Subayi J B, de Brux J L, Delhumeau A, Lotfi N, Moreau X, Cottineau C, Bukowski J G, Corbeau J J, Pillet J
Service de chirurgie cardiovasculaire et thoracique, CHU d'Angers.
Arch Mal Coeur Vaiss. 1994 Dec;87(12):1671-7.
With improved operative technique and postoperative care, progressively older patients are being referred for cardiac surgery. One hundred out of 633 patients operated between September 1990 and December 1992, were over 75 years of age (Group I). These patients were compared with the last 100 patients under 75 years of age (Group II). Both groups were operated by the same surgical team with the same anaesthetic, cardiopulmonary bypass and myocardial protection techniques. The average age of the groups was 79.5 +/- 3.1 and 62.1 +/- 9.2 years, respectively. The procedures performed were: myocardial revascularisation (Group I, 28 cases; Group II, 59 cases), aortic valve surgery alone or associated with coronary bypass (56 and 22 cases respectively), and mitral valve surgery alone or associated with another procedure (11 and 12 cases). There were no significant differences between the two groups with respect to true low output state, the duration of mechanical ventilation and of intensive care and hospital stay. On the other hand, there were significant differences in: the number of blood transfusions (44 cases versus 20, p < 0.001), the occurrence of atrial fibrillation (52 cases versus 29, p < 0.001) and neuropsychiatric disturbances (27 cases versus 5, p < 0.0001). There were no cases of mediastinitis in either group. The hospital mortality was 6% in Group I and 5% in Group II (NS). The medium-term mortality after an interval of 5 to 32 months in the over 75 age group was 7 cases, including 4 cases of cerebrovascular accident. An enquiry was performed in the 87 survivors of Group I.(ABSTRACT TRUNCATED AT 250 WORDS)
随着手术技术和术后护理的改进,越来越多的老年患者被转诊至心脏外科进行手术。1990年9月至1992年12月期间接受手术的633例患者中,有100例年龄超过75岁(第一组)。将这些患者与最后100例年龄在75岁以下的患者(第二组)进行比较。两组均由同一手术团队采用相同的麻醉、体外循环和心肌保护技术进行手术。两组的平均年龄分别为79.5±3.1岁和62.1±9.2岁。所实施的手术包括:心肌血运重建(第一组28例;第二组59例)、单纯主动脉瓣手术或联合冠状动脉搭桥手术(分别为56例和22例),以及单纯二尖瓣手术或联合其他手术(分别为11例和12例)。两组在真正的低心排血量状态、机械通气时间、重症监护时间和住院时间方面无显著差异。另一方面,在以下方面存在显著差异:输血次数(44例对20例,p<0.001)、房颤发生率(52例对29例,p<0.001)和神经精神障碍(27例对5例,p<0.0001)。两组均无纵隔炎病例。第一组的医院死亡率为6%,第二组为5%(无统计学意义)。75岁以上年龄组在5至32个月的中期死亡率为7例,包括4例脑血管意外。对第一组的87名幸存者进行了调查。(摘要截取自250字)