非体外循环和体外循环高龄冠状动脉旁路移植术临床分析比较

Clinical analysis of off-pump and on-pump coronary CABGs in the aged patients

目的:比较75岁以上老年患者行非体外循环冠状动脉旁路移植术(Off-pump CABG)与体外循环冠状动脉旁路移植术(On-pump CABG)的临床效果。方法:59例75岁以上老年患者,Off-pump CABG组(10例);On-pump CABG组(49例)。结果:Off-pump组手术时间、引流量>600mL、呼吸机辅助时间>20h、正性肌力药物使用时间>36h指标均少于或低于On-pump组(P<0.05,或P<0.01)。On-pump组死亡2例,死于多脏器功能衰竭和恶性心律失常。Off-pump组无死亡。结论:对75岁以上的老年冠心病患者行冠状动脉旁路移植术是安全可行的。2组比较,Off-pump组手术有时间短、引流量少、呼吸机辅助时间短及正性肌力药物使用时间短等优点。

Objective：The purpose of clinical analysis in this series was comparison the results of this two techniques of CABG in patients of 75 year-old and above. Methods：59 cases of CABGs was performed from Jan. 2003 through Dec. 2009 in our hospital. In 10 cases of them,off-pump technique was used where as onpump technique was used in 49 cases. The mean age of them were 76. 9 ± 1. 5 and 76. 9 ± 2. 0 respectively. The pre-operative LVEF were 〔（58. 1 ± 6. 9）% vs （54. 7 ± 8. 3）% 〕respectively in the two groups. previous myocardial infarction were had been diagnosed in 4 cases （40% ） and 23 cases （47% ）,Triple vessel disease were found in 8 cases （80% ） and 46 cases （96% ） in the two groups. Results：Mean operating time were （291. 9 ± 51. 9） and （394. 2 ± 126. 0） minutes （P 0. 05）,coronary artery grafting number were 2. 7 ± 0. 5 and 4. 1 ± 1. 1,Intermammary artery graft was used in 9（90% ）and 39（80% ）,respiratory assist time more than 20 hours were 1 case （10% ） and 31 cases （63% ,P 0. 01）,blood loss in thorax more than 600 mL were 2 cases （20%）and 28 cases（57%,P 0. 05）,administing of positive inotropics more than 36 hours were 2（20%） and 38（76% ,P 0. 01）,length of ICU stay of patient after operation were （76. 2 ± 27. 5） and （103. 5 ± 111. 4） hours,respectively in the off-pump and on-pump groups. The need for insertion of intra-aortic balloon pump （IABP） was 2 cases,tracheotomy performed were 2 cases,reoperation for excessive postoperative bleeding was 1 case,acute cerebrovascular events was 1 case,stress ulceration was 1 case,the overall hospital mortality rate were 4% （2 cases） in on-pump group after operation. Conclusion：Off-pump CABG and no-pump CABG for the geriatric patients （the age of them≥75 years） could have quite satisfactory outcomes,if only the surgical indications and the opportunity-timing for operation as well as the surgical technique are correctly selected. But then,coronary artery bypass grafting with off-pump technique has more redeeming features.