高龄冠心病患者冠状动脉搭桥术

Coronary artery bypass grafting for elderly patients

目的；总结高龄冠心病患者冠状动脉搭桥术的术式选择和围术期处理特点。方法：101例高龄冠心病患者，行体外循环下冠状动脉旁路移植术（CCABG组）45例，非体外循环下冠状动脉旁路移植术（OPCAB组）56例，搭桥数目1-5支，平均3．1支。结果：所有病例无死亡，在手术时间、输血量、术后正性肌力药物应用、辅助呼吸时间等指标上OPCAB组高龄患者均优于CCABG组。术后并发症14例，其中CCABG组8例（17．8％），包括低心排出量综合征2例，低氧血症5例，心律失常3例，脑梗塞2例。OPCAB组6例（10．7％），包括低氧血症5例，心律失常3例。结论；根据高龄冠心病患者的特点制定相应的手术方案、选择合适的术式以及恰当的围术期处理，可以有效地降低高龄冠心病患者的手术并发症和死亡率。

Objective To summarize the character of operation and operative management in elderly patients with coronary heart disease receiving coronary artery bypass grafting. Methods In 101 patients with coronary heart disease, 45 cases underwent conventional （on-pump） coronary artery bypass grafting surgery, the other 56 patients underwent off-pump coronary artery bypass grafting surgery. Number of bypass grafts was 3.1. Results No operative death occurred. Elder patients of on pump coronary artery bypass grafting had better outcome than off-pump coronary artery bypass grafting in operation time, blood transfusion quantity, application of inotropics and ventilalorassisting. Of 14 cases with complication after operation, there were 8 CCABG cases （17. 8%）, including 2 heart function failure, 5 hypoxemia, 3 arrhythmia and 2 cerebral infarction and 6 cases OPCAB（10. 7%） including 5 hypoxemia and and 3 arrhythmia. ConclusionThe incidence after operation and mortality in elderly patients with coronary heart disease could be reduced by appropriate operation plan, right surgery mode and good perioperative management.