment. One died of severe low cardiac output. Another died of traffic accident. Conclusion Surgery operation an
d effective perioperative treatment are key elements in improving surgery successful rate and decreasing mortality in patients with valve and coronary artery diseases. Valve replacement combined with CABG is safe for patients older than 70 years old.

参考文献/References

备注/Memo

备注/Memo:
更新日期/Last Update: 2010-07-06