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1、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..JAMGeriatirsoc,1983,3l:156.国内外报道十
2、分不一致,主要原因有种族差异、也存在方法学的问题Theincidenceandetiologicalclassificationofvalvulardiseaseswereexaminedon358casesfrom3,000consecutiveautopsiesofmorethan60yearsofage.Theincidenceofvalvulardiseasewas11.9%(358outof3,000cases)JpnCircJ.1982Apr;46(4):337-45Mitralstenosiswasfoundin23cases(6.4%),ofwhich21
3、caseswererheumaticandtheremaining2weremitralringcalcification(MRC).Mitralregurgitationwasobservedin126cases(35.3%):69ofpapillarymuscledysfunction,26ofmitralvalveprolapse(MVP),16ofMRC,9ofrupturedchordaetendineae,3ofrheumaticand3ofcongenital.JpnCircJ.1982Apr;46(4):337-45Aorticstenosiswasnot
4、edin33cases(9.2%):27ofcalcified,5ofrheumaticandoneofcongenital.Aorticregurgitationwasfoundin169cases(47.2%):112ofdegenerative,47ofsyphilitic,7ofrheumaticand2ofaortitissyndrome.Therewere6cases(1.7%)oftricuspidregurgitation.JpnCircJ.1982Apr;46(4):337-45Etiologicalclassificationrevealed6case
5、s(1.7%)ofcongenital,36(10%)ofrheumatic,49(13.7%)ofsyphilitic,27(7.5%)ofMVP,69(19.3%)ofischemicand166(46.4%)ofdegenerativevalvulardisease.JpnCircJ.1982Apr;46(4):337-45Atotalof458cases(11.5%)withvalvularheartdiseasesintheaged(greaterthanorequalto60years)werefoundamong4,000consecutiveautopsi
6、es.Theyincluded204cases(45%)ofaorticregurgitation(AR),171cases(37%)ofmitralregurgitation(MR),followedby45(10%)ofaorticstenosis(AS)and27cases(6%)ofmitralstenosis(MS).JCardiolSuppl.1988;19:29-38.anetiologyofthevalvulardiseases,degenerativetypewasfoundin195cases(43%),ischemicoriginin91cases(
7、20%),followedbyinflammatoryoriginsuchassyphiliticin51andinfectiveendocarditisinthree,aortitisintwoandrheumaticin49(11%).Congenitaloriginwasalsofoundin18cases(4%).JCardiolSuppl.1988;19:29-38.仍关注对老年人风心病。山西医科大学第一临床医学院心内科从1979-01～1998-12共收治风心病1227例,其中老年风心病215例,对其逐年发病情况及
