高龄冠心病患者冠状动脉搭桥术

Coronary artery bypass grafting for coronary artery disease in octogenariansCoronary artery bypass grafting for coronary artery disease in octogenarians

目的比较冠脉搭桥术（CABG）的术式选择对高龄冠心病患者的影响，讨论高龄冠心病患者的围手术期管理方法。方法以我院心脏血管外科2003年1月至2009年12月所实施的514例CABG患者为研究对象，其中75岁以上患者49例，为高龄患者组，占同期CABG的9．5％；75岁以下患者465例，为非高龄患者组，占同期CABG的90．5％。结果患者的年龄、不稳定型心绞痛、有无急性心梗、冠脉危险因子、术前血红蛋白含量比例两组相比差异无统计学意义；左室射血分数〈30％，既往合并肾功能异常、脑梗塞及患有三支冠状动脉病变的患者比例两组相比差异有统计学意义。主动脉内气囊反搏（IABP）、移植血管种类、手术时间两组相比差异无统计学意义，但远心端吻合口数及完全性血运再建例数比例、跳动下冠状动脉搭桥手术（OPCAB）比例两组之间比较差异有统计学意义。术后气管插管时间、留置ICU时间两组之间比较差异无统计学意义，患者住院天数两组之间比较差异有统计学意义。术后肺部感染、肾衰、并发症脑梗塞发生率两组之间比较差异无统计学意义。围手术期死亡率两组之间比较差异无统计学意义。术后平均39个月的电话随访，心衰、心梗发生率及心源性死亡率两组之间比较差异无统计学意义。结论对于高龄患者的CABG要多考虑采用OPCAB方式及动、静脉移植血管相组合等低侵袭性手术方法，术后应早期下床进行康复训练。

Objective To compare the effect of procedure selection of CABG on coronary artery disease in octogenarians and discuss it＇s peri-operative management. Methods 514 CABG had been performed from Jan. 2003 to Dee. 2009 in China-Japan Friendship Hospital. 9.5% of them （49cases） aged older than 75 years old be- longs to Octogenarians group,90.5% of them （465 eases） belongs to non-octogenarians group. Results There were no statistical significant difference in terms of age,unstable angina peetors, AMI, risk factors and preoperative hemoglobin between two groups. There were statistical significant difference in left ventricle ejection fraction 〈30%, combined renal dysfunction, combined cerebral infarction and triple vessels disease between two groups. There were no statistical significant difference between two groups in IABP assist,graft type and operative time. But there were statistical signifieant differenee in the numbers of distal anastomosis, ratio of complete arterial re-vasculariza- tion and ratio of off-pump CABG between two groups. There were no significant difference between two groups in time of tracheal tube use and ICU stay,there were statistical difference in hospital stay between two ~oups. There were no statistical differenee in incidence of pulmonary infection, renal failure and cerebral infarction after opera- tion. There were no statistical difference in perioperative mortality rate between two groups. During average 39 months follow up by telephone call, there were no statistical difference in heart failure, myocardial infarction and cardiac mortality. Conclusion Minimal invasive procedure such as OPCAB and hybrid of arterial and venous graft should be apply as much as possible for octogenarians. Early Rehabilitation after operation is needed.