Schurr P, Boeken U, Litmathe J, Feindt P, Kurt M, Gams E
Department of Thoracic and Cardiovascular Surgery, University Hospital, Duesseldorf, Germany.
Thorac Cardiovasc Surg. 2010 Jun;58(4):200-3. doi: 10.1055/s-0029-1240654. Epub 2010 May 31.
Aim of the study was to clarify the impact of different pre- and perioperative conditions on outcome in octogenarians undergoing cardiac surgery.
We retrospectively analyzed preoperative risk factors and intraoperative adverse events and studied in-hospital morbidity and mortality in 646 patients > or = 80 years of age (82.5 +/- 3.5 years) and in 6081 younger patients (70.3 +/- 3.4 years) who underwent cardiac surgery between 1/2001 and 12/2006.
Preoperatively, octogenarians suffered significantly more from arterial hypertension, renal failure, previous neurological problems, unstable angina and NYHA class IV than younger subjects. The incidence of combined valve and coronary procedures and of urgent operations was also significantly higher in patients > or = 80 years (27.7 % vs. 18.2 %, P < 0.05, and 7.3 % vs. 4.2 %, P < 0.05, respectively). In-hospital mortality was higher (7.4 % vs. 3.7 %, P < 0.05), and average ICU and total in-hospital stay was longer in the older age group. Postoperative complications occurred in 15 % of patients > or = 80 years compared to 7.6 % of patients < or = 79 years ( P < 0.05). NYHA class IV, female sex and preoperative renal failure correlated with perioperative morbidity. Multivariate analysis could identify urgent procedures, redo surgery, mitral valve surgery and prolonged cross-clamping times as predictors of mortality.
Cardiac surgery in octogenarians can be performed with an acceptable risk but an increased mortality and morbidity compared to younger patients. High-risk octogenarians, who require intensive perioperative management, should be identified to reduce the incidence of postoperative complications.
本研究旨在阐明不同的术前和围手术期条件对接受心脏手术的八旬老人手术结果的影响。
我们回顾性分析了646例年龄≥80岁（82.5±3.5岁）以及6081例年龄较小患者（70.3±3.4岁）的术前危险因素和术中不良事件，并研究了他们在2001年1月至2006年12月期间接受心脏手术后的院内发病率和死亡率。
术前，八旬老人患动脉高血压、肾衰竭、既往神经系统问题、不稳定型心绞痛和纽约心脏协会（NYHA）IV级的情况比年轻患者严重得多。年龄≥80岁患者的联合瓣膜和冠状动脉手术以及急诊手术的发生率也显著更高（分别为27.7%对18.2%，P<0.05；以及7.3%对4.2%，P<0.05）。老年组的院内死亡率更高（7.4%对3.7%，P<0.05），且平均重症监护病房（ICU）住院时间和总住院时间更长。≥80岁患者中有15%发生术后并发症，而≤79岁患者中这一比例为7.6%（P<0.05）。NYHA IV级、女性以及术前肾衰竭与围手术期发病率相关。多因素分析可确定急诊手术、再次手术、二尖瓣手术以及较长的主动脉阻断时间为死亡率的预测因素。
八旬老人进行心脏手术虽风险可接受，但与年轻患者相比，死亡率和发病率有所增加。应识别出需要强化围手术期管理的高危八旬老人，以降低术后并发症的发生率。
