高龄病人冠状动脉旁路移植术的临床分析——附32例报道

Coronary artery bypass grafting in the elderly

目的总结高龄病人行冠状动脉旁路移植术病人的特点。方法对近8年来32例75岁以上冠心病病人行冠状动脉旁路移植术(coronary artery bypass grafting,CABG),其中行不停搏冠状动脉旁路移植术25例,体外循环下冠状动脉旁路移植术4例(占12%),体外循环下冠状动脉旁路移植术加二尖瓣置换3例(占9%)。结果32例高龄冠状动脉旁路移植术病人无院内死亡,平均术后气管插管时间12h,重症监护病房停留时间4d,术后住院时间18d,术后引流量831ml。共有29例次术后发生各种不同的并发症。20例随访3～88个月,晚期死亡3例(占9%),其中因心脏病死亡2例(占6%)。结论高龄冠心病病人只要一般情况好,无严重肺、肝、肾和脑疾病,选择合适的手术方式,加强围手术期处理,可获得良好的手术效果。不停搏冠状动脉旁路移植术可显著降低术后并发症的发生率及院内病死率,为高龄冠状动脉旁路移植术病人首选术式。

Objectives To appraise the clinical characteristics of patients aged 75 years or over after coronary artery bypass grafting. Methods In the past 8 years, 32 patients aged 75 or over underwent coronary artery bypass grafting （CABG）. 25 cases underwent off-pump coronary artery bypass grafting （OPCAB）, 4 cases had CABG with cardiopulmonary bypass （CPB） , and 3 cases had combined mitral valve replacement and CABG. Results There was no death case in the hospital. The average intubation time of all cases was 11 h, the average ICU stay time was 4 d, the average postoperative stay time was 18 d, the average drainage was 831 ml. 29 postoperative complications were found, 20 cases followed up for 3-88 months. Conclusions Patients without severe pulmonary, liver, renal and cerebral diseases, underwent suitable surgical type and intensive peri-operative management, could have encouraging result in CABG. OPCAB , which remarkably reduced the rate of postoperative complications and hospital death, should be recommended as the first choice.