老年糖尿病、非糖尿病患者非体外循环冠状动脉旁路移植术疗效比较

Off-pump coronary artery bypass grafting in the elderly patients with diabetes mellitus

目的探讨糖尿病对老年患者行非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)的影响。方法回顾性分析176例60岁以上行OPCABG患者的临床资料。根据术前是否合并糖尿病分为糖尿病组(n=86)及非糖尿病组(n=90)。比较两组患者的一般资料及术中、术后资料,分析60岁以上糖尿病患者OPCABG近期预后的特点。结果糖尿病组高脂血症发生率明显高于非糖尿病组,差别有统计学意义(37.2%vs 17.8%,P<0.01)。糖尿病组患者的3支血管病变及冠脉弥漫性病变的发生率明显高于非糖尿病组(83.7%vs 62.2%,P<0.05;75.6%vs 52.2%,P<0.05),两组桥血管数(3.2±0.8 vs 2.8±0.6,P<0.05),ICU时间[(3.6±0.9)d vs(3.2±0.6)d,P<0.05]等方面差导有统计学意义。糖尿病组主动脉球囊反搏(itraarotic ballon pumping,IABP)使用率(7%vs 1.1%,P<0.05)、肺内感染(12.8%vs4.4%,P<0.05)、二次插管发生率(9.3%vs 2.2%,P<0.05)等显著增加。两组在呼吸机使用时间、ICU停留时间、住院时间和院内病死率等方面差异无统计学意义。结论合并糖尿病老年患者冠脉血管病变较重,但是OPCABG总体疗效与非糖尿病患者相同。

Objective To study the impact of diabetes mellitus in elderly patients above sixty years old undergoing off-pump coronary artery bypass grafting.Methods Data were collected as part of prospective registry of off-pump coronary artery bypass grafting（OPCABG） from September 2009 to September 2010.One hundred and seventy-six patients were recruited.They were divided into diabetic group（n=86） and nondiabetic group（n=90）.Peroperative variables,such as age,EF and operative mortality,were compared between the two groups by univariate analysis or chi-square tests.Results The incidence of hyperlipidemia was higher in diabetic group than that in non-diabetic group,with significant difference（37.2% vs 17.8%,P〈0.01）.There was significant difference between the two groups in the number of affected coronary artery and the degree of lesion,especially the incidence of multi-branch lesion and diffuse lesion,was higher than that in non-diabetic group.The rate of itraarotic ballon pumping（7% vs 1.1%;P〈0.05）,the incidence of pulmonary infection（12.8% vs 4.4%,P〈0.05） and the reuse of lifesaver（9.3% vs 2.2% P〈0.05） were much higher in the diabetic patients.There was no significant difference in the duration of mechanical ventilation,ICU stay time,hospital stay time and in-hospital mortality between the two groups.Conclusions Although the occlusion of the coronary arteries is severe,the therapeutic effect of OPCABG in diabetic senile patients is similar as that in patients without diabetes.