摘要目的 研究老年患者行心脏瓣膜置换术的治疗效果,总结手术治疗经验. 方法 回顾性分析2008年1月至2011年12月在我院行心脏瓣膜置换术的76例老年患者的临床资料及随访情况,分析手术方式的选择、一般效果、术后死亡和并发症情况、随访中患者生存率和生活质量. 结果 无术中死亡,术后早期病死4例,早期病死率为5.3％.术后31例出现并发症,发生率为40.8％,包括呼吸功能不全、肺部感染、心律失常、切口感染、胸腔积液、低心排血量综合征、肾功能不全等.随访时间为18个月至52个月,平均(24.7±3.6)个月.失访5例,随访率为93.4％.手术1个月后死亡6例,病死率7.9％.生存患者心功能得到不同程度的改善,最后1次随访结果心功能Ⅰ～Ⅱ级47例,Ⅲ级13例,Ⅳ级6例. 结论 正确判断手术适应证、充分做好术前准备、术中严谨操作并做好心肌保护、术后加强监护,有助于降低老年心脏瓣膜置换术患者的病死率,减少并发症.

abstractsObjective To investigate the efficacy of heart value replacement on elderly patients and summarize the experience of surgical treatment.Methods The clinical data and follow-up status of 76 elderly patients were analyzed retrospectively in our hospital from January 2008 to December 2011.The operative method,general effect,postoperative death,postoperative complications,survival rate and life quality followed-up were analyzed.Results No intraoperative death appeared and there were 4 early operative deaths with a mortality rate of 5.3％.There were 31 cases occurred postoperative complication with a complication rate of 40.8％ which including respiratory insufficiency,lung infection,arrhythmia,incision infection,pleural effusion,low cardiac output syndrome and renal insufficiency.The follow-up time was 18-52 months and the mean follow-up time was (24.7± 3.6)months.There were 5 cases lost of follow up and the follow-up rate was 93.4％.There were 6 patients died after a month postoperative with a mortality rate of 7.9％.The heart function of the survivors achieved differed degree improvements and the result at the end of follow-up were grade Ⅰ-Ⅱ 47 cases,grade Ⅲ 13 cases and grade Ⅳ 6 cases.Conclusions To correctly determine the surgery indications,do all the preoperative preparation,intraoperative rigorous operating with a good myocardial protection and to strengthen the postoperative care will be help to reduce the mortality and complications of the elderly patients with heart value replacement.