80岁以上高龄患者冠状动脉旁路移植术的围术期处理

Peri-operative Treatments of Coronary Artery Bypass Grafting in Patients of 80 Years of Age or Older

目的探讨80岁以上高龄患者行冠状动脉旁路移植术（CABG）的围术期处理经验。方法自2001年6月至2007年3月，我院共为56例80岁（82．98±5．97岁）以上高龄患者行单纯CABG，其中体外循环CABG9例，非体外循环CABG（OPCAB）47例。每例移植血管1～5支（2．99±0．47支）。结果围术期死亡4例（7．14％），死于呼吸衰竭2例、低心排血量综合征1例、急性肾功能衰竭1例。术后发生低心排血量综合征5例、呼吸系统并发症6例（3例行气管切开）、急性肾功能损伤4例（2例行持续性肾脏替代治疗）。术后发生心房颤动39例。术中和术后应用主动脉内球囊反搏3例，呼吸机辅助时间12．0±9．8h，住ICU时间3．91±1．98d，术后住院时间12．35±4．46d。48例患者随访1～59个月，随访期间死亡10例，生存的患者心绞痛症状均缓解或消失。结论80岁以上高龄患者行cABG仍有较高的死亡率，应加强围术期处理，以进一步降低死亡率和并发症的发生率。

Objective To investigate the peri-operative treatments of coronary artery bypass grafting（CABG） in patients of 80 years of age or older. Methods From June 2001 to March 2007, fihy-six patients of 80 years of age or older （82.98±5.97years） underwent isolated CABG. Nine patients underwent conventional （on-pump） CABG and 47 patients underwent off-pump CABG （OPCAB）. The number of bypass grafts for each patient was 1 to 5 （2.99±0.47）. Results Four deaths occurred peri-operatively（7.14%）. Two patients died of respiratory failure, one patient died of low cardiac output and one died of acute renal failure. Major postoperative complications included low cardiac output in 5 patlents, respiratory dysfunction in 6 patients（3 patients underwent tracheotomy）, and acute kidney injury in 4 patients （2 patients underwent continuous renal replacement treatment）. The atrial fibrillation occurred in 39 patients postoperatively. Intra-aortic balloon pump（IABP） was used intra-and post-operatively in 3 patients. The ventilation time was 12. 0 ± 9. 8 hours. The intensive care unit stay was 3. 91 ±1. 98 days and postoperative in-hospital stay was 12. 35 ± 4. 46 days. Forty-eight patients were followed up 1-59 months. Ten patients died during the follow-up period. The survivors were free or partly relieved from symptom. Conclusion The mortality of CABG is still high in octogenarians. Intensive perioperative treatment should be stressed in octogenarians to reduce the morbidity and mortality after CABG.