高龄冠状动脉旁路移植术患者的中期疗效分析

Analysis of median-term therapeutic effect of coronary artery bypass grafting in the elderly patients.

目的总结70岁以上高龄冠心病患者行冠状动脉搭桥术的早、中期结果和经验教训，以期提高手术治疗效果。方法回顾性分析我院2006年12月至2007年12月86例70岁以上冠心病患者进行冠状动脉旁路移植术（CABG）的临床资料，其中行不停搏CABG71例，体外循环下CABG15例，同时行二尖瓣置换5例、主动脉瓣置换3例和室壁瘤切除1例：结果1例术后死亡，死亡原因为术后肠穿孔。平均术后气管插管时间8h，ICU停留时间（77．4±49．6）h，术后住院时间15d，术后引流量平均530ml。共有22例次术后发生各种不同的并发症。76例随访10～22个月，随访效果良好，心功能Ⅰ、Ⅱ级，无心绞痛、心肌梗死发生和晚期死亡。结论高龄冠心病患者只要一般情况好，与一般患者相比病死率无明显提高；但高龄患者应注意术前呼吸功能的锻炼、心绞痛症状控制；不停搏CABG可显著降低术后并发症的发生率及院内痛死率．为高龄CABG患者首选术式。

Objective To summarize the clinical experiences and early-to median effect of coronary artery bypass grafting（CABG） in patients aged 70 years or above. Methods From Dec. 2006 to Dec. 2007,86 patients aged 70 or above underwent CABG, of whom 71 cases underwent off-pump coronary artery bypass grafting （ OPCAB）, 15 cases had CABG with cardiopulmonary bypass （CPB）. 5 cases underwent mitral valve replacement,3 underwent aortic valve replacement besides CABG, and one case underwent removal of ventricular aneurysm. Their clinical data were retrospectively analyzed. Results There was one case who died of enterobrosis after operation. The average ICU stay time was （77.4 ± 49.6） h,the average postoperative stay time was 15 d,and the average drainage was 530 ml. 22 postoperative complications were found. 76 cases were followed up for 10-22 months. Follow up effect was better showing cardiac classification Ⅰ- Ⅱ and no angina pectoris, myocardial infarction and late death. Conclusion Patients with coronary heart disease in good condition will have not remarkable improvement in mortality as compared with ordinary patients but attention should be paid to their preoperative pulmonary function and angina pectoffs. OPCABG would have encouraging result in reducing the rate of postoperative complications and hospital death, which should be recommended as the first choice for the elderly patients.