80岁以上冠状动脉旁路移植术的临床观察

Coronary artery bypass grafting surgery in patients over 80 years

目的:总结80岁以上超高龄患者冠状动脉旁路移植术(CABG)的临床特点和结果。方法:对阜外心血管病医院2003年8月至2013年7月期间,112例行CABG的80岁以上患者的临床资料进行回顾性分析。记录术前一般情况、冠状动脉病变、合并疾病、治疗情况、术中手术方式、术后恢复情况以及并发症和病死率。结果:术前3支病变或合并左主干病变的患者占72%,66%的患者合并高血压,52%高血脂,22%心律失常,31%糖尿病,19%呼吸功能不全,58%不稳定心绞痛,9.8%急性心肌梗死,23%陈旧性心肌梗死,22%脑卒中史。70例患者常温下行CABG术,42例体外循环下行CABG术,其中3例为CABG+室壁瘤切除术。平均旁路移植数量为(2.7±0.6)支。全组死亡3例,围术期心肌梗死2例,延迟苏醒5例,肺部感染8例,机械通气时间延长13例,新发生脑卒中2例,肾替代治疗4例,出血需二次手术6例。结论:80岁以上的超高龄冠心病患者,体外循环和非体外循环CABG均可提供安全有效的治疗效果,对于术前冠状动脉病变程度较重,术中需要再血管化搭桥数量较多、合并室壁瘤切除或其他心脏直视手术的患者,采用体外循环下手术。对于冠状动脉病变适合不停跳条件下就可以充分再血管化的患者,采用非体外循环CABG是适宜的手术方式。

Objective：To review the clinical characteristics and outcomes of the patients over 80 years old received coronary artery bypass grafting（ CABG） surgery at our center. Methods： We retrospectively reviewed 112 consecutive cases over 80 years old diagnosed with CAD and received CABG at our institution from Jan 2003 to Dec 2013. The detailed clinical data of these patients were analyzed,recording the preoperative general situation,coronary lesions,merge disease,treatment,surgical procedure,postoperative recovery,complications and mortality. Results： For the elderly,the history of hypertension,hyperlipidemia,diabetes,stroke,unstable angina,myocardial infarction,and respiratory insufficiency is common. 72% patients presented left main stenosis or three vessel lesions. 70 patients received off-pump coronary artery bypass grafting and 42 received on-pump CABG with a mean of 2. 7 grafts. There were 3 deaths in hospital（ 2. 7%）. The postoperative complications include 5 delayed awakening,8 pulmonary infections,5 new strokes,2 myocardial infarction,6bleeding,6 new renal failure and 10 arrhythmia. Conclusion： Both on-pump and off-pump CABG are safe procedures when performed in elderly patients.