70岁及以上老年患者非体外循环冠状动脉旁路移植术

Off-pump coronary artery bypass in the elderly aged 70 and over

目的 探讨非体外循环冠状动脉旁路移植术 (OPCAB)在 70岁及以上 (≥ 70岁 )老年冠心病患者施行的可行性和优越性。 方法 回顾性分析≥ 70岁患者 6 3例及 70岁以下 (<70岁 )患者197例施行OPCAB的临床资料。≥ 70岁组术前有脑血管病史和慢性阻塞性肺病史的比例大于 <70岁组 (P <0 0 5 ) ,其余相关因素差异无显著性。 结果 ≥ 70岁组和 <70岁组平均远端吻合口数目分别为 (3 5± 0 9)个和 (3 4± 0 8)个 ,差异无显著性 (P >0 0 5 )。≥ 70岁组采用动脉桥的比例明显少于 70以下组 (分别占 12 7%及 5 2 3% ,P <0 0 1) ,监护时间大于 72h和机械通气大于 12h的比例 ,≥70岁组明显增多 (P <0 0 5 )。≥ 70岁组输血比例明显大于 <70岁组 (P <0 0 5 )。 2组死亡率分别为1 6 %和 1 0 % ,差异无显著性。心律失常的发生 ,≥ 70岁组明显多于 <70岁组 (P <0 0 5 ) ,其余并发症差异无显著性。 结论 OPCAB手术对于≥ 70岁老年冠心病患者同样安全可行 。

Objective To analyze the feasibility and the superiority of the off-pump coronary artery bypass (OPCAB) in 63 patients >70 years of age. Methods There were 63 patients older than 70 in Group O and 197 patients younger than 70 in Group Y. The incidence of previous cerebrovascular disease and chronic obstructive pulmonary disease were higher in Group O than in Group Y (P<0.05). Other relative factors were similar to each other in both groups. Results The number of distal anastomosis was 3.5±0.9 in Group O and 3.4±0.8 in Group Y, showing no significant difference between two groups (P>0.05). Less arterial grafts was used in group O than in Group Y (P<0.01). The patients for intensive care over 72 hours and maintained mechanic ventilation over 12 hours in Group O were more than that in Group Y (P<0.05). The percentage of patients underwent blood transfusion was higher in Group O than that in Group Y (P<0.05). The mortality of Group O and Group Y were 1.6% and 1.0%. Higher incidence of atrial fibrillation in Group O was observed than that in Group Y(P<0.05). It showed no significant difference in the postoperative mortality between two groups. Conclusions It is safe and feasible to perform OPCAB in patients elder than 70. OPCAB shows a good early outcomes in the elderly patients.