心瓣膜病合并房颤及心衰的处理原则.ppt

老年人心瓣膜病合并房颤及心衰的处理原则广州市第一人民医院刘丰 随着人口的老龄化,老年退行性钙化性瓣膜病逐渐占有重要的地位,是目前老年人的特殊疾病。 已经成为老年人心力衰竭、心律失常、晕厥、猝死的原因之一。对冠心病具有重要预测价值 国外报道的发病率明显高于国内。Pomerance 等 尸检162 例死于心衰的患者, 分析其原因后发现钙化性瓣膜病变占45 % ,仅次于冠心病。Wong 等 在78 例65～102 岁的患者中 发现瓣膜退行性改变占74 %。90～100 岁年龄组几近100 % Springer. Verlag ,1982 :63～67. . J AM Geriatir soc ,1983 ,3l :156. The incidence and etiological classification of valvular diseases were examined on 358 cases from 3,000 consecutive autopsies of more than 60 years of age. The incidence of valvular disease was 11.9% (358 out of 3,000 cases) Jpn Circ J. 1982 Apr;46(4):337-45 Mitral stenosis was found in 23 cases (6.4%), of which 21 cases were rheumatic and the remaining 2 were mitral ring calcification (MRC). Mitral regurgitation was observed in 126 cases (35.3%): 69 of papillary muscle dysfunction, 26 of mitral valve prolapse (MVP), 16 of MRC, 9 of ruptured chordae tendineae, 3 of rheumatic and 3 of congenital. Jpn Circ J. 1982 Apr;46(4):337-45 Aortic stenosis was noted in 33 cases (9.2%): 27 of calcified, 5 of rheumatic and one of congenital. Aortic regurgitation was found in 169 cases (47.2%): 112 of degenerative, 47 of syphilitic, 7 of rheumatic and 2 of aortitis syndrome. There were 6 cases (1.7%) of tricuspid regurgitation. Jpn Circ J. 1982 Apr;46(4):337-45 Etiological classification revealed 6 cases (1.7%) of congenital, 36 (10%) of rheumatic, 49 (13.7%) of syphilitic, 27 (7.5%) of MVP, 69 (19.3%) of ischemic and 166 (46.4%) of degenerative valvular disease. Jpn Circ J. 1982 Apr;46(4):337-45 A total of 458 cases (11.5%) with valvular heart diseases in the aged (greater than or equal to 60 years) were found among 4,000 consecutive autopsies. They included 204 cases (45%) of aortic regurgitation (AR), 171 cases (37%) of mitral regurgitation (MR), followed by 45 (10%) of aortic stenosis (AS) and 27 cases (6%) of mitral stenosis (MS). J Cardiol Suppl. 1988;19:29-38. an etiology of the valvular diseases, degenerative type was found in 195 cases (43%), isc