80岁以上高龄患者行冠状动脉旁路移植术危险因素与手术效果的对比研究

A Comparative Study of Risk Factors and Operative Outcomes for Octogenarian Patients Undergoing Coronary Artery Bypass Grafting

目的：对比研究80岁以上高龄患者行冠状动脉旁路移植术（CABG）的术前、术中危险因素及术后主要并发症。方法：回顾性分析2004-01-01至2009-07-31我院心脏外科行CABG或CABG合并手术的≥80岁高龄患者资料50例（≥80岁组）,同时随机抽取同期行CABG或CABG合并手术的60~79岁一般老年患者临床资料50例（60~79岁组）。对两组术前、术中潜在危险因素及术后主要并发症进行对比研究。结果：≥80岁组手术时平均年龄（81.52±1.93）岁,女性18%（9/50）;60~79岁组手术时平均年龄（66.80±4.41）岁,女性24%（12/50）。统计分析结果：≥80岁组较60~79岁组外周血管疾病、心律失常、主动脉瓣反流的发生、术前最后一次肌酐值、术前最后一次血糖值、术前使用正性肌力药物的发生均较高（P均〈0.05或0.01）,差异均有统计学意义;左心室射血分数（LVEF）、术前最后一次血红蛋白值、吸烟的发生、体重指数、使用乳内动脉的发生均较低（P均〈0.05或0.01）,差异均有统计学意义。≥80岁组较60~79岁组重症监护时间延长（术后重症监护时间≥5 d）、术后呼吸衰竭、二次开胸止血等3个术后主要并发症的发生较高（P均〈0.05或0.01）,差异均有统计学意义。结论：比较一般老年人,80岁以上的高龄CABG患者具有更多的潜在危险因素,术后主要并发症发生率较高,重症监护治疗时间也有所延长。

Objective：To identify the pre-operative risk factors and post-operative major complications in patients elder than 80 years who underwent coronary artery bypass grafting（CABG）.Methods：We retrospectively analyzed the information of 50 patients at the mean age of（81.52±1.93）years（Octogenarian group）who underwent CABG or CABG combined cardiac surgery from January 2004 to July 2009 in our hospital,and randomly selected another 50 patients at the mean age of（66.80±4.41）years（Control group）who underwent the same procedures during the same period of time.The pre-operative risk factors and post-operative major complications were studied and compared in both groups.Results：The female patients were 18%（9/50）in Octogenarian group and 24%（12/50）in Control group.Compared with Control group,in Octogenarian group,more patients suffered from peripheral vascular disease,arrhythmia and aortic regurgitation,they also showed increased blood creatinine and glucose（P0.05 respectively）,decreased left ventricular ejection fraction,hemoglobin and body mass index（P0.05 respectively）before the operation.While after the operation,octogenarians had more incidence of extended ICU time,post-operative respiratory failure and secondary thoracotomy for bleeding（P0.05 respectively）.Conclusion：Octogenarian patients had more potential risks for CABG before the operation,they usually needed extended ICU time after the operation and had more chance to suffer from the major post-operative complications.