非体外循环冠状动脉旁路移植术在80岁及以上患者中的临床应用

The clinical application of off-pump coronary artery bypass grafting for octogenarians

目的：总结80岁及以上非体外循环冠状动脉旁路移植术（off-pump coronary artery bypass grafting， OPCABG）患者的临床治疗经验，提高临床治疗效果。方法回顾性分析33例80岁及以上患者的临床资料，平均年龄（81.30±1.51）岁，择期行OPCABG手术。结果全组患者手术顺利，平均搭桥（2.94±0.97）根，手术时间（224.09±50.05）min，术后机械通气时间（1067.73 ±594.97）min，ICU滞留时间（3776.24±3269.34）min，术后住院天数（19.78±17.66）d。术后死亡2例，死亡率为6.1%，均为肺部感染引起的多脏器功能衰竭。1例患者胸骨哆开二次手术固定。26例患者随访4～24个月，死亡3例，其余患者恢复良好，无心肌缺血症状。结论80岁及以上OPCABG患者手术治疗效果总体满意，值得临床开展。

Objective To investigate clinical characteristics and effects of treatment on off-pump coronary artery bypass grafting （OPCABG） in octogenarians with coronary artery disease. Methods We retrospectively analyzed the information of 33 octogenarians（81.30 ± 1.51 years old）who underwent elective OPCABG in our hospital. Results An average of 2.94 ± 0.97 grafts were performed per patient,the operative time was 244.09 ± 50.05 minutes,the ventilation time were 1067.73 ± 594.97 minutes,ICU stay was 3776.24 ± 3269.34 minutes and postoperative stay in hospital was 19.78 ± 17.66 days. There were 2 cases of death （mortality 6.1%） because of multiple orgen failure due to pulmonary infection. 1 case underwent surgery again because of sterna dehiscence. 26 patients were followed up 4-24 months. 3 patients died during the follow-up period and the survivors were relieved form symptom. Conclusion The clinical outcomes of octogenarians undergoing OPCABG is acceptable and this technique should be clinically promoted.